Diseases of the Pharynx Practice Questions

Q: A black colored patch in the mouth is seen in which of the following conditions?

Vincent's angina. **Explanation:** **Vincent’s Angina** (also known as Trench Mouth or Acute Necrotizing Ulcerative Gingivitis/Pharyngitis) is the correct answer. It is caused by a symbiotic infection of two organisms: the Gram-negative anaerobic spirochete ***Borrelia vincentii*** and the fusiform bacillus ***Fusobacterium nucleatum***. Clinically, it presents as a painful, necrotic ulceration of the tonsils and gums. The hallmark of this condition is the formation of a **dirty-grey or blackish slough (pseudomembrane)** over the ulcerated area. When this membrane is removed, it reveals a bleeding granular surface. The "black" appearance is due to tissue necrosis and the specific microbial flora involved. **Analysis of Incorrect Options:** * **Acute Tonsillitis:** Typically presents with an erythematous, congested tonsil with white or yellowish follicular exudates, not a black patch. * **Peritonsillar Abscess (Quinsy):** Characterized by a bulge of the soft palate and anterior pillar with deviation of the uvula. While there is severe inflammation, there is no characteristic black patch. * **Leukemia:** While leukemic infiltration can cause gingival enlargement or secondary necrotic ulcers (due to neutropenia), it is not the classic primary association for a black patch compared to the specific pseudomembrane of Vincent’s Angina. **High-Yield Clinical Pearls for NEET-PG:** * **Microbiology:** Look for the "Fusospirochetal" complex. * **Clinical Sign:** "Halitosis" (foul breath) is very prominent in Vincent’s Angina. * **Treatment:** Penicillin is the drug of choice, along with Metronidazole to cover anaerobes and oxidizing mouthwashes (Hydrogen Peroxide). * **Differential Diagnosis:** Must be differentiated from Diphtheria (greyish-white membrane) and Infectious Mononucleosis.

Q: Stylalgia may present with ear pain. Which nerve may refer the pain?

Glossopharyngeal nerve. **Explanation:** **Stylalgia (Eagle’s Syndrome)** occurs due to an elongated styloid process or calcification of the stylohyoid ligament. This anatomical variation causes irritation of the surrounding structures, primarily the **Glossopharyngeal nerve (CN IX)**, which passes in close proximity to the styloid process. **Why Glossopharyngeal nerve is correct:** The Glossopharyngeal nerve provides sensory innervation to the oropharynx and the base of the tongue. It also gives off the **Jacobson’s nerve (tympanic branch)**, which provides sensory supply to the middle ear. In Stylalgia, irritation of CN IX in the tonsillar fossa results in **referred otalgia** (ear pain) via this tympanic branch. This is a classic example of pain originating in the pharynx being felt in the ear. **Why other options are incorrect:** * **Auriculotemporal nerve (CN V3):** While it causes referred otalgia, it is typically associated with Temporomandibular Joint (TMJ) disorders or molar tooth pathologies, not the styloid process. * **Posterior auricular nerve:** This is a branch of the Facial nerve (CN VII) primarily supplying motor function to muscles behind the ear; it is not the mediator for referred pain in Stylalgia. * **Occipital nerve:** This supplies the scalp and back of the head; irritation here leads to occipital neuralgia, not pharyngeal-related ear pain. **High-Yield NEET-PG Pearls:** * **Eagle’s Syndrome Presentation:** Characterized by "3 Ts": **T**hroat pain, **T**innitus/Otalgia, and **T**ongue pain (especially during swallowing). * **Diagnosis:** Palpation of the elongated styloid process in the tonsillar fossa triggers pain. * **Treatment:** Medical (NSAIDs/Carbamazepine) or Surgical (Styloidectomy via trans-oral or cervical approach). * **Other nerves causing referred otalgia:** V3 (teeth/TMJ), CN X (larynx/hypopharynx), and C2-C3 spinal nerves (cervical spine).

Q: During tonsillectomy, which of the following structures is NOT typically injured?

External carotid artery. **Explanation:** The **External Carotid Artery (ECA)** is located approximately **2 cm lateral** to the tonsillar fossa, separated from the superior constrictor muscle by the stylopharyngeus muscle and the parapharyngeal space. Due to this anatomical distance, it is not typically at risk during a routine tonsillectomy. **Analysis of Options:** * **Glossopharyngeal Nerve (CN IX):** This nerve lies in the tonsillar bed, just deep to the superior constrictor muscle. It is the most common nerve injured during tonsillectomy, leading to loss of taste and sensation in the posterior 1/3rd of the tongue and referred earache. * **Paratonsillar Vein (Gatekeeper’s Vein):** This is the most common source of **venous bleeding** during tonsillectomy. It descends from the soft palate to the tonsillar bed and is usually divided during the procedure. * **Tonsillar Branch of Facial Artery:** This is the **main arterial supply** to the tonsil. It enters the lower pole by piercing the superior constrictor muscle and is the most common source of **primary arterial hemorrhage**. **High-Yield Clinical Pearls for NEET-PG:** * **Main Artery:** Tonsillar branch of the Facial Artery. * **Most common nerve injured:** Glossopharyngeal nerve. * **Post-Tonsillectomy Hemorrhage:** * **Reactionary (within 24 hours):** Usually due to slipping of a ligature or rise in BP. * **Secondary (5–10 days):** Usually due to **infection** (most common cause). * **Eagle’s Syndrome:** Elongated styloid process causing throat pain post-tonsillectomy due to irritation of the glossopharyngeal nerve.

Q: Trismus in tonsillar abscess is due to spasm of which muscle?

Pterygoid muscle. **Explanation:** **Trismus** (lockjaw) in the context of a peritonsillar abscess (Quinsy) is a classic clinical sign indicating that the inflammatory process has spread beyond the confines of the pharyngeal wall. 1. **Why Pterygoid Muscle is Correct:** The tonsillar fossa is separated from the **parapharyngeal space** by the superior constrictor muscle and the pharyngobasilar fascia. When a tonsillar abscess develops, the inflammation or infection can penetrate this boundary, irritating the **medial pterygoid muscle**, which lies in the lateral boundary of the parapharyngeal space. This irritation leads to protective muscle spasm (reflex tonic contraction), resulting in the inability to open the mouth (trismus). 2. **Why Other Options are Incorrect:** * **Prevertebral muscles:** These are located posterior to the prevertebral fascia. While they may be involved in Retropharyngeal abscesses (causing neck stiffness), they do not control mandibular movement. * **Superior constrictor:** This muscle forms the floor of the tonsillar fossa. While it is inflamed during tonsillitis (causing odynophagia), its contraction does not cause jaw closure. * **Inferior constrictor:** This muscle is located much lower in the laryngopharynx and is involved in swallowing, not mastication. **Clinical Pearls for NEET-PG:** * **Quinsy Triad:** Severe odynophagia, "hot potato" voice, and trismus. * **Anatomy:** The medial pterygoid and the masseter are the primary "jaw closers." In Quinsy, it is specifically the **medial pterygoid** due to its proximity to the parapharyngeal space. * **Complication:** If trismus is present, it often suggests the infection has reached the **masticator space** or the anterior compartment of the **parapharyngeal space**.

Q: All of the following can give rise to a membrane on the pharynx except?

Staphylococcus aureus. ### Explanation The formation of a **pseudomembrane** on the pharynx is a classic clinical sign of specific infections characterized by tissue necrosis and fibrinous exudate. **1. Why Staphylococcus aureus is the correct answer:** While *Staphylococcus aureus* is a common cause of acute follicular tonsillitis, it typically presents with **purulent exudate** (pus) localized to the tonsillar crypts rather than a cohesive, spreading membrane. It does not typically produce the fibrinous, necrotic layer required to form a true or false membrane on the pharyngeal wall. **2. Analysis of Incorrect Options (Membrane-forming conditions):** * **Corynebacterium diphtheriae:** The hallmark of Diphtheria is a thick, **greyish-white, leathery membrane** that is highly adherent. Attempting to remove it results in bleeding because it involves the underlying epithelium. * **Candida albicans:** Fungal pharyngitis (Oral Thrush) presents as **creamy white, curd-like patches**. These can coalesce into a membrane that, unlike diphtheria, is easily scraped off, leaving an erythematous base. * **Vincent’s Angina:** Caused by a symbiotic infection of *Borrelia vincentii* and *Fusobacterium*, it produces a **dirty grey membrane** over a sloughing ulcer on the tonsil, often accompanied by a characteristic malodor (halitosis). **3. Clinical Pearls for NEET-PG:** * **Differential Diagnosis of Pharyngeal Membrane:** Diphtheria, Vincent’s Angina, Infectious Mononucleosis (EBV), Candidiasis, Agranulocytosis, and Aphthous ulcers. * **Infectious Mononucleosis:** Often presents with a widespread white membrane on the tonsils, associated with posterior cervical lymphadenopathy and splenomegaly. * **High-Yield Distinction:** If the membrane **bleeds on touch**, think Diphtheria; if it is **painless and scrapable**, think Candidiasis.

Q: Rose's position is extension at which joint?

Atlanto-occipital joint. ### Explanation **Rose’s position** is a classic surgical posture used in ENT and pediatric surgery. It involves placing the patient supine with a bolster or sandbag under the shoulders, allowing the head to hang off the edge of the table. **1. Why the Correct Answer is Right:** The primary objective of Rose’s position is to achieve **maximal extension of the head**. This extension occurs specifically at the **Atlanto-occipital joint** (the articulation between the atlas/C1 and the occipital bone). By extending this joint, the surgeon gains a direct, vertical line of sight into the oropharynx and nasopharynx, while also preventing the aspiration of blood into the larynx by allowing it to pool in the nasopharynx (which acts as a dependent sump). **2. Why the Incorrect Options are Wrong:** * **Option B (C1 and C2 joint):** The Atlanto-axial joint is primarily responsible for **rotation** (the "no" movement), not the primary extension required for this surgical exposure. * **Options C & D (C3-C4 and C5-C6):** These represent the lower cervical spine. While some degree of cervical flexion/extension occurs here, Rose’s position specifically targets the craniovertebral junction to align the oral and pharyngeal axes. **3. Clinical Pearls for NEET-PG:** * **Indications:** Most commonly used for **Tonsillectomy**, Adenoidectomy, and repair of Cleft Palate. * **The "Barking Dog" Position:** Do not confuse Rose's position with the **Boyce-Jackson position** (Sniffing position), which involves *flexion* of the lower cervical spine and *extension* at the atlanto-occipital joint, used for direct laryngoscopy and intubation. * **Complication:** Excessive extension in patients with Down Syndrome or Rheumatoid Arthritis can lead to atlanto-axial subluxation.

Question 1

A black colored patch in the mouth is seen in which of the following conditions?

Accepted Answer

Vincent's angina

Answer

Acute tonsillitis

Answer

Peritonsillar abscess

Answer

Leukemia

Question 2

Stylalgia may present with ear pain. Which nerve may refer the pain?

Accepted Answer

Glossopharyngeal nerve

Answer

Auriculotemporal nerve

Answer

Posterior auricular nerve

Answer

Occipital nerve

Question 3

During tonsillectomy, which of the following structures is NOT typically injured?

Accepted Answer

External carotid artery

Answer

Glossopharyngeal nerve

Answer

Paratonsillar vein

Answer

Tonsillar branch of facial artery

Question 4

Trismus in tonsillar abscess is due to spasm of which muscle?

Accepted Answer

Pterygoid muscle

Answer

Prevertebral muscles

Answer

Superior constrictor

Answer

Inferior constrictor

Question 5

Which of the following is most accurate in describing coblation intracapsular tonsillectomy?

Accepted Answer

It can only cut, and not coagulate

Answer

Electric energy is transferred to vibration energy

Answer

It creates significant thermal injury to tissues

Answer

It utilizes a thin layer of ionized sodium to ablate tissues

Question 6

A 20-year-old patient presents with difficulty in breathing and impaired hearing. Examination reveals enlargement of upper deep cervical lymph nodes. What is the most likely diagnosis?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Angiofibroma

Answer

Hodgkin's Lymphoma

Answer

Carcinoma tongue

Question 7

A 58-year-old male patient presents with halitosis, mild dysphagia, and regurgitation of undigested food. Radiological examination reveals a specific anatomical abnormality. What is the most likely location of this presentation?

Accepted Answer

Posterior segment of the esophagus, inferior to the inferior pharyngeal constrictor muscle

Answer

Anterior segment of the esophagus, superior to the inferior pharyngeal constrictor muscle

Answer

Posterior segment of the esophagus, superior to the inferior pharyngeal constrictor muscle

Answer

Anterior segment of the esophagus, inferior to the inferior pharyngeal constrictor muscle

Question 8

All of the following can give rise to a membrane on the pharynx except?

Accepted Answer

Staphylococcus aureus

Answer

Corynebacterium

Answer

Candida

Answer

Vincent's angina

Question 9

All of the following statements about Lymphoepithelioma are true, except?

Accepted Answer

Parotid gland is the most common site of Lymphoepithelioma in the Head & Neck region.

Answer

It is associated with EBV infection.

Answer

It is highly radiosensitive.

Answer

It is a type of squamous cell carcinoma.

Question 10

Rose's position is extension at which joint?

Accepted Answer

Atlanto-occipital joint

Answer

C1 and C2 joint

Answer

C3 and C4

Answer

C5 and C6

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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