Diseases of the Pharynx Practice Questions

Q: Peritonsilar abscess is also called:

Quinsy. ***Quinsy*** - This is the traditional and **common medical term** used to refer to a peritonsillar abscess. - It describes a **collection of pus** located between the tonsillar capsule and the superior constrictor muscle. *Thornwaldt's abscess* - This refers to an abscess in **Thornwaldt's cyst**, which is a **pharyngeal bursa** located in the nasopharynx. - It is distinct from a peritonsillar abscess, which is located in the oropharynx. *Ludwig's angina* - This is a **severe cellulitis** of the **floor of the mouth**, often originating from an infected tooth. - It is a life-threatening condition involving deep neck spaces, not the peritonsillar region. *Vincent's angina* - This is also known as **necrotizing ulcerative gingivitis** or **trench mouth**. - It is an infection of the **gums and oral mucosa**, characterized by painful ulcers, necrosis, and halitosis, and is not an abscess in the peritonsillar space.

Q: A 21-year-old college student presents with hot potato voice and trismus. Clinical diagnosis is?

Quinsy. ***Quinsy*** - **Quinsy**, or **peritonsillar abscess**, is characterized by a "hot potato" or muffled voice and **trismus** (difficulty opening the mouth) due to inflammation and muscle spasm. - The abscess typically forms adjacent to the palatine tonsil, causing severe unilateral throat pain and difficulty swallowing. *Chronic Tonsillitis* - **Chronic tonsillitis** is characterized by recurrent episodes of throat pain, fever, and enlarged tonsils, but does not typically present with acute **trismus** or a "hot potato" voice. - It results from persistent or repeated bacterial infections of the tonsils, often without significant abscess formation. *Epiglottitis* - **Epiglottitis** presents with rapid onset of severe sore throat, **dysphagia**, drooling, and inspiratory stridor, and can be life-threatening due to airway obstruction. - While it causes significant throat pain and difficulty swallowing, it does not typically present with a "hot potato" voice or **trismus**, but rather a muffled voice and tripod positioning. *Infectious mononucleosis* - **Infectious mononucleosis** leads to swollen tonsils with exudates, fatigue, and lymphadenopathy, but usually does not cause **trismus** or the distinctive "hot potato" voice. - It is caused by the **Epstein-Barr virus** and can lead to significant pharyngitis, but is not associated with peritonsillar abscess formation.

Q: Trotter's triad is seen with:

Nasopharyngeal carcinoma. ***Nasopharyngeal carcinoma*** - **Trotter's triad** is a classic presentation of nasopharyngeal carcinoma, particularly when the tumor involves the pharyngeal recess (fossa of Rosenmüller) and extends to involve surrounding structures. - The triad consists of: 1. **Unilateral conductive deafness** (due to Eustachian tube obstruction by the tumor) 2. **Ipsilateral trigeminal neuralgia** (usually V2 or V3 distribution, from mandibular nerve involvement) 3. **Ipsilateral palatal immobility** (due to involvement of the levator veli palatini muscle or its nerve supply) - This triad indicates advanced disease with invasion of adjacent structures. *Nasopharyngeal angiofibroma* - This is a **benign, highly vascular, locally aggressive tumor** typically found in adolescent males. - While it can cause nasal obstruction, epistaxis, and cranial nerve palsies due to extension, it does not specifically present with Trotter's triad. - The tumor arises from the sphenopalatine foramen region and extends differently than nasopharyngeal carcinoma. *Cancer tongue* - **Tongue cancer** typically presents with a **non-healing ulcer**, pain, dysphagia, and cervical lymphadenopathy. - It primarily affects the oral cavity and involves neck lymphatic drainage. - It does not involve the nasopharynx or Eustachian tube, so Trotter's triad would not occur. *Adenoid cystic carcinoma of parotid gland* - This is a malignant tumor of the salivary glands with characteristic **perineural invasion**, which can lead to pain and facial nerve palsy. - While it can involve cranial nerves (particularly CN VII), it does not affect the nasopharynx, Eustachian tube, or palatal muscles in the manner that produces Trotter's triad.

Q: True about Trotter's triad - a) Conductive deafness b) Involvement of CN VI c) Involvement of CN X d) Palatal paralysis e) Associated with nasopharyngeal angiofibroma

acd. ***acd*** - Trotter's triad consists of **conductive deafness** (option a) due to Eustachian tube obstruction, **ipsilateral trigeminal neuralgia** (CN V involvement), and **soft palate paralysis** (option d) caused by tumor infiltration. - Option c refers to **CN X (vagus nerve) involvement**, which can contribute to palatal paralysis, making it part of the clinical presentation. - The combination of **conductive deafness**, **CN X involvement** causing palatal issues, and **palatal paralysis** are correct components of Trotter's triad. - This triad is classically associated with **nasopharyngeal carcinoma**. *Incorrect Option: bde* - This option incorrectly includes CN VI involvement (abducens nerve), which is **not part of Trotter's triad**. - It also incorrectly associates the triad with **nasopharyngeal angiofibroma** rather than carcinoma. - While option d (palatal paralysis) is correct, the combination is incorrect due to options b and e. *Incorrect Option: bc* - Option b refers to **CN VI (abducens nerve) involvement**, which is **not part of the classic Trotter's triad**. - The triad involves **CN V (trigeminal)** for neuralgia, not CN VI. - While CN X involvement (option c) can be present, this combination misses the essential conductive deafness and includes the wrong cranial nerve. *Incorrect Option: ad* - This option correctly includes **conductive deafness** (a) and **palatal paralysis** (d). - However, it **misses option c (CN X involvement)**, which is important for explaining the mechanism of palatal paralysis. - While partially correct, it's incomplete compared to option acd.

Q: Most common presentation in nasopharyngeal carcinoma is with:

Cervical lymphadenopathy. ***Cervical lymphadenopathy*** - **Cervical lymphadenopathy** is the most frequent initial symptom, with over 75% of patients presenting with a palpable neck mass, often a **painless, firm mass** in the upper deep cervical chain. - This is due to the rich lymphatic drainage of the nasopharynx to the cervical lymph nodes, leading to early metastasis. *Epistaxis* - While **epistaxis** (nosebleeds) can occur in nasopharyngeal carcinoma, it is generally not the most common presenting symptom. - It usually presents as recurrent, mild **epistaxis** or bloody discharge rather than severe bleeding. *Hoarseness of voice* - **Hoarseness of voice** is typically associated with laryngeal involvement or recurrent laryngeal nerve palsy, which is a less common and usually later manifestation of nasopharyngeal carcinoma. - Primary nasopharyngeal tumors do not directly cause hoarseness unless they extend significantly or metastasize to structures affecting vocal cord function. *Nasal stuffiness* - **Nasal stuffiness** or obstruction can be a symptom due to tumor growth within the nasopharynx. - However, it is a less specific symptom and often overshadowed by the more prominent presentation of cervical lymphadenopathy.

Q: Hynes pharyngoplasty is used to improve a child's?

Speech. ***Speech*** - Hynes pharyngoplasty is a surgical procedure specifically designed to correct **velopharyngeal insufficiency (VPI)**, which is a common cause of **hypernasal speech**. - By reshaping the soft palate and pharynx, it helps create a better seal during speech, thus improving **oral resonance** and reducing air escaping through the nose. *Teething* - **Teething** refers to the process of teeth erupting through the gums, which is a normal developmental stage in infants. - Surgical intervention like Hynes pharyngoplasty is unrelated to the **eruption of teeth**. *Feeding* - While velopharyngeal insufficiency can sometimes contribute to **feeding difficulties** (e.g., nasal regurgitation), Hynes pharyngoplasty's primary goal is not to improve overall feeding mechanics. - Surgical interventions for feeding issues often address different anatomical structures or neurological deficits impacting **swallowing** or suck-swallow-breathe coordination. *Appearance* - Although some craniofacial anomalies that lead to VPI might also affect appearance (e.g., cleft palate), Hynes pharyngoplasty is solely focused on **functional improvement of speech**. - It does not significantly alter the **external facial appearance** of the child.

Q: Time of occurrence of secondary haemorrhage after tonsillectomy -

6 days. ***6 days*** - **Secondary hemorrhage** after tonsillectomy typically occurs **5-10 days post-surgery**, making 6 days a common presentation time. - This timing is often due to **infection** causing vessel erosion or sloughing of the **fibrin clot** before mucosal healing is complete. *24 hrs* - Hemorrhage within the first **24 hours** is classified as **primary or reactionary hemorrhage** and is usually due to inadequate hemostasis during surgery or dislodgement of a clot. - This occurs much earlier than secondary hemorrhage. *12 hrs* - Similar to 24 hours, **12 hours** post-surgery falls within the window for **primary or reactionary hemorrhage**. - This timeframe is too early for the typical onset of secondary hemorrhage. *12 days* - While late bleeding can occur, **12 days** post-tonsillectomy is **less common** for secondary hemorrhage compared to the 5-10 day window. - By this point, significant mucosal healing would have usually occurred, reducing the risk of a secondary bleed.

Q: In Stylalgia, the most common nerve affected is:

Glossopharyngeal nerve. ***Glossopharyngeal nerve*** - Stylalgia, also known as **Eagle syndrome**, classically involves pain that is commonly attributed to irritation of the **glossopharyngeal nerve**. - This is due to an elongated **styloid process** or calcification of the **stylohyoid ligament** compressing the nerve. *Greater petrosal nerve* - The greater petrosal nerve is primarily involved in **parasympathetic innervation** to the lacrimal gland and mucous glands of the nose and palate. - It is not typically implicated in the pain pathway of stylalgia. *Abducent nerve* - The abducent nerve is responsible for the **lateral rectus muscle** of the eye, controlling eye movement. - Its dysfunction would lead to **diplopia** or strabismus, not the throat or facial pain characteristic of stylalgia. *Auditory nerve* - The auditory nerve (vestibulocochlear nerve) is responsible for **hearing and balance**. - Problems with this nerve would cause **tinnitus**, hearing loss, or vertigo, and is not directly involved in stylalgia.

Q: Reactionary hemorrhage in case of tonsillectomy is hemorrhage occurring-

Within 24 hours of surgery. ***Within 24 hours of surgery*** - **Reactionary hemorrhage** occurs specifically within the first **24 hours** after tonsillectomy, typically once the initial vasoconstriction from adrenaline in local anesthetic wears off or due to a rise in blood pressure. - This is a form of **primary hemorrhage**, meaning it happens close to the time of the operation. *Within 6 hours of surgery* - While hemorrhage can occur within the first 6 hours, the definition of **reactionary hemorrhage** encompasses the full **24-hour period** post-surgery. - Limiting it to 6 hours would be too narrow and exclude many cases correctly categorized as reactionary. *Between 2- 7 days* - Hemorrhage occurring between 2 and 7 days post-tonsillectomy is classified as **secondary hemorrhage**, often due to infection or sloughing of the eschar. - This timing is distinct from **reactionary hemorrhage**, which is an early complication. *Between 1 -2 weeks* - Bleeding occurring between 1 to 2 weeks post-tonsillectomy also falls under the category of **secondary hemorrhage**. - This late bleeding is usually associated with the separation of the fibrin clot or infection and is not considered reactionary.

Q: The most common site of rupture of the esophagus during rigid esophagoscopy is at

At Killian's dehiscence. ***At Killian's dehiscence*** - This area is a naturally occurring triangular weak point in the posterior pharyngeal wall, formed by the divergent cricopharyngeal muscles, making it particularly susceptible to **perforation** during instrumentation. - Perforation at this site often leads to a **retropharyngeal dissection** of air and contents. *Gastroesophageal junction* - While the gastroesophageal junction is another site of potential perforation, especially due to **narrowing** or the acute angle of entry, it is less common than Killian's dehiscence during rigid esophagoscopy. - Perforation here can lead to a **mediastinal or pleural cavity leak**. *Above cricopharynx* - Perforation above the cricopharynx is less common because the esophagus is typically less constrained and more distensible in this region. - The instrument generally navigates this area with relative ease unless significant **anatomical anomalies** are present. *Near vocal cords* - The vocal cords are located in the larynx, superior to the esophagus. Injury near the vocal cords is more typical of **laryngoscopy** or intubation, not direct esophageal instrumentation. - While instrumentation can lead to laryngeal trauma, direct rupture of the esophagus at this level is exceedingly rare.

Question 1

Peritonsilar abscess is also called:

Accepted Answer

Quinsy

Answer

Thornwaldt's abscess

Answer

Ludwig's angina

Answer

Vincent's angina

Question 2

A 21-year-old college student presents with hot potato voice and trismus. Clinical diagnosis is?

Accepted Answer

Quinsy

Answer

Chronic Tonsillitis

Answer

Epiglottitis

Answer

Infectious mononucleosis

Question 3

Trotter's triad is seen with:

Accepted Answer

Nasopharyngeal carcinoma

Answer

Nasopharyngeal angiofibroma

Answer

Cancer tongue

Answer

Adenoid cystic carcinoma of parotid gland

Question 4

True about Trotter's triad - a) Conductive deafness b) Involvement of CN VI c) Involvement of CN X d) Palatal paralysis e) Associated with nasopharyngeal angiofibroma

Accepted Answer

acd

Answer

bde

Answer

bc

Answer

ad

Question 5

Most common presentation in nasopharyngeal carcinoma is with:

Accepted Answer

Cervical lymphadenopathy

Answer

Epistaxis

Answer

Hoarseness of voice

Answer

Nasal stuffiness

Question 6

Hynes pharyngoplasty is used to improve a child's?

Accepted Answer

Speech

Answer

Teething

Answer

Feeding

Answer

Appearance

Question 7

Time of occurrence of secondary haemorrhage after tonsillectomy -

Accepted Answer

6 days

Answer

24 hrs

Answer

12 hrs

Answer

12 days

Question 8

In Stylalgia, the most common nerve affected is:

Accepted Answer

Glossopharyngeal nerve

Answer

Greater petrosal nerve

Answer

Abducent nerve

Answer

Auditory nerve

Question 9

Reactionary hemorrhage in case of tonsillectomy is hemorrhage occurring-

Accepted Answer

Within 24 hours of surgery

Answer

Within 6 hours of surgery

Answer

Between 2-7 days

Answer

Between 1-2 weeks

Question 10

The most common site of rupture of the esophagus during rigid esophagoscopy is at

Accepted Answer

At Killian's dehiscence

Answer

Gastroesophageal junction

Answer

Above cricopharynx

Answer

Near vocal cords

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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