Diseases of the Pharynx Practice Questions

Q: What is a potential cause of cervical lymphadenopathy in a 70-year-old man?

Nasopharyngeal carcinoma. **Explanation:** **1. Why Nasopharyngeal Carcinoma (NPC) is correct:** In an elderly patient (70 years old) presenting with cervical lymphadenopathy, the primary concern is a metastatic malignancy from the head and neck. **Nasopharyngeal carcinoma** is notorious for its "silent" primary site; the most common presenting symptom (up to 75% of cases) is a painless, firm, upper cervical lymph node mass (typically Level II or Level V). Due to the rich lymphatic network of the nasopharynx, nodal metastasis often occurs early, even when the primary tumor is small. **2. Why the other options are incorrect:** * **Angiofibroma (Juvenile Nasopharyngeal Angiofibroma):** This is a benign but locally aggressive vascular tumor. It almost exclusively affects **adolescent males** (10–20 years). It presents with profuse epistaxis and nasal obstruction, not cervical lymphadenopathy. * **Acoustic Neuroma (Vestibular Schwannoma):** This is a benign tumor of the 8th cranial nerve. It presents with unilateral sensorineural hearing loss, tinnitus, and dysequilibrium. It does not involve the lymphatic system. * **Otosclerosis:** This is a metabolic bone disease of the otic capsule leading to stapes fixation. it presents with progressive **conductive hearing loss** in young to middle-aged adults with a normal tympanic membrane. It has no association with lymphadenopathy. **Clinical Pearls for NEET-PG:** * **Trotter’s Triad (for NPC):** 1. Conductive hearing loss (due to Eustachian tube blockage), 2. Ipsilateral palatal paralysis, 3. Trigeminal neuralgia (facial pain). * **Fossa of Rosenmüller:** The most common site of origin for NPC. * **EBV Association:** Nasopharyngeal carcinoma (Type II and III) is strongly associated with the **Epstein-Barr Virus**. * **Rule of Thumb:** Any adult with unilateral serous otitis media must be evaluated for NPC to rule out a mass obstructing the Eustachian tube.

Q: Epstein Barr virus is associated with which of the following carcinomas?

Carcinoma of the nasopharynx. **Explanation:** **Nasopharyngeal Carcinoma (NPC)**, particularly the undifferentiated type (WHO Type 3), has a strong and consistent causal association with the **Epstein-Barr Virus (EBV)**. The virus infects the nasopharyngeal epithelial cells, and the expression of viral proteins like LMP-1 (Latent Membrane Protein-1) promotes oncogenesis by inhibiting apoptosis and stimulating cell proliferation. * **Why Option C is correct:** EBV DNA is found in almost 100% of undifferentiated NPC cases regardless of geographical location. It is especially prevalent in Southern China and Southeast Asia. Serum titers of IgA antibodies against EBV viral capsid antigen (VCA) are used as a diagnostic and screening marker. * **Why Options A, B, and D are incorrect:** * **Carcinoma of the larynx and maxilla:** These are primarily associated with risk factors like tobacco smoking, alcohol consumption, and certain strains of Human Papillomavirus (HPV), but not EBV. * **Carcinoma of the bladder:** This is strongly linked to smoking, occupational exposure to aromatic amines (aniline dyes), and *Schistosoma haematobium* infection. **High-Yield Clinical Pearls for NEET-PG:** 1. **Bimodal Age Distribution:** NPC shows two peaks—one in adolescence/young adulthood and another in the 5th–6th decades. 2. **Trotter’s Triad:** Conductive hearing loss (due to Eustachian tube blockage), Ipsilateral palatal paralysis, and Trigeminal neuralgia (V2 involvement). 3. **Fossa of Rosenmüller:** The most common site of origin for NPC. 4. **Treatment of Choice:** Radiotherapy is the primary treatment as NPC is highly radiosensitive. 5. **Other EBV Associations:** Burkitt Lymphoma, Hodgkin Lymphoma, and Oral Hairy Leukoplakia.

Q: Tonsillectomy is contraindicated in which of the following conditions?

Poliomyelitis epidemic. **Explanation:** The correct answer is **C. Poliomyelitis epidemic.** **Why it is the correct answer:** Performing a tonsillectomy during a poliomyelitis epidemic is strictly contraindicated. The procedure involves trauma to the pharyngeal mucosa, which exposes nerve endings (specifically the glossopharyngeal and vagus nerves). This provides a direct portal for the poliovirus to enter the nervous system, significantly increasing the risk of the patient developing the **bulbar form of poliomyelitis**, which is the most severe and life-threatening manifestation of the disease. **Analysis of Incorrect Options:** * **A. Small atrophic tonsils:** These are not a contraindication. While they may be harder to dissect, they can still be a source of chronic infection or focal sepsis, necessitating removal. * **B. Quinsy (Peritonsillar Abscess):** While traditional teaching suggested waiting 4–6 weeks after an infection, "Quinsy Tonsillectomy" (abscess tonsillectomy) is now a recognized procedure performed during the acute phase to provide immediate drainage and prevent recurrence. * **D. Tonsillolith:** Tonsil stones are a common indication for tonsillectomy if they cause persistent halitosis, foreign body sensation, or recurrent discomfort. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications:** Bleeding disorders (e.g., Hemophilia, Leukemia), uncontrolled systemic disease (Diabetes, HTN), and acute infections (unless it's a Quinsy tonsillectomy). * **Relative Contraindications:** Cleft palate (risk of velopharyngeal insufficiency), age below 3 years, and menstruation (due to increased vascularity/bleeding risk). * **Most common complication:** Hemorrhage (Reactionary: within 24 hours; Secondary: 5–10 days due to infection). * **Most common nerve injured:** Glossopharyngeal nerve (leads to loss of taste on the posterior 1/3 of the tongue).

Q: A 17-year-old woman is admitted to the hospital with tonsillitis. A tonsillectomy is performed and the patient complains postoperatively of ear pain. Which of the following nerves was most likely injured during the surgical procedure?

Glossopharyngeal nerve. **Explanation:** The correct answer is the **Glossopharyngeal nerve (CN IX)**. This is a classic example of **referred otalgia** (ear pain) following a tonsillectomy. **1. Why Glossopharyngeal nerve is correct:** The glossopharyngeal nerve provides sensory innervation to the **oropharynx** and the **palatine tonsils** via its tonsillar branches. It also provides sensory innervation to the **middle ear** via its tympanic branch (**Jacobson’s nerve**). During a tonsillectomy, the nerve (which lies in the tonsillar bed, deep to the superior constrictor muscle) can be irritated or injured. Due to the shared nerve supply, the brain perceives pain from the oropharynx as originating from the ear. **2. Why other options are incorrect:** * **Auriculotemporal nerve (Branch of V3):** Supplies the TMJ and external auditory canal. While it causes referred ear pain in dental or TMJ issues, it does not innervate the tonsillar fossa. * **Lesser petrosal nerve:** A preganglionic parasympathetic branch of CN IX involved in salivation (parotid gland); it does not carry general somatic sensation from the tonsil. * **Vagus nerve (CN X):** Provides sensation to the laryngopharynx and the external ear (Arnold’s nerve). It causes referred ear pain in cases of laryngeal or hypopharyngeal pathologies (e.g., malignancy), not tonsillitis. **NEET-PG High-Yield Pearls:** * **Tonsillar Bed Anatomy:** The glossopharyngeal nerve is the most common nerve injured during tonsillectomy. * **Referred Otalgia Rule:** Pain in the ear with a normal ear exam should prompt an evaluation of the "4 Ts": **T**ongue, **T**onsil, **T**eeth, and **T**MJ. * **Eagle’s Syndrome:** Elongated styloid process compressing the glossopharyngeal nerve, causing throat and ear pain.

Q: Which of the following statements about pharyngeal diverticula is FALSE?

Lies in the posterior wall of the pharynx. ### Explanation The question refers to **Zenker’s Diverticulum** (Pharyngeal Pouch), which is a pulsion-type diverticulum. **1. Why Option B is the Correct (False) Statement:** While Zenker’s diverticulum originates in the posterior wall of the pharynx at **Killian’s Dehiscence** (a weak area between the thyropharyngeus and cricopharyngeus muscles), it does not remain strictly posterior. As the pouch enlarges, it is restricted by the vertebral column and is forced to deviate, usually to the **left side** of the neck. Therefore, stating it simply "lies in the posterior wall" is clinically inaccurate compared to its lateral presentation. **2. Analysis of Other Options:** * **Option A (True):** It results from **neuromuscular incoordination** where the cricopharyngeal sphincter fails to relax during swallowing, increasing intraluminal pressure. * **Option C (True):** Pharyngeal pouches are anatomical norms in certain animals like **pigs** and camels. * **Option D (True):** The pouch acts as a reservoir where **undigested food accumulates**, leading to symptoms like halitosis (bad breath), regurgitation, and nocturnal aspiration. ### NEET-PG High-Yield Pearls: * **Killian’s Dehiscence:** The site of origin; located between the oblique and transverse fibers of the inferior constrictor. * **Boyce’s Sign:** A gurgling sound heard on pressing the swelling in the neck. * **Investigation of Choice:** **Barium Swallow** (shows a "teapot" or "bag-like" appearance). * **Contraindication:** Rigid Esophagoscopy (high risk of perforation). * **Treatment:** Small pouches require Cricopharyngeal Myotomy; larger ones require **Dohlman’s Procedure** (Endoscopic Stapling).

Q: Prophylactic radiotherapy to the neck is given in which of the following malignancies with palpable swelling?

Nasopharyngeal carcinoma. **Explanation:** The correct answer is **Nasopharyngeal Carcinoma (NPC)**. **Why Nasopharyngeal Carcinoma is correct:** Nasopharyngeal carcinoma is unique among head and neck cancers due to its **exceedingly high rate of lymphatic spread**. Even in the absence of clinically palpable nodes (N0 neck), the risk of occult metastasis is approximately 75–90%. Furthermore, NPC is highly **radiosensitive**. Therefore, elective (prophylactic) irradiation of the bilateral neck (Levels II-V and retropharyngeal nodes) is the standard of care for all cases, regardless of whether nodes are palpable, to prevent regional recurrence. **Why other options are incorrect:** * **Laryngeal Carcinoma:** Management of the neck depends strictly on the sub-site and stage. Early glottic cancers have negligible lymphatic drainage and do not require prophylactic treatment. * **Sinuses Malignancy:** Maxillary and ethmoid sinus tumors have relatively sparse lymphatic drainage. Prophylactic neck treatment is generally not indicated unless the tumor involves the oral cavity or skin. * **Tongue Carcinoma:** While tongue cancers have a high rate of nodal metastasis, the primary treatment for a N0 neck is usually elective neck dissection (surgical) rather than prophylactic radiotherapy, especially if the primary tumor is being managed surgically. **High-Yield Clinical Pearls for NEET-PG:** * **EBV Association:** NPC (especially Type II and III) is strongly associated with the Epstein-Barr Virus. * **Fossa of Rosenmüller:** This is the most common site of origin for NPC. * **Trotter’s Triad:** Conductive hearing loss (due to ET blockage), palatal paralysis, and trigeminal neuralgia (ipsilateral) are classic signs of NPC. * **Treatment of Choice:** Radiotherapy is the primary treatment for both the primary tumor and the neck in NPC.

Question 1

A 9-year-old boy presents with nasal obstruction, proptosis, and recurrent epistaxis for 3-4 years. What is the appropriate management?

Accepted Answer

Embolisation followed by surgery

Answer

Routine radiological investigations

Answer

Embolisation alone should be done

Answer

Surgery is the treatment of choice

Question 2

What is a potential cause of cervical lymphadenopathy in a 70-year-old man?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Angiofibroma

Answer

Acoustic neuroma

Answer

Otosclerosis

Question 3

Epstein Barr virus is associated with which of the following carcinomas?

Accepted Answer

Carcinoma of the nasopharynx

Answer

Carcinoma of the larynx

Answer

Carcinoma of the bladder

Answer

Carcinoma of the maxilla

Question 4

A child presents with high fever and hoarseness of voice and is found to have a retropharyngeal abscess. All of the following statements are true about acute retropharyngeal abscess, EXCEPT:

Accepted Answer

Infection is posterior to the prevertebral fascia.

Answer

It is usually restricted to one side of the midline.

Answer

Causes difficulty in deglutition and respiration.

Answer

Can be easily palpated by placing a fingertip on the posterior pharyngeal wall.

Question 5

Tonsillectomy is contraindicated in which of the following conditions?

Accepted Answer

Poliomyelitis epidemic

Answer

Small atrophic tonsils

Answer

Quinsy

Answer

Tonsillolith

Question 6

Which of the following statements regarding adenoids is FALSE?

Accepted Answer

Immediate surgery is indicated even for minor symptoms related to adenoids.

Answer

Adenoids can be associated with failure to thrive.

Answer

Adenoids can contribute to a high-arched palate.

Answer

Adenoids commonly lead to mouth breathing.

Question 7

Which of the following statements is NOT true about nasopharyngeal carcinoma?

Accepted Answer

Nasopharyngectomy and lymph node dissection are the mainstay of treatment.

Answer

It has a bimodal age distribution.

Answer

EBV is implicated as an etiological agent.

Answer

Squamous cell carcinoma is the most common histological type.

Question 8

A 17-year-old woman is admitted to the hospital with tonsillitis. A tonsillectomy is performed and the patient complains postoperatively of ear pain. Which of the following nerves was most likely injured during the surgical procedure?

Accepted Answer

Glossopharyngeal nerve

Answer

Auriculotemporal nerve

Answer

Lesser petrosal nerve

Answer

Vagus nerve

Question 9

Which of the following statements about pharyngeal diverticula is FALSE?

Accepted Answer

Lies in the posterior wall of the pharynx

Answer

Results due to neuromuscular incoordination

Answer

They are normal in pigs

Answer

Food may get accumulated

Question 10

Prophylactic radiotherapy to the neck is given in which of the following malignancies with palpable swelling?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Laryngeal carcinoma

Answer

Sinuses malignancy

Answer

Tongue carcinoma

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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