Diseases of the Pharynx Practice Questions

Q: A patient presents with a history of hoarseness in voice. Identify the lesion based on the clinical condition shown in the image.

Diphtheria. ***Diphtheria*** - The image likely displays the characteristic **pseudomembrane** found in **diphtheria**, which can spread to the larynx and cause hoarseness due to airway obstruction. - Hoarseness is a common symptom of **laryngeal diphtheria** due to the inflammation and potential involvement of the vocal cords. *Follicular tonsillitis* - This condition presents with **pus-filled follicles** on the tonsils, which appear as discrete yellow or white spots, rather than a confluent membrane. - While it can cause a sore throat, **hoarseness** is not a primary or characteristic symptom. *Aphthous ulcer* - **Aphthous ulcers** are typically small, painful sores found on the mucous membranes of the mouth and are usually solitary or in small clusters. - They do not form a widespread membrane and are not associated with hoarseness. *Membranous tonsillitis* - While presenting with a membrane, **membranous tonsillitis** refers to conditions like infectious mononucleosis or streptococcal pharyngitis, which produce a less adherent and less extensive membrane compared to diphtheria. - The formation of a tough, **greyish-white pseudomembrane** that bleeds on attempts to remove it is pathognomonic for **diphtheria**, distinct from other forms of membranous tonsillitis.

Q: A patient presents with fever and dysphagia. An image shows a tonsil that is pushed medially. What is the most likely diagnosis?

Peritonsillar abscess. ***Peritonsillar abscess*** - The image clearly shows **unilateral bulging** of the peritonsillar area, causing the **uvula to be pushed towards the opposite side**, which is characteristic of a peritonsillar abscess. - Patients typically present with severe **sore throat**, **dysphagia**, **trismus**, and a "hot potato" voice, often following an episode of tonsillitis. *Parapharyngeal abscess* - A parapharyngeal abscess often presents with **neck swelling** and **tenderness along the sternocleidomastoid muscle**, rather than primarily affecting the tonsillar area and displacing the uvula. - While it can cause dysphagia and fever, the **intraoral findings** would typically include swelling of the lateral pharyngeal wall, not the peritonsillar space. *Retropharyngeal abscess* - A retropharyngeal abscess is located **behind the pharynx** and presents with symptoms like **neck stiffness**, **stridor**, and airway compromise, often more severe than tonsillar displacement. - Intraoral examination might show **posterior pharyngeal wall bulging**, without the specific displacement of the tonsil and uvula seen in the image. *Ludwig's angina* - Ludwig's angina is a **rapidly spreading cellulitis** of the submandibular and sublingual spaces, typically presenting with **bilateral floor of mouth swelling**, **tongue elevation**, and tenderness. - It does not primarily involve the tonsillar region, nor does it typically cause unilateral uvular displacement as depicted.

Q: Which of the following statements regarding adenoids is true?

Mouth breathing is a common symptom of enlarged adenoids.. ***Mouth breathing is a common symptom of enlarged adenoids.*** - **Enlarged adenoids** obstruct the **nasopharyngeal airway**, forcing individuals, especially children, to breathe through their mouths. - This leads to characteristic facial features, known as **adenoid facies**, and can cause snoring, sleep disturbances, and altered speech. - Mouth breathing is one of the **cardinal symptoms** of adenoid hypertrophy. *Enlarged adenoids can lead to failure to thrive.* - While enlarged adenoids **can contribute** to failure to thrive through **poor feeding**, **sleep-disordered breathing**, and **increased work of breathing**, it is considered a **less common** direct consequence. - Failure to thrive from adenoid hypertrophy typically occurs in severe cases with significant obstructive symptoms. - This statement has some validity but is not as consistently true as mouth breathing being a common symptom. *A CT scan is the preferred method to assess the size of adenoids.* - **Lateral neck X-ray** or **nasal endoscopy** are generally the **preferred initial assessment methods** due to lower radiation exposure, cost-effectiveness, and adequate visualization. - A **CT scan** is typically reserved for cases with suspected complications, alternative diagnoses, or when detailed anatomical assessment of surrounding structures is required. - This statement is **false**. *Both a and b are true.* - This option refers to the first two options (enlarged adenoids causing failure to thrive, and CT scan being preferred). - Since the CT scan statement is clearly **false**, this combined option is **incorrect**. - While enlarged adenoids can sometimes contribute to failure to thrive, the CT scan statement is definitively wrong, making this option incorrect.

Q: A lumpy feeling in the throat that is relieved upon eating is typically attributed to which condition?

Globus pharyngeus. ***Globus pharyngeus*** - This condition is characterized by a sensation of a **lump or foreign body in the throat** without any physical obstruction. - The symptom is often **relieved by eating or swallowing**, as the act of swallowing can temporarily alleviate the feeling. *Pharyngeal pouch* - A pharyngeal pouch, specifically **Zenker's diverticulum**, typically causes **dysphagia**, **regurgitation of undigested food**, and sometimes **halitosis** [1]. - The sensation of a lump generally **worsens with eating** or drinking due to food accumulating in the pouch, contrary to the scenario described [1]. *Diverticular disease* - Diverticular disease primarily affects the **colon**, leading to symptoms like **abdominal pain**, **bloating**, and changes in bowel habits. - It does not typically present with a lumpy feeling in the throat that is relieved by eating. *Esophageal atresia* - Esophageal atresia is a **congenital condition** where the esophagus is not fully formed, usually diagnosed in **neonates**. - It causes immediate symptoms like **choking**, **coughing**, and **regurgitation during feeding**, and is not consistent with the adult presentation described.

Q: A patient presents with fever and dysphagia. An image shows a tonsil that is pushed medially. What is the most likely diagnosis?

Peritonsillar abscess. ***Peritonsillar abscess*** - The image clearly shows **unilateral bulging** of the soft palate and displacement of the tonsil medially, consistent with a peritonsillar abscess. - Patients typically present with **fever**, **dysphagia**, severe sore throat, and a "hot potato" voice. *Parapharyngeal abscess* - A parapharyngeal abscess involves the **deep neck spaces** lateral to the pharynx, often presenting with neck swelling, trismus, and systemic symptoms. - While it can cause pharyngeal bulging, the classic **medial displacement of the tonsil** is more indicative of a peritonsillar abscess. *Retropharyngeal abscess* - This involves the space behind the posterior pharyngeal wall, usually presenting with **dysphagia**, **neck stiffness**, and fever. - Imaging would reveal a **prevertebral soft tissue swelling**, not primarily a medially displaced tonsil. *Ludwig's angina* - Ludwig's angina is a **rapidly spreading cellulitis** of the submandibular and sublingual spaces, typically arising from an odontogenic infection. - It presents with **woody induration** of the neck and floor of the mouth, elevation of the tongue, and potential airway compromise, but not primarily a medially displaced tonsil.

Q: Which of the following is not typically associated with enlarged adenoids?

Esophagitis. ***Esophagitis*** - **Enlarged adenoids** are localized to the **nasopharynx** and do not directly impact the esophagus, making esophagitis an unlikely direct complication. - While chronic mouth breathing from enlarged adenoids can lead to **dry mouth**, it is not a direct cause of esophageal inflammation. *Otitis media* - Enlarged adenoids can obstruct the **eustachian tubes**, which connect the middle ear to the nasopharynx, predisposing to **recurrent acute otitis media** or **otitis media with effusion**. - This obstruction impairs middle ear ventilation and drainage, facilitating bacterial growth and inflammation. *Nasal obstruction* - Enlarged adenoids directly block the **nasopharyngeal airway**, leading to chronic **nasal obstruction** and obligate mouth breathing. - This can cause symptoms like snoring, sleep-disordered breathing, and a characteristic "adenoid facies." *Failure to thrive of child* - **Severe nasal obstruction** from enlarged adenoids can disrupt feeding, particularly in infants, as they must breathe through their mouths while attempting to feed. - This compromised feeding, along with **sleep apnea**, increases energy expenditure and can collectively contribute to **failure to thrive**.

Q: Most common cause of retropharyngeal abscess in adults?

Lymphadenitis. ***Lymphadenitis*** - **Lymphadenitis** in the retropharyngeal space, often secondary to an upper respiratory tract infection, is the most common cause of retropharyngeal abscesses in adults. - The infection spreads from inflamed lymph nodes to form a **purulent collection** in the potential space behind the pharynx. *TB* - **Tuberculosis (TB)** can cause retropharyngeal abscesses, particularly in immunocompromised individuals or endemic areas, but it is less common than pyogenic infections [1]. - TB abscesses tend to be more **chronic** and may be associated with vertebral involvement (Pott's disease) [1]. *Tooth extraction* - While dental infections, including complications from **tooth extraction**, can lead to deep neck space infections, they are not the most common cause of retropharyngeal abscess specifically. - Infections from teeth more often spread to the **submandibular** or **parapharyngeal spaces**. *Tonsillitis* - **Tonsillitis** is a common cause of pharyngeal inflammation and can lead to peritonsillar abscesses, which are distinct from retropharyngeal abscesses. - While severe tonsillitis can occasionally spread to the retropharyngeal space, it is primarily local and less common than direct lymphatic seeding.

Q: All are absolute indications of tonsillectomy except which of the following?

Chronic tonsillitis. ***Chronic tonsillitis*** - **Chronic tonsillitis** is a **relative indication** for tonsillectomy, not an **absolute indication**. - It becomes an indication based on frequency criteria (e.g., Paradise criteria: ≥7 episodes in 1 year, ≥5 episodes per year for 2 years, or ≥3 episodes per year for 3 years). - Absolute indications involve conditions requiring urgent surgical intervention. *Suspicious malignancy* - Suspected **malignancy** is an **absolute indication** for tonsillectomy to obtain tissue for histopathological diagnosis. - Early diagnosis and treatment of tonsillar malignancy is critical for patient outcomes. *Peritonsillar abscess* - **Peritonsillar abscess** (quinsy) is typically managed with needle aspiration or incision & drainage plus antibiotics, NOT immediate tonsillectomy. - Acute tonsillectomy during active infection ("hot tonsillectomy") is generally **contraindicated** due to increased bleeding risk and surgical complications. - **Recurrent peritonsillar abscess** may warrant **interval tonsillectomy** (4-6 weeks after resolution) as a **relative indication**, not an absolute one. *Tonsils causing obstructive sleep apnea* - **Obstructive sleep apnea (OSA)** caused by tonsillar hypertrophy is an **absolute indication** for tonsillectomy, particularly in children. - Untreated OSA can lead to serious complications including failure to thrive, cor pulmonale, developmental delays, and neurocognitive problems.

Q: Which of the following statements about Grisel syndrome is false?

A neurosurgeon is never needed.. ***A neurosurgeon is never needed.*** - This statement is false because severe cases of **Grisel syndrome** may require surgical intervention, necessitating consultation with a **neurosurgeon**. - Surgical management, such as **cervical fusion**, may be indicated in cases of irreducible subluxation or neurological compromise. *It can occur after adenoidectomy.* - This statement is true; **Grisel syndrome** is a rare complication that may occur following **adenoidectomy** or other head and neck surgeries. - The postulated mechanism involves inflammation spreading from the pharynx to the alar and transverse ligaments, leading to **atlantoaxial subluxation**. *It involves inflammation of cervical spine ligaments.* - This statement is true; **Grisel syndrome** is characterized by non-traumatic **atlantoaxial subluxation** resulting from inflammatory laxity of the cervical ligaments. - Specifically, the **transverse and alar ligaments** become inflamed and weakened, leading to instability between the atlas (C1) and axis (C2). *Conservative treatment is the first-line approach in most cases.* - This statement is true; initial management of **Grisel syndrome** typically involves conservative measures such as **neck immobilization**, pain control, and muscle relaxants. - Early diagnosis and conservative treatment are crucial to prevent progression and potential neurological complications.

Q: Moure's sign (lateral displacement of the soft palate) is associated with which of the following conditions?

Peritonsillar abscess. ***Peritonsillar abscess (Quinsy)*** - **Moure's sign** refers to the **lateral displacement of the soft palate** toward the affected side, which is a classic finding in **peritonsillar abscess**. - This occurs due to the **accumulation of pus** between the tonsillar capsule and the superior constrictor muscle, causing the soft palate to bulge and deviate. - Other features include **severe throat pain**, trismus, drooling, and a "hot potato" voice. *Laryngeal carcinoma* - **Laryngeal carcinoma** presents with **hoarseness**, dysphagia, and potential airway obstruction. - While laryngeal examination may show mass lesions or vocal cord fixation, **soft palate displacement is not a feature** of laryngeal malignancy. *Chronic tonsillitis* - **Chronic tonsillitis** involves recurrent throat infections with tonsillar hypertrophy and cryptic debris. - It does **not cause acute soft palate displacement** like peritonsillar abscess does. *Acute epiglottitis* - **Acute epiglottitis** is characterized by **supraglottic inflammation** causing severe dysphagia, drooling, and stridor. - The pathology is at the **epiglottis level**, not the peritonsillar space, so **Moure's sign is absent**.

Question 1

A patient presents with a history of hoarseness in voice. Identify the lesion based on the clinical condition shown in the image.

Accepted Answer

Diphtheria

Answer

Aphthous ulcer

Answer

Follicular tonsillitis

Answer

Membranous tonsillitis

Question 2

A patient presents with fever and dysphagia. An image shows a tonsil that is pushed medially. What is the most likely diagnosis?

Accepted Answer

Peritonsillar abscess

Answer

Parapharyngeal abscess

Answer

Retropharyngeal abscess

Answer

Ludwig's angina

Question 3

Which of the following statements regarding adenoids is true?

Accepted Answer

Mouth breathing is a common symptom of enlarged adenoids.

Answer

Enlarged adenoids can lead to failure to thrive.

Answer

A CT scan is the preferred method to assess the size of adenoids.

Answer

Both a and b are true.

Question 4

A lumpy feeling in the throat that is relieved upon eating is typically attributed to which condition?

Accepted Answer

Globus pharyngeus

Answer

Pharyngeal pouch

Answer

Diverticular disease

Answer

Esophageal atresia

Question 5

A patient presents with fever and dysphagia. An image shows a tonsil that is pushed medially. What is the most likely diagnosis?

Accepted Answer

Peritonsillar abscess

Answer

Parapharyngeal abscess

Answer

Retropharyngeal abscess

Answer

Ludwig's angina

Question 6

Which of the following is not typically associated with enlarged adenoids?

Accepted Answer

Esophagitis

Answer

Otitis media

Answer

Nasal obstruction

Answer

Failure to thrive of child

Question 7

Most common cause of retropharyngeal abscess in adults?

Accepted Answer

Lymphadenitis

Answer

Tonsillitis

Answer

Tooth extraction

Answer

TB

Question 8

All are absolute indications of tonsillectomy except which of the following?

Accepted Answer

Chronic tonsillitis

Answer

Peritonsillar abscess

Answer

Tonsils causing obstructive sleep apnea

Answer

Suspicious malignancy

Question 9

Which of the following statements about Grisel syndrome is false?

Accepted Answer

A neurosurgeon is never needed.

Answer

It can occur after adenoidectomy.

Answer

It involves inflammation of cervical spine ligaments.

Answer

Conservative treatment is the first-line approach in most cases.

Question 10

Moure's sign (lateral displacement of the soft palate) is associated with which of the following conditions?

Accepted Answer

Peritonsillar abscess

Answer

Laryngeal carcinoma

Answer

Chronic tonsillitis

Answer

Acute epiglottitis

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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