Diseases of the Pharynx Practice Questions

Q: Trotter's syndrome involves:

Nasopharynx. ***Nasopharynx*** - **Trotter's syndrome** is a classic triad of symptoms (unilateral conductive hearing loss, trigeminal neuralgia, and soft palate paralysis) associated with malignant tumors of the **nasopharynx** [1]. - The syndrome arises from the tumor's invasion of critical structures surrounding the **nasopharynx**, including the Eustachian tube, trigeminal nerve, and cranial nerves IX, X, XI [1]. *Oropharynx* - Malignancies of the **oropharynx** typically present with symptoms such as dysphagia, odynophagia, globus sensation, and referred otalgia to the ear, rather than the specific triad of Trotter's syndrome. - While oropharyngeal tumors can metastasize, they do not directly cause the unique combination of symptoms seen in Trotter's syndrome due to their anatomical location. *Pharynx* - The **pharynx** is a broader anatomical region encompassing the nasopharynx, oropharynx, and hypopharynx. While Trotter's syndrome involves a part of the pharynx (the nasopharynx), simply stating "Pharynx" is too general and lacks the specificity required for this syndrome. - The specific symptoms of Trotter's syndrome are linked to tumor involvement in a very particular area of the pharynx, not the entire structure. *Larynx* - Tumors of the **larynx** primarily cause symptoms related to voice changes (hoarseness), stridor, and difficulty breathing or swallowing. - The anatomical position of the larynx is distinct from the nasopharynx, and therefore, laryngeal pathologies do not lead to the specific neurological and auditory symptoms characterizing Trotter's syndrome.

Q: Which of the following regions is involved in Plummer-Vinson syndrome?

Postcricoid region. ***Postcricoid region*** - **Plummer-Vinson syndrome** is characterized by the formation of **esophageal webs** in the postcricoid region, leading to dysphagia. - This syndrome is often associated with long-standing **iron-deficiency anemia**. *Valleculae* - The valleculae are anatomical spaces located between the base of the tongue and the epiglottis, primarily involved in swallowing, but not typically affected by Plummer-Vinson syndrome. - While food can collect here, they are not the site of web formation characteristic of the syndrome. *Posterior pharyngeal wall* - The posterior pharyngeal wall is part of the pharynx and, while involved in the passage of food, is not the primary site for the formation of esophageal webs in Plummer-Vinson syndrome. - Web formation in this region would be highly unusual for the syndrome described. *Pyriform sinus* - The **pyriform sinus** is a potential space lateral to the laryngeal inlet, where food can temporarily pool, but it is not the location where esophageal webs form in Plummer-Vinson syndrome. - Obstruction or pathology in the pyriform sinus would present differently from the progressive dysphagia caused by a postcricoid web.

Q: What is a clinical feature of mouth breathing?

Adenoid facies. ***Adenoid facies*** - **Adenoid facies** (also known as long face syndrome) is characterized by a long, narrow face; open mouth posture; protruding upper anterior teeth; narrow maxillary arch; and a flattened nasal bridge. - This is a direct consequence of chronic mouth breathing, leading to altered growth and development of the facial bones and dental structures. - Commonly associated with adenoid hypertrophy causing nasal obstruction. *Shallow and flat maxillary arch* - Mouth breathing typically leads to a **high, narrow maxillary arch** (Gothic palate), not shallow and flat, due to the absence of normal tongue pressure against the palate. - The lack of tongue contact during mouth breathing prevents the lateral expansion of the maxilla, resulting in increased arch height and reduced width. *Retroclined maxillary anteriors* - Mouth breathing often results in **proclined (flared out) maxillary anteriors** due to the forces from the lower lip and tongue not properly opposing the upper anterior teeth. - The open mouth posture and insufficient lip seal allow the upper incisors to tip labially. *Proclined mandibular anteriors* - While various factors can cause proclined mandibular anteriors, mouth breathing primarily affects the **maxillary arch and associated facial structures**. - The characteristic changes are more prominent in the upper face and maxilla rather than mandibular anterior positioning.

Q: Following are the characteristics of vincent’s angina, except:

Caused by Leptospira interrogans. ***Caused by Leptospira interrogans*** - Vincent's angina, also known as **necrotizing ulcerative gingivitis (NUG)**, is not caused by *Leptospira interrogans*. - *Leptospira interrogans* is the causative agent of **leptospirosis**, a zoonotic infection. *Caused due to malnutrition* - **Malnutrition**, particularly deficiencies in vitamins B and C, is considered a **predisposing factor** for Vincent's angina, worsening the immune response. - While not the direct cause, it can significantly contribute to the development and severity of the condition. *Ulcerative gingivostomatitis* - Vincent's angina is characterized by **ulcerative lesions** on the gums and oral mucosa, fitting the description of ulcerative gingivostomatitis. - These ulcers are often painful and covered with a grayish pseudomembrane. *A symbiotic infection* - It is caused by a **symbiotic infection** involving an overgrowth of specific oral bacteria, primarily **spirochetes** (e.g., *Treponema denticola*) and **fusobacteria** (e.g., *Fusobacterium nucleatum*). - These bacteria thrive in anaerobic conditions, leading to tissue necrosis and ulceration.

Q: A child presenting with recurrent respiratory tract infections, mouth breathing and decreased hearing. Treatment of choice is

Adenoidectomy. ***Adenoidectomy*** - The combination of **recurrent respiratory tract infections**, **mouth breathing**, and **decreased hearing** strongly suggests hypertrophied adenoids. - **Adenoidectomy** is the definitive treatment to remove the enlarged adenoids, alleviating airway obstruction and improving Eustachian tube function. *Grommet insertion* - **Grommet insertion** (tympanostomy tubes) is primarily done for **recurrent acute otitis media** or **otitis media with effusion** to ventilate the middle ear. - While it can help hearing loss secondary to middle ear fluid, it doesn't address the underlying cause of recurrent infections and mouth breathing from adenoid hypertrophy. *Tonsillectomy* - **Tonsillectomy** is indicated for **recurrent tonsillitis** or significant **obstructive sleep apnea** due to enlarged tonsils. - Although often performed with adenoidectomy, the primary symptoms described (mouth breathing, recurrent URTIs, hearing loss) point more specifically to adenoid issues than tonsillar hypertrophy alone. *Myringotomy* - **Myringotomy** is a surgical incision into the **eardrum** to drain fluid from the middle ear. - It is often a first step before grommet insertion but doesn't provide a long-term solution for recurrent fluid or address the underlying cause of Eustachian tube dysfunction, which is often adenoid hypertrophy.

Q: Trismus is commonly seen in

Quinsy. ***Quinsy*** - **Quinsy (peritonsillar abscess)** is the **most common cause of trismus** among pharyngeal infections. - Trismus occurs due to **inflammation and reflex spasm of the pterygoid muscles** adjacent to the abscess. - The severe pain and swelling in the peritonsillar region directly limit **mandibular movement**, making it difficult or impossible to open the mouth. - **Trismus is one of the cardinal clinical features** of quinsy. *Parapharyngeal abscess* - A **parapharyngeal abscess** can also cause trismus due to direct inflammation and irritation of the muscles of mastication. - However, it is **less common than quinsy** and typically presents with other prominent symptoms like **neck swelling**, lateral pharyngeal bulging, and internal carotid artery involvement risk. *Ludwig's angina* - While Ludwig's angina is a severe infection of the **submandibular and sublingual spaces**, trismus is **less common** and less pronounced compared to peritonsillar abscess. - The primary concern in Ludwig's angina is **airway obstruction** due to tongue elevation and "bull neck" swelling, not typically severe trismus. *Retropharyngeal abscess* - A **retropharyngeal abscess** is located behind the pharynx and typically manifests with **dysphagia**, **odynophagia**, **neck stiffness**, and respiratory distress. - While indirect muscle spasm can occur, **trismus is not a characteristic or common symptom** of retropharyngeal abscess, which primarily affects swallowing and neck mobility.

Q: A person presents with neck node and B type tympanogram. What is the most likely diagnosis?

Nasopharyngeal CA. ***Nasopharyngeal CA*** - A **neck node** can be a presenting symptom of **nasopharyngeal carcinoma (NPC)** due to metastatic spread to cervical lymph nodes, often as the first presenting feature in ~75% of cases. - A **Type B tympanogram** indicates reduced compliance of the tympanic membrane, often due to **otitis media with effusion (OME)**, which can be caused by Eustachian tube obstruction from a nasopharyngeal mass like NPC. - This is the **classic presentation** combining lymphadenopathy with conductive hearing loss/middle ear effusion. *Acoustic neuroma* - An **acoustic neuroma** (vestibular schwannoma) typically presents with **unilateral sensorineural hearing loss**, tinnitus, and balance issues. - It does not directly cause an obstructive process leading to a Type B tympanogram or cervical lymphadenopathy. - Metastasis from acoustic neuroma is extremely rare. *Angiofibroma* - **Angiofibroma** is a benign, highly vascular tumor typically found in the **nasopharynx**, primarily affecting adolescent males. - While it can cause **nasal obstruction** and epistaxis, leading to Eustachian tube dysfunction and a Type B tympanogram, it is **benign and does not metastasize** to neck nodes. - This is a key differentiating feature from nasopharyngeal carcinoma.

Q: Treatment of choice for nasopharyngeal carcinoma T1 is:

Radiation therapy. ***Radiation therapy*** - **Radiation therapy** (RT) is the primary treatment modality for early-stage (T1) nasopharyngeal carcinoma due to the tumor's high radiosensitivity and its anatomical location, which makes surgical resection challenging. - The goal is to deliver a definitive dose of radiation to the tumor with curative intent, often using techniques like intensity-modulated radiation therapy (IMRT) to spare surrounding critical structures. - T1 NPC has excellent cure rates (>90%) with RT alone. *Chemotherapy* - **Chemotherapy** is generally used in combination with radiation for locally advanced nasopharyngeal carcinoma (stage II-IVB) or for metastatic disease, not typically as monotherapy for T1 tumors. - While concurrent chemoradiotherapy improves outcomes in more advanced stages, it's not the primary curative treatment for early-stage disease and adds unnecessary toxicity. *Observation* - **Observation** or watchful waiting is not appropriate for nasopharyngeal carcinoma, even at T1 stage, as NPC is an aggressive malignancy requiring active treatment. - Unlike some indolent tumors, NPC has potential for local progression and early lymphatic spread, necessitating definitive treatment at diagnosis. *Surgery* - **Surgery** plays a very limited role in the primary treatment of nasopharyngeal carcinoma, especially for T1 lesions. - The nasopharynx's deep anatomical location, proximity to skull base, critical neurovascular structures, and the tumor's infiltrative nature make surgical resection technically challenging with high morbidity. - Surgery might be considered for salvage in selected cases of recurrent disease after radiation failure, but it is not the first-line treatment.

Q: Adenoidectomy is contraindicated in:

Bleeding disorder. ***Bleeding disorder*** - Adenoidectomy involves surgical removal of tissue, which carries a risk of **intraoperative and postoperative bleeding**. - In individuals with a **pre-existing bleeding disorder**, this risk is significantly elevated, potentially leading to serious complications. *SOM* - **Serous otitis media (SOM)**, or otitis media with effusion, is often caused by Eustachian tube dysfunction, which can be exacerbated by adenoid hypertrophy. - Adenoidectomy can actually be a **treatment for recurrent SOM**, as it can relieve obstruction of the Eustachian tube. *CSOM* - **Chronic suppurative otitis media (CSOM)** involves a persistent perforation of the tympanic membrane with chronic ear discharge. - While adenoid hypertrophy can contribute to Eustachian tube dysfunction and recurrent acute otitis media that might lead to CSOM, an adenoidectomy is **not directly contraindicated** for CSOM itself. *None of the options* - This option is incorrect because **bleeding disorder** is a clear contraindication for adenoidectomy due to the increased risk of hemorrhagic complications.

Question 1

Trotter's syndrome involves:

Accepted Answer

Nasopharynx

Answer

Oropharynx

Answer

Pharynx

Answer

Larynx

Question 2

Which of the following regions is involved in Plummer-Vinson syndrome?

Accepted Answer

Postcricoid region

Answer

Valleculae

Answer

Posterior pharyngeal wall

Answer

Pyriform sinus

Question 3

What is a clinical feature of mouth breathing?

Accepted Answer

Adenoid facies

Answer

Shallow and flat maxillary arch

Answer

Retroclined maxillary anteriors

Answer

Proclined mandibular anteriors

Question 4

Following are the characteristics of vincent’s angina, except:

Accepted Answer

Caused by Leptospira interrogans

Answer

Caused due to malnutrition

Answer

Ulcerative gingivostomatitis

Answer

A symbiotic infection

Question 5

A child presenting with recurrent respiratory tract infections, mouth breathing and decreased hearing. Treatment of choice is

Accepted Answer

Adenoidectomy

Answer

Grommet insertion

Answer

Tonsillectomy

Answer

Myringotomy

Question 6

Trismus is commonly seen in

Accepted Answer

Quinsy

Answer

Ludwig's angina

Answer

Parapharyngeal abscess

Answer

Retropharyngeal abscess

Question 7

A person presents with neck node and B type tympanogram. What is the most likely diagnosis?

Accepted Answer

Nasopharyngeal CA

Answer

Acoustic neuroma

Answer

None of the options

Answer

Angiofibroma

Question 8

A 13-year-old boy has a 3-day history of low-grade fever, symptoms of upper respiratory infection, and a sore throat. A few hours before his presentation to the emergency room, he has an abrupt onset of high fever, difficulty swallowing, and poor handling of his secretions. He indicates that he has a marked worsening in the severity of his sore throat. His pharynx has a fluctuant bulge in the posterior wall. A soft tissue radiograph of his neck is shown. Which of the following is the most appropriate initial therapy for this patient?

Accepted Answer

Surgical consultation for incision and drainage under general anesthesia

Answer

Narcotic analgesics

Answer

Rapid streptococcal screen

Answer

Trial of oral penicillin V

Question 9

Treatment of choice for nasopharyngeal carcinoma T1 is:

Accepted Answer

Radiation therapy

Answer

Chemotherapy

Answer

Observation

Answer

Surgery

Question 10

Adenoidectomy is contraindicated in:

Accepted Answer

Bleeding disorder

Answer

SOM

Answer

CSOM

Answer

None of the options

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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