Diseases of the Pharynx Practice Questions

Q: Which of the following is not a defining feature of Paterson-Brown-Kelly syndrome?

Achalasia. *Dysphagia* - **Dysphagia** is a symptom associated with Paterson-Brown-Kelly syndrome as it results from the presence of **mucosal webs**. - It contributes to the difficulty in swallowing due to obstructive lesions in the esophagus. *Cheilosis* - **Cheilosis** (or angular cheilitis) can occur in patients with iron deficiency anemia, which is part of the syndrome. - However, it is not one of the classical components of the triad established for this syndrome. *Mucosal webs* - **Mucosal webs** are a key feature of Paterson-Brown-Kelly syndrome. - They lead to an **obstruction** in the esophagus, which is intrinsic to the condition. *Iron deficiency anemia* - **Iron deficiency anemia** is a significant aspect of Paterson-Brown-Kelly syndrome, as it accompanies the pathophysiology of the mucosal webs. - It is one of the clinical features that result from chronic bleeding or malabsorption.

Q: Which of the following is the MOST appropriate indication for adenoidectomy in children?

Enlarged adenoids causing obstructive sleep apnea. ***Enlarged adenoids causing obstructive sleep apnea*** - **Adenoidectomy** is a primary treatment for **obstructive sleep apnea (OSA)** in children when enlarged adenoids are the cause, as surgical removal can alleviate airway obstruction. - OSA can lead to serious health issues, including **neurocognitive impairment** and **cardiovascular problems**, making surgical intervention important. *Recurrent respiratory tract infections* - While enlarged adenoids can contribute to recurrent infections, particularly **otitis media**, their removal solely for recurrent upper respiratory tract infections is generally not the primary indication. - Other factors like **immune status** and **exposure to pathogens** are often more significant contributors to recurrent respiratory infections. *Chronic nasal obstruction due to allergies* - **Allergic rhinitis** is typically managed with medical treatments such as **antihistamines** and **nasal corticosteroids**, not adenoidectomy. - Adenoid enlargement in allergic children is often a secondary effect of inflammation, and addressing the underlying allergy is key. *Middle ear infections requiring surgical intervention* - While a contributing factor, **recurrent acute otitis media** or **chronic otitis media with effusion** that fails medical management often leads to the consideration of **tympanostomy tube insertion** rather than adenoidectomy alone. - Adenoidectomy can be considered as an adjunctive procedure in cases of recurrent otitis media, especially if adenoid hypertrophy is significant, but it is not the sole indication for "surgical intervention" for middle ear infections.

Q: Which of the following is NOT a component of Trotter's triad associated with nasopharyngeal carcinoma?

Sensorineural deafness. ***Sensorineural deafness*** - **Trotter's triad** specifically refers to unilateral **painless conductive hearing loss**, **trigeminal neuralgia**, and **palatal paralysis** in the context of nasopharyngeal carcinoma. - Sensorineural deafness is not typically part of this classic triad as the tumor's direct pressure tends to affect the Eustachian tube leading to conductive hearing loss. *Palatal paralysis* - This is a key component of **Trotter's triad**, resulting from the tumor's invasion of the **IX (glossopharyngeal)** and **X (vagus)** cranial nerves, which innervate the soft palate. - It leads to **dysphagia** and **dysarthria**, often presenting as an early symptom. *Trigeminal Neuralgia* - This refers to **unilateral facial pain** due to involvement of the **V (trigeminal)** cranial nerve, which is a core symptom of **Trotter's triad**. - The tumor's extension can cause compression or infiltration of the nerve, leading to sharp, shooting pains. *Conduction deafness* - This is a cardinal sign of **Trotter's triad** and is caused by the nasopharyngeal tumor obstructing the **Eustachian tube**. - Obstruction leads to fluid accumulation in the middle ear, resulting in **painless unilateral conductive hearing loss**.

Q: What is the most common source of hemorrhage during tonsillectomy?

Injury to tonsillar branch of facial artery. ***Injury to tonsillar branch of facial artery*** - The **tonsillar branch of the facial artery** is the most significant arterial supply to the palatine tonsil and is located superficially, making it highly susceptible to injury during tonsillectomy. - Its relatively large caliber and direct tonsillar supply contribute to it being the **most common source of hemorrhage** during the procedure. *Injury to tonsillar branch of lingual artery* - The **tonsillar branch of the lingual artery** provides some supply to the tonsil, but it is typically less significant and less common as a source of hemorrhage compared to the facial artery branch. - This vessel usually penetrates the superior constrictor muscle to reach the tonsil, making it less directly exposed during standard tonsillectomy dissection. *Injury to external palatine vein* - The **external palatine vein** (paratonsillar vein) is often a source of venous bleeding due to its superficial location and direct drainage of the tonsil. - While it can cause significant bleeding, arterial hemorrhage, particularly from the facial artery branch, is generally considered more common and profuse. *Injury to tonsillar branch of ascending pharyngeal artery* - The **tonsillar branch of the ascending pharyngeal artery** supplies the tonsil but is usually a smaller vessel and is located deeper or more posterior to the tonsil. - Due to its anatomical position, it is less frequently injured during the typical tonsillectomy dissection planes compared to the tonsillar branch of the facial artery.

Q: Dohlman's procedure is primarily indicated for which of the following conditions?

Zenker's diverticulum. ***Zenker's diverticulum*** - **Dohlman's procedure** is an **endoscopic diverticulotomy** specifically designed for Zenker's diverticulum. - This procedure involves dividing the **cricopharyngeus muscle** and the common wall between the esophagus and the diverticulum. *Meckel's diverticulum* - This is a **congenital outpouching of the small intestine** and its treatment involves surgical resection, not Dohlman's procedure. - It is typically asymptomatic but can present with bleeding, obstruction, or inflammation. *Achalasia* - Achalasia is a motility disorder of the esophagus characterized by failure of the **lower esophageal sphincter (LES)** to relax and loss of peristalsis. - Treatment options include **Heller myotomy** or endoscopic balloon dilation, not Dohlman's procedure. *Esophageal cancer* - Treatment of esophageal cancer typically involves **esophagectomy**, chemotherapy, and radiation therapy. - Dohlman's procedure is not indicated for the management of esophageal malignancy.

Q: Zenker's diverticulum is also known as

Hypopharyngeal diverticulum. ***Hypopharyngeal diverticulum*** - Zenker's diverticulum is a **pulsion diverticulum** located in the **posterior hypopharynx**, specifically in Killian's triangle. - Due to its anatomical location, it is accurately termed a hypopharyngeal diverticulum, forming a pouch of mucosa and submucosa through a weakness in the cricopharyngeal muscle. *Pharyngobasilar diverticulum* - This term is not typically used to describe Zenker's diverticulum. - The diverticulum is located lower in the pharynx, not near the pharyngeal or skull base. *Pharyngotympanic diverticulum* - This term is anatomically incorrect as it implies a connection or proximity to the tympanic cavity (middle ear). - Zenker's diverticulum is located in the pharynx and has no direct relation to the ear. *Prepharyngeal diverticulum* - The term "prepharyngeal" might suggest a location anterior to the pharynx. - Zenker's diverticulum is a posterior diverticulum, protruding dorsally from the pharynx.

Q: Not true about parapharyngeal abscess?

Horner's syndrome. ***Horner's syndrome*** - While parapharyngeal abscess is close to the **sympathetic chain**, Horner's syndrome (ptosis, miosis, anhydrosis) is a **rare complication**, not a common or typical presentation, making this statement the most likely to be false regarding usual clinical features. - The inflammatory process usually affects the adjacent structures, such as pterygoid muscles, pharyngeal muscles, and carotid sheath, rather than directly compressing the **sympathetic fibers** in the majority of cases. *Torticollis* - **Torticollis**, or neck stiffness and deviation, is a common symptom due to irritation and spasm of the neck muscles adjacent to the inflamed parapharyngeal space. - The inflammatory process can cause pain and muscle guarding, leading to the characteristic head tilt. *Drooling of saliva* - **Drooling of saliva** occurs due to odynophagia (painful swallowing) and dysphagia (difficulty swallowing) making patients reluctant to swallow, allowing saliva to accumulate and spill from the mouth. - The inflammation and swelling in the parapharyngeal space can obstruct the pharynx, making swallowing difficult and painful. *Trismus* - **Trismus**, or difficulty opening the mouth, is a characteristic feature of parapharyngeal abscess due to inflammation and spasm of the **medial pterygoid muscle**, which is located near the parapharyngeal space. - The abscess can directly irritate or compress the **masticatory muscles**, limiting jaw movement.

Q: Which of the following arises from the pharyngeal bursa?

Tornwaldt's disease. ***Tornwaldt's disease*** - This condition involves a **retropharyngeal cyst** that forms from the persistent embryological remnant of the **pharyngeal bursa**. - Symptoms arise from the cyst's location in the **nasopharynx**, causing drainage, halitosis, and occasionally Eustachian tube dysfunction. *Craniopharyngioma* - This is a **benign brain tumor** that arises from remnants of Rathke's pouch, which is an embryonic anlage of the anterior pituitary gland. - It is typically located in the **suprasellar region** and is not derived from the pharyngeal bursa. *Chordoma* - This is a rare, **malignant bone tumor** that originates from remnants of the **notochord**. - It most commonly occurs at the base of the skull (clivus) or in the sacrum, separate from the pharyngeal bursa. *Lymphoma* - Lymphoma is a **cancer of the lymphocytes**, which are a type of white blood cell. - It typically originates in **lymph nodes** or other lymphoid tissues throughout the body, not from a specific embryonic remnant like the pharyngeal bursa.

Q: Which of the following statements about juvenile nasopharyngeal angiofibroma is true?

Surgery is the treatment of choice. ***Surgery is the treatment of choice*** - **Surgical resection** is the preferred and most effective treatment for juvenile nasopharyngeal angiofibroma (JNA) due to its high vascularity and propensity for local recurrence. - While other modalities like embolization may be used pre-operatively to reduce bleeding, **complete surgical removal** is usually necessary. *It is a malignant tumor* - Juvenile nasopharyngeal angiofibroma is a **benign, locally aggressive tumor** originating in the nasopharynx. - Despite its benign nature, it can cause significant morbidity due to its **vascularity** and tendency to invade surrounding structures like the skull base and orbit. *It commonly occurs in females* - This statement is incorrect; **juvenile nasopharyngeal angiofibroma almost exclusively affects adolescent males**, with a peak incidence between 10 and 20 years of age. - The disease is **extremely rare in females**, and its occurrence in a female should prompt investigation for conditions like androgen insensitivity syndrome. *Hormones are not used in the treatment* - This statement is incorrect; **anti-androgen therapy** (e.g., flutamide) or estrogen therapy has been explored in managing JNA given its androgen receptor sensitivity. - However, **hormonal treatment is generally not the primary modality** but may be considered in specific cases, such as unresectable tumours or for recurrence control, although its efficacy is variable.

Q: Which of the following is the most characteristic symptom of a peritonsillar abscess?

Trismus (difficulty opening the mouth). ***Trismus (difficulty opening the mouth)*** - **Trismus** is a hallmark symptom of a peritonsillar abscess, resulting from irritation and spasm of the **pterygoid muscles** due to inflammation and pus accumulation. - Its presence is a strong indicator, often more specific than generalized symptoms, aiding in the differentiation from simple tonsillitis. *Difficulty swallowing (dysphagia)* - While **dysphagia** is common with a peritonsillar abscess due to pain and swelling, it is also a feature of severe tonsillitis or pharyngitis, making it less specific than trismus. - The pain associated with swallowing is typically **odynophagia**, though both are related to inflammation. *Muffled or 'hot potato' voice* - A **muffled** or "hot potato" voice is characteristic of a peritonsillar abscess due to swelling in the oral pharynx, affecting vocal resonance. - However, this symptom can also be present in other conditions causing significant pharyngeal swelling, making it less unique than trismus. *Severe sore throat* - A **severe sore throat** is a common and prominent symptom, often unilateral, but it is present in many other throat infections such as **strep throat** or severe tonsillitis. - Its presence, though significant, does not specifically point to a peritonsillar abscess over other inflammatory conditions of the throat.

Question 1

Which of the following is not a defining feature of Paterson-Brown-Kelly syndrome?

Accepted Answer

Achalasia

Answer

Mucosal Webs

Answer

Cheilosis

Answer

Dysphagia

Question 2

Which of the following is the MOST appropriate indication for adenoidectomy in children?

Accepted Answer

Enlarged adenoids causing obstructive sleep apnea

Answer

Recurrent respiratory tract infections

Answer

Chronic nasal obstruction due to allergies

Answer

Middle ear infections requiring surgical intervention

Question 3

Which of the following is NOT a component of Trotter's triad associated with nasopharyngeal carcinoma?

Accepted Answer

Sensorineural deafness

Answer

Palatal paralysis

Answer

Trigeminal Neuralgia

Answer

Conduction deafness

Question 4

What is the most common source of hemorrhage during tonsillectomy?

Accepted Answer

Injury to tonsillar branch of facial artery

Answer

Injury to tonsillar branch of lingual artery

Answer

Injury to external palatine vein

Answer

Injury to tonsillar branch of ascending pharyngeal artery

Question 5

Dohlman's procedure is primarily indicated for which of the following conditions?

Accepted Answer

Zenker's diverticulum

Answer

Achalasia

Answer

Meckel's diverticulum

Answer

Esophageal cancer

Question 6

Zenker's diverticulum is also known as

Accepted Answer

Hypopharyngeal diverticulum

Answer

Pharyngobasilar diverticulum

Answer

Pharyngotympanic diverticulum

Answer

Prepharyngeal diverticulum

Question 7

Not true about parapharyngeal abscess?

Accepted Answer

Horner's syndrome

Answer

Torticollis

Answer

Trismus

Answer

Drooling of saliva

Question 8

Which of the following arises from the pharyngeal bursa?

Accepted Answer

Tornwaldt's disease

Answer

Craniopharyngioma

Answer

Chordoma

Answer

Lymphoma

Question 9

Which of the following statements about juvenile nasopharyngeal angiofibroma is true?

Accepted Answer

Surgery is the treatment of choice

Answer

It commonly occurs in females

Answer

It is a malignant tumor

Answer

Hormones are not used in the treatment

Question 10

Which of the following is the most characteristic symptom of a peritonsillar abscess?

Accepted Answer

Trismus (difficulty opening the mouth)

Answer

Difficulty swallowing (dysphagia)

Answer

Muffled or 'hot potato' voice

Answer

Severe sore throat

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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