Diseases of the Pharynx Practice Questions

Q: Trotter's triad is seen in which of the following conditions?

Nasopharyngeal carcinoma. **Explanation:** **Trotter’s Triad** is a classic clinical diagnostic feature of **Nasopharyngeal Carcinoma (NPC)**, typically occurring when the tumor invades the lateral pharyngeal wall (specifically the sinus of Morgagni). The triad consists of: 1. **Ipsilateral Conductive Hearing Loss:** Caused by Eustachian tube obstruction leading to serous otitis media. 2. **Ipsilateral Temporofacial Neuralgia:** Due to involvement of the Mandibular nerve (V3) as it exits the foramen ovale, causing pain in the jaw and temple. 3. **Ipsilateral Palatal Paralysis:** Caused by infiltration of the Levator veli palatini muscle or the Vagus nerve, leading to immobility of the soft palate. **Analysis of Options:** * **Nasopharyngeal Carcinoma (Correct):** This is the definitive condition associated with the triad. The tumor most commonly originates in the **Fossa of Rosenmuller**. * **Growth in Fossa of Rosenmuller (Incorrect):** While NPC often starts here, "Growth" is a non-specific term. In the context of NEET-PG, the specific pathological diagnosis (NPC) is the preferred answer over the anatomical site. * **Angiofibroma (Incorrect):** Juvenile Nasopharyngeal Angiofibroma (JNA) typically presents with painless, profuse epistaxis and nasal obstruction in adolescent males, not the neurological deficits of Trotter’s triad. * **Laryngeal Carcinoma (Incorrect):** This presents with hoarseness of voice, stridor, or dysphagia, depending on the subsite (glottic vs. supraglottic). **High-Yield Clinical Pearls:** * **EBV Association:** NPC is strongly linked to the Epstein-Barr Virus. * **Most Common Site:** Fossa of Rosenmuller. * **Nodal Spread:** The most common presenting symptom of NPC is actually a painless neck mass (level II/V nodes), often involving the **Node of Rouviere** (lateral retropharyngeal node).

Q: A 74-year-old male complains of bad breath, regurgitation of food during his sleep, and weight loss. For several months he has also had trouble swallowing solids. He denies fever, chills, and nausea. The patient does not smoke cigarettes and does not drink alcohol. Barium swallow study with fluoroscopy is obtained. Which of the following is the most likely underlying cause of the patient's condition?

Defect in the muscular wall of laryngopharynx. ***Defect in the muscular wall of laryngopharynx*** - This describes **Zenker's diverticulum**, which occurs due to weakness in **Killian's triangle** (between cricopharyngeus and thyropharyngeus muscles), causing a posterior pharyngeal pouch. - Classic triad includes **halitosis** (bad breath), **nocturnal regurgitation** of undigested food, and **dysphagia** for solids, which matches this elderly male patient's presentation. *Achalasia* - Characterized by failure of the **lower esophageal sphincter** to relax, causing dysphagia for both liquids and solids. - Barium swallow would show a classic **"bird-beak" appearance** with smooth tapering at the gastroesophageal junction, not a pharyngeal pouch. *Gastro-esophageal reflux disease* - Typically presents with **heartburn**, **acid regurgitation**, and chest pain, especially when lying down. - Does not cause **nocturnal regurgitation** of undigested food or the specific constellation of symptoms described. *Diffuse esophageal spasm* - Causes **chest pain** and dysphagia due to uncoordinated esophageal contractions. - Barium swallow shows a **"corkscrew" or "rosary bead" appearance**, not regurgitation of undigested food or halitosis.

Q: The X-ray shown below is diagnostic of what? The finding in the X-ray is marked with a red arrow.

Eagle syndrome. ***Eagle syndrome*** - X-ray shows **elongated styloid process** (>25mm) which is pathognomonic for Eagle syndrome, causing **throat pain** and **dysphagia**. - The **calcified stylohyoid ligament** or elongated styloid process is clearly visible on plain radiographs, making this a definitive radiological diagnosis. *Trigeminal neuralgia* - This is a **clinical diagnosis** based on characteristic **sharp, electric shock-like pain** in trigeminal nerve distribution. - **No specific radiological findings** are seen on plain X-rays; diagnosis relies on clinical presentation and sometimes MRI. *Cervical cord compression* - Requires **MRI or CT myelography** to visualize cord compression and cannot be diagnosed on plain X-rays. - Plain radiographs may show **degenerative changes** but cannot demonstrate actual cord compression or neurological involvement. *Non specific myalgia* - This is a **clinical syndrome** with muscle pain and tenderness without any radiological abnormalities. - **Normal X-ray findings** are expected, and diagnosis is based purely on clinical examination and history.

Q: Which of the following is called the gateway of Tears?

Killian's dehiscence. **Explanation:** **Killian’s dehiscence** is a potential weak spot in the posterior wall of the lower pharynx. It is located between the two parts of the inferior constrictor muscle: the upper oblique fibers (**thyropharyngeus**) and the lower horizontal fibers (**cricopharyngeus**). It is called the **"Gateway of Tears"** because it is the most common site for accidental **iatrogenic perforation** during rigid esophagoscopy. Furthermore, increased intraluminal pressure here leads to the herniation of mucosa, forming a **Zenker’s diverticulum** (pulsion diverticulum). **Analysis of Incorrect Options:** * **Sinus of Morgagni:** This is the space between the base of the skull and the upper border of the superior constrictor muscle. It allows the passage of the Eustachian tube and levator veli palatini. * **Passavant’s Ridge:** A mucosal ridge on the posterior pharyngeal wall formed by the contraction of the palatopharyngeus muscle. It helps in velopharyngeal closure during speech and swallowing. * **Waldeyer’s Ring:** A ring of lymphoid tissue at the entrance of the aerodigestive tract (including palatine, lingual, pharyngeal, and tubal tonsils) that provides local immunity. **High-Yield Clinical Pearls for NEET-PG:** * **Zenker’s Diverticulum:** Always occurs through Killian’s dehiscence. It is a "false" diverticulum as it contains only mucosa and submucosa. * **Killian-Jamieson Area:** A separate weak area located *below* the cricopharyngeus, between the muscle and the esophagus. * **Management:** The gold standard for Zenker’s is endoscopic Dohlman’s procedure (stapling) or open diverticulectomy with cricopharyngeal myotomy.

Q: Which of the following is not a complication of adenoidectomy?

Hyponasality of speech. **Explanation:** Adenoidectomy is the surgical removal of the adenoid lymphoid tissue located in the nasopharynx. Understanding the anatomical changes post-surgery is key to identifying its complications. **1. Why Hyponasality is the Correct Answer:** Adenoids normally occupy space in the nasopharynx. Their presence can cause **hyponasality** (rhinolalia clausa) by obstructing nasal airflow. Removing the adenoids opens the nasopharyngeal airway, which resolves hyponasality but creates a larger space for air to escape during speech. Therefore, the complication of adenoidectomy is **hypernasality** (rhinolalia aperta), not hyponasality. **2. Analysis of Incorrect Options:** * **Velopharyngeal Insufficiency (VPI):** This is a classic complication. The soft palate relies on the adenoid pad to achieve complete closure of the nasopharynx during speech. Removal of this "pad" can result in an inability to seal the nasopharynx, leading to hypernasality and nasal regurgitation of fluids. * **Grisel Syndrome:** This is a rare but high-yield complication involving **non-traumatic atlanto-axial subluxation**. It occurs due to inflammatory edema causing laxity of the anterior transverse ligament of the atlas following local infection or surgery (adenoidectomy). * **Retropharyngeal Abscess:** Post-operative infection or trauma to the posterior pharyngeal wall during curettage can lead to the formation of a retropharyngeal abscess. **Clinical Pearls for NEET-PG:** * **Most common complication:** Post-operative hemorrhage (Primary or Reactionary). * **Grisel Syndrome presentation:** Persistent torticollis (wry neck) following adenoidectomy. * **Contraindication:** Adenoidectomy is strictly contraindicated in children with a **cleft palate** or **submucous cleft palate** because it will precipitate severe velopharyngeal insufficiency. Always palpate the hard palate for a notch before surgery.

Q: Which of the following is NOT a feature of Plummer-Vinson syndrome?

Gastric polyps. **Plummer-Vinson Syndrome (PVS)**, also known as **Paterson-Brown-Kelly syndrome**, is a clinical triad characterized by iron deficiency anemia, dysphagia, and esophageal webs. It is most commonly seen in middle-aged women and is considered a premalignant condition for post-cricoid carcinoma. ### Why Gastric Polyps is the Correct Answer **Gastric polyps** are not a component of Plummer-Vinson Syndrome. While PVS involves the upper gastrointestinal tract (specifically the esophagus), it does not typically involve the stomach mucosa in the form of polyps. The pathology in PVS is primarily related to mucosal atrophy and epithelial changes due to chronic iron deficiency. ### Explanation of Incorrect Options * **A. Iron deficiency anemia:** This is the hallmark of the syndrome. It leads to depleted iron-dependent enzymes in the epithelium, causing the characteristic mucosal changes. * **B. Cheilosis:** Also known as angular stomatitis, this is a common clinical sign of vitamin B12 and iron deficiency, frequently seen in PVS patients along with glossitis (smooth, red tongue). * **C. Esophageal webs:** These are thin, mucosal folds usually found in the **post-cricoid region** (upper esophagus). They cause the characteristic "painless, intermittent dysphagia" to solids. ### NEET-PG High-Yield Pearls * **Clinical Triad:** Iron deficiency anemia + Dysphagia + Cervical esophageal webs. * **Demographics:** Most common in females (4th–7th decade). * **Premalignant Potential:** High risk of developing **Squamous Cell Carcinoma** of the post-cricoid region and upper esophagus. * **Diagnosis:** Best initial test is a **Barium Swallow** (lateral view) to visualize the web; definitive diagnosis via esophagoscopy. * **Treatment:** Iron supplementation often resolves the dysphagia; persistent webs require endoscopic dilation.

Q: A child presented to the OPD with fever and dysphagia. On examination, the following was visualized. What is your most probable diagnosis?

Peritonsillar abscess. ***Peritonsillar abscess*** - Classic **oropharyngeal visual findings** include **peritonsillar bulge**, **uvular deviation to contralateral side**, and **soft palate fullness** on examination. - Presents with **fever**, **severe dysphagia**, **trismus**, and **muffled voice** due to collection of pus between tonsillar capsule and superior constrictor muscle. *Parapharyngeal abscess* - Located in the **deep neck space** lateral to the pharynx, not typically visible on **direct oropharyngeal examination**. - Presents with **neck swelling**, **torticollis**, and **medial displacement of lateral pharyngeal wall** rather than tonsillar bulge. *Retropharyngeal abscess* - Collection of pus in the **retropharyngeal space**, behind the posterior pharyngeal wall, not visible on routine oral examination. - Typically presents with **neck extension**, **drooling**, **stridor**, and **posterior pharyngeal wall bulging** on lateral neck X-ray. *Follicular Tonsillitis* - Shows **white/yellow exudates** in tonsillar crypts without significant **unilateral swelling** or **uvular deviation**. - Bilateral involvement is common with **less severe dysphagia** and absence of **peritonsillar bulging** or **trismus**.

Question 1

A 4-year-old male presents with recurrent upper respiratory tract infections, difficulty breathing, high arched palate, failure to grow, and impaired hearing. What is the most appropriate management?

Accepted Answer

Adenoidectomy with grommet insertion

Answer

Tonsillectomy

Answer

Adenoidectomy

Answer

Antibiotics and nasal decongestants

Question 2

Trotter's triad is seen in which of the following conditions?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Angiofibroma

Answer

Laryngeal carcinoma

Answer

Growth in fossa of Rosenmuller

Question 3

A 74-year-old male complains of bad breath, regurgitation of food during his sleep, and weight loss. For several months he has also had trouble swallowing solids. He denies fever, chills, and nausea. The patient does not smoke cigarettes and does not drink alcohol. Barium swallow study with fluoroscopy is obtained. Which of the following is the most likely underlying cause of the patient's condition?

Accepted Answer

Defect in the muscular wall of laryngopharynx

Answer

Achalasia

Answer

Gastro-esophageal reflux disease

Answer

Diffuse esophageal spasm

Question 4

All of the following are true about Zenker's Diverticulum except?

Accepted Answer

It is an outpouching of the posterior pharyngeal wall.

Answer

Dohlman's procedure is used for its treatment.

Answer

It is a false diverticulum.

Answer

Boyce sign is associated with it.

Question 5

The X-ray shown below is diagnostic of what? The finding in the X-ray is marked with a red arrow.

Accepted Answer

Eagle syndrome

Answer

Trigeminal neuralgia

Answer

Cervical cord compression

Answer

Non specific myalgia

Question 6

Which of the following is called the gateway of Tears?

Accepted Answer

Killian's dehiscence

Answer

Sinus of Morgagni

Answer

Passavant's ridge

Answer

Waldeyer's ring

Question 7

What is not characteristic of Eagle's syndrome?

Accepted Answer

Excessive lacrimation

Answer

Pain during mandibular movement

Answer

Stabbing type pain originating in the tonsillar regions

Answer

Pain subsides when the jaws are closed

Question 8

Which of the following is not a complication of adenoidectomy?

Accepted Answer

Hyponasality of speech

Answer

Retropharyngeal abscess

Answer

Velopharyngeal insufficiency

Answer

Grisel syndrome

Question 9

Which of the following is NOT a feature of Plummer-Vinson syndrome?

Accepted Answer

Gastric polyps

Answer

Iron deficiency anemia

Answer

Cheilosis

Answer

Esophageal webs

Question 10

A child presented to the OPD with fever and dysphagia. On examination, the following was visualized. What is your most probable diagnosis?

Accepted Answer

Peritonsillar abscess

Answer

Parapharyngeal abscess

Answer

Retropharyngeal abscess

Answer

Follicular Tonsillitis

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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