Diseases of the Pharynx Practice Questions

Q: What is the commonest lymph node to enlarge in acute tonsillitis?

Jugulo-digastric. ### Explanation **Correct Option: B. Jugulo-digastric** The palatine tonsils are primarily drained by the deep cervical lymph nodes. The **Jugulo-digastric lymph node** (also known as the **"Tonsillar node"**) is a member of the upper deep cervical group, located just below the angle of the mandible, where the posterior belly of the digastric muscle crosses the internal jugular vein. Because it receives the direct lymphatic drainage from the tonsils, it is the first and most common node to become enlarged and tender during acute tonsillitis. **Analysis of Incorrect Options:** * **A. Jugulo-omohyoid:** This node is located where the omohyoid muscle crosses the internal jugular vein. It primarily drains the **tongue** (specifically the lateral margins and tip), not the tonsils. * **C. Posterior cervical:** These nodes are located along the spinal accessory nerve. They are typically enlarged in conditions like **Rubella** (Post-auricular/Occipital) or **Infectious Mononucleosis**, rather than isolated acute bacterial tonsillitis. * **D. Submandibular:** These nodes drain the submandibular salivary glands, floor of the mouth, gums, and anterior part of the tongue. While they may enlarge in oral cavity infections, they are not the primary drainage site for the tonsils. **Clinical Pearls for NEET-PG:** * **Phorbe’s Node:** Another name for the Jugulo-digastric node. * **Waldeyer’s Ring:** The palatine tonsils are part of this lymphoid ring, which also includes the adenoids (nasopharyngeal tonsil), lingual tonsils, and tubal tonsils. * **Blood Supply:** The main artery of the tonsil is the **Tonsillar branch of the Facial Artery**. * **Pain Referral:** Pain from acute tonsillitis is often referred to the ear via the **Glossopharyngeal nerve (CN IX)**.

Q: A child presented with high fever, severe sore throat, and painful swallowing. Her voice was abnormal. Quinsy was diagnosed. What is referred to as Quinsy?

Peritonsillar abscess. **Explanation:** **Quinsy** is the clinical term for a **Peritonsillar Abscess (PTA)**. It is a collection of pus in the potential space between the tonsillar capsule and the superior constrictor muscle. It typically occurs as a complication of acute follicular tonsillitis. **Why Option A is correct:** The clinical presentation described—high fever, severe odynophagia (painful swallowing), and an abnormal voice—is classic for Quinsy. The "abnormal voice" is specifically known as a **"Hot Potato Voice"** (muffled speech) due to edema and restricted movement of the soft palate. Other hallmark signs include **trismus** (difficulty opening the mouth due to irritation of the medial pterygoid muscle) and uvular deviation to the opposite side. **Why other options are incorrect:** * **Retropharyngeal Abscess:** This occurs in the space behind the pharynx (Prevertebral space). It is more common in infants and presents with neck stiffness and inspiratory stridor rather than trismus. * **Parapharyngeal Abscess:** This involves the lateral pharyngeal space. While it also causes trismus and fever, the swelling is typically located behind the posterior pillar and at the angle of the mandible, rather than the peritonsillar region. **NEET-PG High-Yield Pearls:** * **Most common organism:** *Streptococcus pyogenes* (Group A Strep). * **Site of infection:** Usually starts in the **Crypta Magna**. * **Management:** The gold standard is **Incision and Drainage (I&D)** at the point of maximum bulge (usually lateral to the junction of the anterior pillar and a horizontal line through the base of the uvula). * **Interval Tonsillectomy:** Performed 4–6 weeks after the abscess resolves to prevent recurrence.

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

All of the above. **Explanation:** Adenoidectomy is a common pediatric surgical procedure, but it carries specific contraindications that are frequently tested in the NEET-PG exam. The correct answer is **All of the above** because each option represents a critical clinical scenario where surgery is either unsafe or leads to poor functional outcomes. 1. **Bleeding Disorders (A):** Adenoidectomy is a highly vascular procedure performed in a space where direct pressure is difficult to apply. Conditions like Hemophilia or Von Willebrand disease are absolute contraindications unless the clotting factors are adequately replaced, as they pose a high risk of life-threatening primary or reactionary hemorrhage. 2. **Infection (B):** Surgery should not be performed during an acute upper respiratory tract infection (URTI). Acute infection increases the vascularity of the lymphoid tissue, significantly raising the risk of intraoperative bleeding. It also increases the risk of postoperative complications like pneumonia or septicemia. 3. **Submucous Cleft Palate (C):** This is a **classic high-yield contraindication**. In these patients, the adenoid mass acts as a "plug" that helps the short or weak palate achieve velopharyngeal closure. Removing the adenoids creates a large gap, leading to **Velopharyngeal Insufficiency (VPI)**, which results in hypernasal speech (rhinolalia aperta) and nasal regurgitation of food. **Clinical Pearls for NEET-PG:** * **Most common complication:** Postoperative hemorrhage (Primary or Reactionary). * **Velopharyngeal Insufficiency:** Always palpate the hard palate for a "notch" and look for a bifid uvula before surgery to rule out submucous cleft palate. * **Age Factor:** Generally avoided in children under 3 years unless there is severe obstructive sleep apnea (OSA). * **Other contraindications:** Severe anemia and uncontrolled systemic diseases.

Q: What is the recommended treatment for a peritonsillar abscess?

Abscess drainage followed by interval tonsillectomy. ### Explanation **Peritonsillar Abscess (Quinsy)** is a collection of pus between the tonsillar capsule and the superior constrictor muscle. **Why Option D is Correct:** The standard management of Quinsy involves immediate **Incision and Drainage (I&D)** or needle aspiration to relieve pressure and prevent complications like airway obstruction or parapharyngeal space spread. However, because Quinsy has a high recurrence rate (approx. 10-15%), an **Interval Tonsillectomy** is performed 4–6 weeks after the acute infection has subsided. This "interval" allows the inflammation to resolve, making the surgery safer and reducing the risk of intraoperative hemorrhage. **Analysis of Incorrect Options:** * **A. Tonsillectomy:** While "Quinsy Tonsillectomy" (hot tonsillectomy) can be done during the acute phase, it is not the standard recommendation due to the high risk of bleeding and systemic spread of infection. * **B. Conservative management:** Antibiotics alone are insufficient for a formed abscess; surgical drainage is mandatory. * **C. Drainage using Hilton's method:** This method is specifically used for **deep neck space abscesses** (like parapharyngeal or submandibular abscesses) to avoid injuring vital structures. Quinsy is drained via a mucosal incision at the point of maximum bulge. **Clinical Pearls for NEET-PG:** * **Site of Incision:** The most common site for drainage is at the intersection of a horizontal line through the base of the uvula and a vertical line through the anterior pillar. * **Clinical Sign:** **Trismus** (due to irritation of the medial pterygoid muscle) is a hallmark sign of Quinsy. * **Uvular Deviation:** The uvula is typically pushed to the **contralateral** (opposite) side. * **Organism:** Most common aerobic organism is *Streptococcus pyogenes*; however, it is often a mixed infection including anaerobes.

Q: Which nerve is most commonly affected in stylalgia?

Glossopharyngeal nerve. **Explanation:** **Stylalgia**, also known as **Eagle’s Syndrome**, refers to facial or pharyngeal pain caused by an elongated styloid process (greater than 30 mm) or calcification of the stylohyoid ligament. **Why Glossopharyngeal Nerve is Correct:** The styloid process is located in close anatomical proximity to several neurovascular structures. The **glossopharyngeal nerve (CN IX)** arches around the lateral aspect of the styloid process as it descends to the base of the tongue. When the process is elongated or deviated medially, it mechanically irritates or compresses the glossopharyngeal nerve. This results in the classic presentation: dull, nagging throat pain, a sensation of a foreign body (globus), and referred otalgia (pain in the ear) triggered by swallowing or turning the head. **Why Other Options are Incorrect:** * **Abducent nerve (CN VI):** This nerve controls the lateral rectus muscle of the eye. It is located intracranially and in the orbit, far from the styloid process. * **Auditory nerve (CN VIII):** This nerve is responsible for hearing and balance and is contained within the internal auditory canal and inner ear. * **Greater Petrosal nerve:** A branch of the facial nerve (CN VII) involved in parasympathetic lacrimation; it is located deep within the temporal bone and does not interact with the styloid process. **Clinical Pearls for NEET-PG:** * **Diagnosis:** Confirmed by palpating the styloid process in the tonsillar fossa (which reproduces the pain) and imaging (X-ray or 3D CT). * **Treatment:** Medical management includes NSAIDs or carbamazepine; definitive treatment is **styloidectomy** (trans-oral or external approach). * **Referred Otalgia:** In stylalgia, ear pain is mediated by the **Jacobson’s nerve**, a branch of the glossopharyngeal nerve.

Q: What is the term for swelling located in the tonsillar area, specifically between the tonsil and the superior constrictor muscle?

Quinsy. **Explanation:** The correct answer is **Quinsy**, also known as a **Peritonsillar Abscess**. **1. Why Quinsy is correct:** Quinsy is a collection of pus in the **peritonsillar space**, which is a potential space located between the **capsule of the palatine tonsil** (medially) and the **superior constrictor muscle** (laterally). It usually occurs as a complication of acute tonsillitis. The loose areolar tissue in this space allows for the accumulation of pus, typically starting at the upper pole. **2. Why other options are incorrect:** * **Dental abscess:** This originates from an infected tooth (often the lower molars) and involves the submandibular or sublingual spaces (e.g., Ludwig’s Angina), not the tonsillar fossa. * **Parapharyngeal abscess:** This involves the space lateral to the superior constrictor muscle. While a Quinsy can spread here, a primary parapharyngeal abscess presents with swelling behind the posterior pillar and external swelling at the angle of the jaw. * **Retropharyngeal abscess:** This occurs in the space between the posterior pharyngeal wall and the prevertebral fascia. It presents as a midline or paramedian bulge on the posterior pharyngeal wall, not the tonsillar area. **Clinical Pearls for NEET-PG:** * **Clinical Features:** Severe odynophagia, "Hot potato voice," trismus (due to irritation of the medial pterygoid muscle), and **deviation of the uvula** to the opposite side. * **Management:** Incision and drainage at the point of maximum bulge (usually above the supratonsillar fossa). * **Interval Tonsillectomy:** Performed 4–6 weeks after the abscess resolves to prevent recurrence.

Q: Horner's syndrome is caused by:

Nasopharyngeal carcinoma with metastasis. **Explanation:** **1. Why Option B is Correct:** Horner’s syndrome results from a disruption of the **sympathetic nerve supply** to the eye. In the context of ENT oncology, **Nasopharyngeal Carcinoma (NPC)** can cause this syndrome through two primary mechanisms: * **Direct Extension:** The tumor can invade the parapharyngeal space, involving the cervical sympathetic chain. * **Metastasis:** NPC frequently metastasizes to the **retropharyngeal lymph nodes (Nodes of Rouviere)** or the deep cervical nodes. Enlargement of these nodes can compress the sympathetic chain at the level of the carotid sheath, leading to the classic triad of miosis, partial ptosis, and anhidrosis. **2. Why Other Options are Incorrect:** * **Facial Injury (A):** While trauma can cause Horner’s syndrome, it must specifically involve the neck or thoracic outlet (brachial plexus). A general facial injury typically affects the facial nerve (CN VII), leading to facial palsy, not sympathetic chain disruption. * **Meniere’s Disease (C):** This is an inner ear disorder characterized by endolymphatic hydrops. It presents with vertigo, tinnitus, and sensorineural hearing loss; it has no anatomical or physiological link to the sympathetic nervous system. **3. High-Yield Clinical Pearls for NEET-PG:** * **Trotter’s Triad (NPC):** 1. Conductive deafness (Eustachian tube blockage), 2. Ipsilateral facial pain/numbness (CN V involvement), 3. Palatal paralysis (CN X involvement). * **Pancoast Tumor:** Another high-yield cause of Horner’s syndrome (apical lung carcinoma involving the stellate ganglion). * **Clinical Triad of Horner’s:** Miosis (constricted pupil), Partial Ptosis (Muller’s muscle paralysis), and Anhidrosis (loss of sweating). Enophthalmos is often an apparent, rather than true, finding.

Question 1

What is the most common cause of parapharyngeal abscess?

Accepted Answer

Removal of tonsil

Answer

Hematogenous spread

Answer

Penetrating trauma

Answer

Blunt trauma

Question 2

What is the commonest lymph node to enlarge in acute tonsillitis?

Accepted Answer

Jugulo-digastric

Answer

Jugulo-omohyoid

Answer

Posterior cervical

Answer

Submandibular

Question 3

What is true about Angiofibroma?

Accepted Answer

Recurrence rate is high

Answer

Radiotherapy is the main treatment

Answer

Exclusively in females

Answer

Biopsy is must before initiating treatment

Question 4

A 70-year-old smoker presents with a 3-month history of dysphagia and weight loss. Flexible nasoendoscopy shows pooling of saliva in the pyriform fossae, with restricted mobility of the right hemi-larynx. Malignancy is suspected. At surgery, you find a 3 cm tumour affecting the right pyriform fossa and extending into the post-cricoid region. According to the TNM staging, what T-stage is this malignancy?

Accepted Answer

T2

Answer

T1

Answer

T4a

Answer

T3

Question 5

A child presented with high fever, severe sore throat, and painful swallowing. Her voice was abnormal. Quinsy was diagnosed. What is referred to as Quinsy?

Accepted Answer

Peritonsillar abscess

Answer

Retropharyngeal abscess

Answer

Parapharyngeal abscess

Answer

Any of the above

Question 6

Adenoidectomy is contraindicated in which of the following conditions?

Accepted Answer

All of the above

Answer

Bleeding disorder

Answer

Infection

Answer

Submucous cleft palate

Question 7

What is the recommended treatment for a peritonsillar abscess?

Accepted Answer

Abscess drainage followed by interval tonsillectomy

Answer

Tonsillectomy

Answer

Conservative management

Answer

Drainage using Hilton's method

Question 8

Which nerve is most commonly affected in stylalgia?

Accepted Answer

Glossopharyngeal nerve

Answer

Abducent nerve

Answer

Auditory nerve

Answer

Greater Petrosal nerve

Question 9

What is the term for swelling located in the tonsillar area, specifically between the tonsil and the superior constrictor muscle?

Accepted Answer

Quinsy

Answer

Dental abscess

Answer

Parapharyngeal abscess

Answer

Retropharyngeal abscess

Question 10

Horner's syndrome is caused by:

Accepted Answer

Nasopharyngeal carcinoma with metastasis

Answer

Facial injury

Answer

Meniere's disease

Answer

All of the above

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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