Diseases of the Pharynx — MCQs

Diseases of the Pharynx Indian Medical PG Practice Questions and MCQs

Question 121: The nasopharynx extends from which anatomical landmark to which anatomical landmark?

A. Skull base to the soft palate (Correct Answer)
B. Soft palate to epiglottis
C. Epiglottis to cricoid cartilage
D. None of the above

Explanation: The pharynx is a muscular tube divided into three distinct anatomical regions. Understanding their boundaries is high-yield for NEET-PG. ### **1. Why Option A is Correct** The **Nasopharynx** is the uppermost part of the pharynx. It is bounded superiorly by the **base of the skull** (specifically the body of the sphenoid and the basilar part of the occipital bone) and extends inferiorly to the level of the **soft palate**. It communicates anteriorly with the nasal cavity via the choanae and posteriorly with the oropharynx through the pharyngeal isthmus. ### **2. Analysis of Incorrect Options** * **Option B (Soft palate to epiglottis):** This defines the **Oropharynx**. It lies behind the oral cavity and contains the palatine tonsils. * **Option C (Epiglottis to cricoid cartilage):** This defines the **Laryngopharynx (Hypopharynx)**. It extends from the upper border of the epiglottis to the lower border of the cricoid cartilage (C6 level), where it continues as the esophagus. ### **3. Clinical Pearls for NEET-PG** * **Passavant’s Ridge:** A mucosal ridge formed by the palatopharyngeus muscle during swallowing, located at the junction of the nasopharynx and oropharynx. * **Fossa of Rosenmüller:** A deep recess behind the opening of the Eustachian tube in the nasopharynx; it is the most common site of origin for **Nasopharyngeal Carcinoma**. * **Adenoids:** The nasopharyngeal tonsils are located in the roof and posterior wall of the nasopharynx. Hypertrophy here can lead to mouth breathing and "adenoid facies." * **Eustachian Tube:** Opens into the lateral wall of the nasopharynx, 1.25 cm behind the inferior turbinate.

Question 122: Which of the following is not a cause of a patch on the tonsil?

A. Vincent's angina
B. Candida
C. Staphylococcus
D. Ludwig's angina (Correct Answer)

Explanation: ### Explanation The presence of a "patch" or membrane on the tonsil is a classic clinical finding in ENT. To answer this question, one must differentiate between diseases that cause localized tonsillar exudates/membranes and those that involve the floor of the mouth. **Why Ludwig’s Angina is the Correct Answer:** **Ludwig’s Angina** is a cellulitis of the submandibular space (involving the submental, sublingual, and submandibular compartments). It is characterized by a "woody" hard swelling of the neck, elevation of the tongue, and potential airway obstruction. Crucially, it is an **extra-pharyngeal infection**; it does not involve the tonsils directly and therefore does not present with a tonsillar patch. **Analysis of Incorrect Options:** * **Vincent’s Angina:** Caused by a symbiotic infection of *Borrelia vincentii* and *Fusiform bacilli*. It typically presents with a unilateral, foul-smelling ulcer covered by a **grayish-white membrane** (patch) on the tonsil. * **Candida (Moniliasis):** Fungal infection (Oral Thrush) that presents as creamy white, **curdy patches** on the tonsils and oral mucosa. These patches can be easily scraped off, leaving a raw, bleeding surface. * **Staphylococcus:** Acute membranous tonsillitis can be caused by pyogenic organisms like *Staphylococcus aureus* or *Streptococcus*. These produce a localized **purulent exudate** or patch on the tonsillar surface. **High-Yield Clinical Pearls for NEET-PG:** * **Differential Diagnosis of Tonsillar Patch:** Diphtheria (dirty gray, adherent membrane), Infectious Mononucleosis (thick white membrane), Agranulocytosis (necrotic ulcers), and Leukemia. * **Ludwig’s Angina Key Sign:** Look for "brawny edema" of the neck and "upward and backward displacement of the tongue." The most common cause is dental infection (lower 2nd/3rd molars). * **Diphtheria vs. Others:** The membrane in Diphtheria is extremely adherent; attempting to remove it causes bleeding.

Question 123: What is the commonest post-operative complication of tonsillectomy?

A. Palatal palsy
B. Hemorrhage (Correct Answer)
C. Injury to uvula
D. Infection

Explanation: **Explanation:** **Hemorrhage** is the most common and potentially life-threatening complication following a tonsillectomy. It is classically categorized into three types based on the timing of occurrence: 1. **Primary:** Occurs during the surgery (due to inadequate ligation). 2. **Reactionary:** Occurs within the first 24 hours (usually due to a rise in blood pressure or slipping of a ligature). 3. **Secondary:** Occurs between the 5th and 10th post-operative day (typically due to infection and premature sloughing of the fibrin clot). **Why other options are incorrect:** * **Palatal Palsy:** This is a rare complication usually resulting from excessive scarring or trauma to the muscles of the soft palate. It is not a routine occurrence. * **Injury to Uvula:** While edema of the uvula is common post-operatively, actual surgical injury or excision of the uvula is an avoidable technical error and not a standard complication. * **Infection:** While local infection can occur (often leading to secondary hemorrhage), it is less frequent than bleeding episodes and is usually managed with prophylactic or therapeutic antibiotics. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of Secondary Hemorrhage:** Infection. * **Management of Reactionary Hemorrhage:** Immediate return to the OR for ligation or cauterization. * **Management of Secondary Hemorrhage:** Conservative management (IV fluids, antibiotics, and observation); if severe, surgical intervention may be required. * **Eagle’s Syndrome:** Elongated styloid process causing post-tonsillectomy pain; a classic differential for persistent throat pain.

Question 124: Quinsy is characterized by which of the following, except?

A. Peritonsillar abscess
B. Indication for tonsillectomy
C. Should be drained
D. Affects nasal mucosa (Correct Answer)

Explanation: **Explanation:** **Quinsy**, clinically known as a **Peritonsillar Abscess**, is a collection of pus in the peritonsillar space (the potential space between the tonsillar capsule and the superior constrictor muscle). **Why Option D is the correct answer:** Quinsy is a localized infection of the oropharynx. It does **not affect the nasal mucosa**. The infection typically follows an episode of acute tonsillitis and involves the soft palate and the pillars of the fauces. While it may cause "hot potato voice" due to oropharyngeal swelling, the nasal cavity remains uninvolved. **Analysis of other options:** * **Option A (Peritonsillar abscess):** This is the synonymous medical term for Quinsy. It usually occurs at the upper pole of the tonsil. * **Option B (Indication for tonsillectomy):** A history of Quinsy is a **relative indication** for tonsillectomy. Usually, "Interval Tonsillectomy" is performed 4–6 weeks after the abscess resolves to prevent recurrence. If performed during the acute phase, it is called "Tonsillectomy à chaud" (Hot Tonsillectomy). * **Option C (Should be drained):** Incision and drainage (I&D) is the gold standard treatment. The drainage is typically performed at the point of maximum bulge or at the intersection of a horizontal line from the base of the uvula and a vertical line from the anterior pillar. **Clinical Pearls for NEET-PG:** * **Clinical Features:** Severe odynophagia (painful swallowing), **Trismus** (due to irritation of the medial pterygoid muscle), and uvular deviation to the opposite side. * **Organism:** Most common aerobic organism is *Streptococcus pyogenes*; however, it is often a mixed infection including anaerobes. * **Complication:** The most dangerous complication is laryngeal edema or spread to the parapharyngeal space.

Question 125: Trismus associated with infection of the lateral pharyngeal space is related to the irritation of which muscle?

A. Buccinator
B. Masseter
C. Lateral pterygoid
D. Medial pterygoid (Correct Answer)

Explanation: **Explanation:** The **lateral pharyngeal (parapharyngeal) space** is a cone-shaped potential space located lateral to the pharynx. It is divided into anterior and posterior compartments by the styloid process and its attached muscles. **Why Medial Pterygoid is the Correct Answer:** The **anterior compartment** of the lateral pharyngeal space is in close anatomical proximity to the masticatory muscles. Specifically, the **medial pterygoid muscle** forms the lateral boundary of this space. When an infection (parapharyngeal abscess) involves the anterior compartment, the resulting inflammation and edema cause "reflex spasm" or irritation of the medial pterygoid muscle. Since this muscle is a primary elevator of the mandible, its irritation leads to **trismus** (inability to open the mouth), which is a hallmark clinical feature of anterior space involvement. **Analysis of Incorrect Options:** * **A. Buccinator:** This is a muscle of facial expression forming the cheek; it is not part of the masticatory apparatus and is distant from the parapharyngeal space. * **B. Masseter:** While it is a muscle of mastication, it is located superficially on the lateral aspect of the mandibular ramus, separated from the parapharyngeal space by the mandible. * **C. Lateral Pterygoid:** This muscle is located superiorly in the infratemporal fossa. While it helps in opening the mouth, it is not the primary muscle irritated in parapharyngeal infections compared to the medial pterygoid. **NEET-PG High-Yield Pearls:** * **Anterior Compartment Infection:** Characterized by **trismus** and swelling of the lateral pharyngeal wall/tonsil. * **Posterior Compartment Infection:** Trismus is usually **absent**. Instead, it presents with palsy of Cranial Nerves IX, X, XI, and XII and Horner’s syndrome due to involvement of the carotid sheath. * **Source of Infection:** Most commonly arises from tonsillitis, peritonsillar abscess (Quinsy), or dental infections (lower 3rd molar).

Question 126: A 16-year-old boy presents with anemia (Hb 6 mg/dL) and a history of frequent nasal bleeds. What is the most probable diagnosis?

A. Juvenile angiofibroma (Correct Answer)
B. Nasal trauma
C. Nasal polyp
D. Hypertensive bleed

Explanation: **Explanation:** The clinical presentation of a **young adolescent male** with **recurrent, profuse epistaxis** and significant **secondary anemia** (Hb 6 mg/dL) is the classic triad for **Juvenile Nasopharyngeal Angiofibroma (JNA)**. **Why Option A is Correct:** JNA is a benign but locally aggressive, highly vascular tumor that almost exclusively affects adolescent males (testosterone-dependent). Because the tumor is composed of thin-walled blood vessels lacking a muscular coat, it does not constrict effectively when injured, leading to spontaneous, life-threatening epistaxis and subsequent chronic anemia. **Why Other Options are Incorrect:** * **Nasal Trauma:** While a common cause of epistaxis, it is usually an acute event related to a specific injury and rarely causes chronic, severe anemia unless associated with major facial fractures. * **Nasal Polyp:** Ethmoidal or Antrochoanal polyps typically present with progressive nasal obstruction and hyposmia. They are relatively avascular and do not cause profuse bleeding. * **Hypertensive Bleed:** This is a common cause of epistaxis in the elderly (Woodruff’s plexus). It is extremely rare in a 16-year-old unless there is underlying renal disease or coarctation of the aorta. **High-Yield Clinical Pearls for NEET-PG:** * **Site of Origin:** Sphenopalatine foramen (specifically the posterior aspect of the nasal cavity). * **Pathognomonic Sign:** **Holman-Miller Sign** (Antral Sign) – Anterior bowing of the posterior wall of the maxillary sinus seen on CT/MRI. * **Gold Standard Investigation:** Contrast-Enhanced CT (CECT) is the initial choice; Angiography shows a characteristic "tumor blush." * **Contraindication:** **Biopsy is strictly contraindicated** in the OPD due to the risk of torrential hemorrhage. * **Treatment of Choice:** Surgical excision (usually preceded by preoperative embolization to reduce blood loss).

Question 127: Infections of the pharyngeal bursa are most commonly associated with which of the following conditions?

A. Craniopharyngioma
B. Chordoma
C. Thornwaldt's cyst (Correct Answer)
D. Lymphoma

Explanation: **Explanation:** **Thornwaldt’s cyst** (Option C) is the correct answer. The pharyngeal bursa is a midline embryonic remnant formed by the persistent attachment of the notochord to the pharyngeal ectoderm. It is located in the nasopharynx, specifically within the adenoid tissue. When the opening of this bursa becomes obstructed (due to infection or inflammation), it leads to the formation of a cyst known as Thornwaldt’s cyst. If this cyst becomes infected, it can cause persistent post-nasal drip, halitosis, and a dull occipital headache. **Why other options are incorrect:** * **Craniopharyngioma (A):** These are benign tumors arising from the remnants of **Rathke’s pouch** (an upward evagination of the stomodeum), not the pharyngeal bursa. They are typically suprasellar in location. * **Chordoma (B):** These are rare, slow-growing malignant tumors arising from **notochordal remnants** in the bone (clivus or sacrum). While they share a common embryonic origin (notochord), they are primary bone tumors and do not involve the pharyngeal bursa. * **Lymphoma (D):** While the nasopharynx is rich in lymphoid tissue (Waldeyer’s ring), lymphoma is a primary malignancy of the lymphatic system and is not etiologically related to the pharyngeal bursa. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Midline of the posterior nasopharyngeal wall, superficial to the longus capitis muscle. * **Diagnosis:** MRI is the gold standard (shows a high-signal intensity lesion on T2-weighted images). * **Treatment:** Marsupialization or endoscopic excision is indicated only if the cyst is symptomatic or infected. * **Differential:** Must be distinguished from a **Rathke’s pouch cyst**, which is located more superiorly and anteriorly.

Question 128: Hemorrhage occurring 6 hours after tonsillectomy is called as?

A. Primary hemorrhage
B. Secondary hemorrhage
C. Reactionary hemorrhage (Correct Answer)
D. None of the above

Explanation: ### Explanation Tonsillectomy hemorrhage is classified based on the **timing** of the bleeding relative to the surgery. **1. Why Reactionary Hemorrhage is correct:** Reactionary hemorrhage occurs within **24 hours** of surgery (most commonly between 4–6 hours). It is triggered by a rise in blood pressure as the patient recovers from anesthesia, the wearing off of vasoconstrictors (like adrenaline) used during the procedure, or the slipping of a ligature. Since 6 hours falls within this critical window, it is the correct classification. **2. Why the other options are incorrect:** * **Primary Hemorrhage:** This occurs **during the surgery** or immediately after. It is usually managed by the surgeon on the operating table through ligation or diathermy. * **Secondary Hemorrhage:** This occurs **5–10 days** after surgery. It is almost always due to **infection** of the tonsillar fossa, which causes the premature sloughing of the scab and erosion of a small vessel. **3. High-Yield Clinical Pearls for NEET-PG:** * **Management of Reactionary Hemorrhage:** This is a surgical emergency. The patient must be taken back to the OR to identify the bleeding point and achieve hemostasis. * **Management of Secondary Hemorrhage:** Usually managed conservatively with intravenous antibiotics and observation. If bleeding is profuse, surgical intervention may be required. * **Most common vessel involved:** The **External Palatine Vein** (Paratonsillar vein) is the most common source of bleeding during/after tonsillectomy. * **Arterial source:** The **Tonsillar branch of the Facial Artery** is the main artery supplying the tonsil and a common source of significant arterial bleed.

Question 129: Which of the following statements is false regarding sideropenic dysphagia?

A. Presence of post cricoid webs
B. Increased risk of esophageal cancer
C. Increased risk of hypopharyngeal carcinoma
D. None of the above (Correct Answer)

Explanation: **Explanation:** **Sideropenic Dysphagia**, also known as **Plummer-Vinson Syndrome** (in the US) or **Paterson-Brown-Kelly Syndrome** (in the UK), is a clinical triad characterized by iron-deficiency anemia, glossitis, and esophageal webs. **Why "None of the above" is correct:** All the statements provided (A, B, and C) are actually **true** clinical features or complications of the disease. Since the question asks for the *false* statement, and none are false, Option D is the correct choice. * **Option A (True):** The hallmark of this condition is the presence of **post-cricoid webs**. These are thin, mucosal folds that occur at the junction of the hypopharynx and upper esophagus, leading to painless, progressive dysphagia (initially for solids). * **Option B & C (True):** Sideropenic dysphagia is considered a **premalignant condition**. The chronic mucosal atrophy caused by iron deficiency predisposes patients to squamous cell carcinoma. While it is most famously associated with **post-cricoid (hypopharyngeal) carcinoma**, it also increases the risk of carcinoma in the upper third of the esophagus. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most commonly affects middle-aged females (90% of cases). * **Clinical Features:** Look for signs of iron deficiency like **koilonychia** (spoon-shaped nails), angular stomatitis, and a smooth, red tongue (glossitis). * **Diagnosis:** **Barium swallow** is the investigation of choice to visualize the web (seen as a notch on the anterior wall). * **Treatment:** Iron supplementation often reverses the mucosal changes, though mechanical dilation of the web may be required. Regular follow-up is mandatory due to the high risk of malignancy.

Question 130: Which of the following is NOT a characteristic of Plummer-Vinson syndrome?

A. Dysphagia
B. Esophageal web
C. Iron deficiency anemia
D. Kidney disease (Correct Answer)

Explanation: **Plummer-Vinson Syndrome (PVS)**, also known as **Paterson-Brown-Kelly Syndrome**, is a rare condition characterized by a classic triad of symptoms. It primarily affects middle-aged women and is considered a premalignant condition. ### **Explanation of Options** * **Kidney Disease (Correct Answer):** There is no clinical or pathophysiological association between Plummer-Vinson Syndrome and renal pathology. PVS is strictly a hematological and upper gastrointestinal disorder. * **Dysphagia (Option A):** This is a hallmark symptom. The dysphagia is typically painless, intermittent, and progressive, specifically for solids. It is caused by the presence of esophageal webs. * **Esophageal Web (Option B):** These are thin, mucosal folds that partially obstruct the lumen. In PVS, they are characteristically found in the **post-cricoid region** (upper esophagus). * **Iron Deficiency Anemia (Option C):** This is the primary underlying driver of the syndrome. Chronic iron deficiency leads to mucosal atrophy and the subsequent formation of webs. ### **NEET-PG High-Yield Clinical Pearls** * **The Triad:** 1. Iron deficiency anemia, 2. Glossitis (smooth red tongue), 3. Cheilosis/Stomatitis, and 4. Esophageal webs. * **Koilonychia:** Patients often present with "spoon-shaped nails," a classic sign of chronic iron deficiency. * **Premalignant Potential:** PVS significantly increases the risk of **Squamous Cell Carcinoma** of the post-cricoid region and upper esophagus. * **Diagnosis:** The investigation of choice to visualize the web is a **Barium Swallow** (lateral view), though endoscopy is used for confirmation and treatment. * **Treatment:** Management involves aggressive iron supplementation and endoscopic dilation of the webs if symptoms persist.

Practice by Chapter

Pharyngitis

Practice Questions

Tonsillitis

Practice Questions

Peritonsillar Abscess

Practice Questions

Retropharyngeal Abscess

Practice Questions

Adenoid Hypertrophy

Practice Questions

Sleep-Disordered Breathing

Practice Questions

Obstructive Sleep Apnea

Practice Questions

Nasopharyngeal Carcinoma

Practice Questions

Oropharyngeal Carcinoma

Practice Questions

Hypopharyngeal Carcinoma

Practice Questions

Dysphagia

Practice Questions

Globus Pharyngeus

Practice Questions

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