Diseases of the Pharynx Practice Questions

Q: All of the following are true about Thornwaldt's abscess except?

Antitubercular treatment is given. **Explanation:** **Thornwaldt’s Abscess** (or Tornwaldt’s cyst) is a benign midline nasopharyngeal lesion. It occurs due to the persistence of the **notochordal remnant**, which leads to the formation of a cyst in the bursa pharyngea (located between the longus capitis muscles). 1. **Why Option C is the Correct Answer (False Statement):** Thornwaldt’s abscess is a developmental/anatomical pathology, not an infectious granulomatous disease. Therefore, **Antitubercular Treatment (ATT) has no role** in its management. The "abscess" usually forms when a pre-existing cyst becomes secondarily infected by pyogenic bacteria, not *Mycobacterium tuberculosis*. 2. **Analysis of Other Options:** * **Option A:** It is indeed called **pharyngeal bursitis** because it involves the inflammation/infection of the pharyngeal bursa. * **Option B:** The most common clinical presentation is a **persistent, foul-smelling postnasal drip**. Other symptoms include occipital headache, halitosis, and Eustachian tube dysfunction. * **Option D:** The definitive treatment is surgical. **Marsupialization** or endoscopic excision of the cyst wall is performed to prevent recurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Always in the **midline** of the posterior nasopharyngeal wall (above the superior constrictor). * **Diagnosis:** Best visualized via **Nasal Endoscopy** (smooth midline swelling) or **MRI** (shows a high-signal intensity cyst on T2 images). * **Differential Diagnosis:** Must be differentiated from Adenoiditis or a Rathke’s pouch cyst (which is usually more superior/anterior).

Q: An 80-year-old female presents with complaints of difficulty swallowing and foul breath for 4 months. On auscultation, her lung fields have crepitations. A barium swallow finding is shown. What is your diagnosis?

Zenker's diverticulum. ***Zenker's diverticulum*** - The classic triad of **dysphagia**, **halitosis** (foul breath from food stagnation), and **pulmonary crepitations** (from aspiration) in an elderly patient strongly suggests Zenker's diverticulum. - Barium swallow typically shows a **posterior pharyngeal pouch** at **Killian's triangle** (between the thyropharyngeus and cricopharyngeus muscles). *Plummer-Vinson syndrome* - Characterized by **iron deficiency anemia**, **esophageal webs**, and **dysphagia** in middle-aged women, not elderly patients. - Associated with **koilonychia** (spoon-shaped nails) and **glossitis**, which are not mentioned in this case. *Schatzki's ring* - Presents with **intermittent dysphagia** to solids only, typically triggered by eating bread or meat ("steakhouse syndrome"). - Barium swallow shows a **thin circumferential ring** at the gastroesophageal junction, not a posterior pouch. *Corkscrew esophagus* - Associated with **diffuse esophageal spasm** causing severe **chest pain** and dysphagia to both liquids and solids. - Barium swallow shows **tertiary contractions** creating a corkscrew appearance, not a diverticular pouch.

Q: Which of the following statements is NOT true about Glossopharyngeal neuralgia?

Syncope is not seen. **Glossopharyngeal Neuralgia (GPN)** is a rare clinical condition characterized by paroxysms of severe, stabbing, lancinating pain in the distribution of the 9th cranial nerve (tonsillar fossa, base of tongue, and ear). ### **Explanation of Options** * **Why Option C is the Correct Answer (The False Statement):** **Syncope is indeed seen** in about 10% of GPN cases. This occurs due to the close proximity of the glossopharyngeal nerve to the vagus nerve. Intense afferent impulses from the 9th nerve can trigger a **vasovagal response**, leading to bradycardia, hypotension, and subsequent syncope. Therefore, stating that syncope is "not seen" is clinically incorrect. * **Option A (Eagle’s Syndrome):** This is a specific cause of GPN where an **elongated styloid process** (or calcified stylohyoid ligament) compresses the glossopharyngeal nerve. It is a classic association. * **Option B (Reichert Syndrome):** This is an eponymous name for primary glossopharyngeal neuralgia, characterized by idiopathic paroxysmal facial pain. * **Option D (Tonsillectomy):** In cases where GPN is caused by Eagle’s syndrome, a **trans-oral approach** is often used to reach the styloid process. This typically requires a tonsillectomy to provide adequate surgical exposure for styloidectomy. ### **Clinical Pearls for NEET-PG** * **Trigger Factors:** Swallowing (most common), chewing, coughing, or talking. * **Pain Distribution:** Often referred to the ear (**Jacobson’s nerve** involvement), known as otalgia. * **First-line Medical Management:** Carbamazepine (similar to Trigeminal Neuralgia). * **Surgical Management:** Microvascular decompression (MVD) of the 9th nerve or Styloidectomy (if Eagle's syndrome). * **Differential Diagnosis:** Must be distinguished from Trigeminal Neuralgia (V3) based on the trigger zone (tonsillar pillar vs. face).

Q: Hot potato voice is seen in all of the following conditions EXCEPT:

Glottic cancer. **Explanation:** **Hot Potato Voice (Dyslalia)** refers to a thick, muffled quality of speech, similar to how one would speak with a hot potato in the mouth. It occurs due to **mechanical obstruction or mass effect** in the oropharynx or supraglottic region, which interferes with the resonance of sound rather than the vibration of the vocal cords. **Why Glottic Cancer is the Correct Answer:** Glottic cancer involves the true vocal cords. Any pathology affecting the free edge or vibration of the vocal cords results in **Hoarseness of Voice** (dysphonia), not a muffled voice. Therefore, glottic cancer is the exception. **Analysis of Other Options:** * **Peritonsillar Abscess (Quinsy):** This is the most classic cause of hot potato voice. The inflammatory edema and medial displacement of the tonsil/soft palate restrict oropharyngeal space and limit palate movement. * **Tonsillar Malignancy:** Large tumors of the palatine tonsil create a bulky mass in the oropharynx, leading to muffled speech through altered resonance. * **Posterior Tongue Malignancy:** Tumors at the base of the tongue interfere with the movement of the tongue and narrow the oropharyngeal inlet, resulting in a thick, muffled voice. **High-Yield Clinical Pearls for NEET-PG:** 1. **Hoarseness:** Think **Glottic** lesions (Vocal nodules, Glottic CA, Laryngitis). 2. **Hot Potato Voice:** Think **Supraglottic/Oropharyngeal** lesions (Quinsy, Epiglottitis, Retropharyngeal abscess, Base of tongue tumors). 3. **Stridor:** High-pitched sound indicating airway narrowing (Inspiratory = Supraglottic; Biphasic = Subglottic; Expiratory = Bronchial). 4. **Acute Epiglottitis:** A life-threatening cause of hot potato voice in children, often associated with the "Thumb sign" on X-ray.

Q: Which of the following statements is true regarding Plummer-Vinson syndrome?

Associated vitamin B12 deficiency may be present.. **Plummer-Vinson Syndrome (PVS)**, also known as **Paterson-Brown-Kelly Syndrome**, is characterized by a classic triad of iron-deficiency anemia, dysphagia, and esophageal webs. ### **Explanation of Options** * **Correct Answer (B):** While iron deficiency is the hallmark, PVS is frequently associated with other nutritional deficiencies. Studies and clinical observations have shown that **Vitamin B12 deficiency** and other B-complex vitamins (like riboflavin) may coexist, contributing to the mucosal changes (glossitis, cheilosis) seen in these patients. * **Option A:** This is incorrect. PVS has a strong **female predilection**, typically affecting middle-aged women (4th to 7th decade). * **Option C:** This is incorrect. Plummer-Vinson syndrome and **Paterson-Brown-Kelly syndrome** are synonymous terms for the same clinical entity. * **Option D:** This is incorrect. PVS is a well-known **premalignant condition**. It significantly increases the risk of squamous cell carcinoma of the **post-cricoid region** and upper esophagus. ### **Clinical Pearls for NEET-PG** * **The Triad:** 1. Iron deficiency anemia (Microcytic hypochromic), 2. Dysphagia (due to webs), 3. Esophageal webs (usually in the post-cricoid/cervical esophagus). * **Physical Findings:** Glossitis (smooth red tongue), Koilonychia (spoon-shaped nails), and angular stomatitis. * **Diagnosis:** **Barium swallow** is the investigation of choice to visualize the web (seen as a thin filling defect). * **Treatment:** Iron supplementation often resolves the dysphagia; however, persistent webs may require endoscopic dilation. * **High-Yield Association:** It is the most common cause of **post-cricoid carcinoma** in females.

Q: A marked area in the nasopharynx gives rise to which of the following diseases?

Nasopharyngeal carcinoma. ***Nasopharyngeal carcinoma*** - The **fossa of Rosenmüller** (pharyngeal recess/lateral recess of nasopharynx) is the most common site of origin for nasopharyngeal carcinoma, accounting for approximately **70%** of cases. - This **marked area** in the nasopharynx is the typical anatomical location where **squamous cell carcinoma** develops, often associated with **EBV infection**. *Angiofibroma* - Originates from the **sphenopalatine foramen area** and **pterygomaxillary fossa**, not the fossa of Rosenmüller. - Primarily affects **adolescent males** and presents with **unilateral nasal obstruction** and **epistaxis**. *Antrochoanal polyp* - Arises from the **maxillary sinus** mucosa, typically from the **posterior wall** or **floor** of the sinus. - Extends through the **middle meatus** into the **choana**, not originating from the nasopharyngeal recess. *Inverted papilloma* - Originates from the **lateral nasal wall** near the **middle meatus** and **ethmoid region**. - Has a characteristic **inverted growth pattern** into the underlying stroma and **high malignant potential** (10-15%).

Q: The association of membranous tonsillitis with petechial eruption on the palate and generalized lymphadenopathy should suggest which diagnosis?

Infectious mononucleosis. ### Explanation The clinical triad of **membranous tonsillitis**, **palatal petechiae**, and **generalized lymphadenopathy** is a classic presentation of **Infectious Mononucleosis (IM)**, also known as Glandular Fever. **1. Why Infectious Mononucleosis is correct:** Caused by the **Epstein-Barr Virus (EBV)**, IM typically affects adolescents and young adults. The pharyngeal involvement presents as an exudative or membranous tonsillitis (often mimicking streptococcal sore throat). A key diagnostic clue is the presence of **petechiae at the junction of the hard and soft palate** (Holzel’s sign). The lymphadenopathy is characteristically generalized, involving the posterior cervical chain, and is often accompanied by splenomegaly and hepatomegaly. **2. Why other options are incorrect:** * **Cat Scratch Disease:** Caused by *Bartonella henselae*, it typically presents with **localized** lymphadenopathy (draining the site of a scratch) rather than generalized involvement or membranous tonsillitis. * **Measles:** While it features a prodromal cough, coryza, and conjunctivitis, the pathognomonic oral finding is **Koplik spots** (white spots on the buccal mucosa), not palatal petechiae or membranous tonsillitis. * **Scarlet Fever:** Caused by Group A Streptococcus, it presents with a "strawberry tongue" and a diffuse sandpaper-like rash. While it causes tonsillitis, it does not typically cause generalized lymphadenopathy or palatal petechiae. **Clinical Pearls for NEET-PG:** * **Paul-Bunnell Test:** Detects heterophile antibodies (diagnostic for EBV). * **Peripheral Smear:** Shows **atypical lymphocytes** (Downey cells). * **Treatment Warning:** Administration of **Ampicillin or Amoxicillin** in a patient with IM often triggers a characteristic maculopapular skin rash. * **Complication:** Splenic rupture is a rare but life-threatening complication; patients should avoid contact sports.

Q: A 70-year-old man presents with regurgitation of food, dysphagia, halitosis, and a sensation of 'lump in the throat'. What is the most likely diagnosis?

Pharyngeal pouch. **Explanation:** The clinical presentation of an elderly male with **regurgitation of undigested food**, **halitosis** (due to fermentation of food in the pouch), **dysphagia**, and a **"lump in the throat"** is a classic description of a **Pharyngeal Pouch (Zenker’s Diverticulum)**. **Why it is correct:** Zenker’s diverticulum is a pulsion diverticulum occurring through **Killian’s dehiscence**, a weak area between the thyropharyngeus and cricopharyngeus muscles (parts of the inferior constrictor). It is caused by neuromuscular incoordination. The "lump in the throat" and gurgling sounds in the neck (**Boyce’s sign**) are characteristic. Regurgitation often occurs while sleeping or bending over. **Why incorrect options are wrong:** * **Carcinoma Esophagus:** Usually presents with progressive dysphagia (solids then liquids) and significant weight loss. Regurgitation of undigested food and long-standing halitosis are less common than in Zenker’s. * **Diffuse Esophageal Spasm:** Characterized by intermittent chest pain (mimicking angina) and dysphagia. Barium swallow shows a "corkscrew esophagus," not a pouch. * **Esophageal Dysmotility (e.g., Achalasia):** Presents with dysphagia to both solids and liquids from the onset and nocturnal regurgitation, but typically lacks the specific "neck lump" sensation and the anatomical localization seen in Zenker’s. **NEET-PG High-Yield Pearls:** * **Investigation of Choice:** Barium Swallow (shows a pouch behind the esophagus). * **Treatment:** Small pouches are managed by **Dohlman’s Procedure** (Endoscopic staple diverticulotomy); large pouches may require external diverticulectomy with cricopharyngeal myotomy. * **Complication:** Aspiration pneumonia is the most common serious complication. * **Contraindication:** Rigid esophagoscopy should be done with extreme caution due to the high risk of pouch perforation.

Q: Anti-gravity aspiration is done in which of the following conditions?

TB abscess. **Explanation:** The concept of **anti-gravity aspiration** is specifically associated with the management of a **Cold Abscess** (Tuberculous abscess) in the neck, most commonly seen in **Retropharyngeal TB**. 1. **Why TB Abscess is correct:** A cold abscess is caused by tuberculosis of the cervical spine (Pott’s spine). The pus collects behind the prevertebral fascia. If the abscess is drained through a dependent (lower) incision, gravity causes persistent tracking of pus, leading to the formation of a **persistent discharging sinus** and secondary pyogenic infection. To prevent this, aspiration is performed from a higher level (anti-gravity) or through healthy skin away from the most fluctuant point, ensuring the tract collapses and heals without sinus formation. 2. **Why other options are incorrect:** * **Quinsy (Peritonsillar Abscess):** This is an acute pyogenic infection. Management involves **Incision and Drainage (I&D)** at the point of maximum bulge (usually lateral to the anterior pillar) to allow gravity to assist drainage. * **Parapharyngeal Abscess:** This is a deep neck space infection managed via an external cervical approach (Mosher’s incision) to ensure dependent drainage of the multi-loculated pus. * **Ludwig’s Angina:** This is a submandibular space cellulitis. Treatment involves aggressive airway management and a wide horizontal incision for decompression, not anti-gravity aspiration. **Clinical Pearls for NEET-PG:** * **Retropharyngeal Abscess:** Acute (Pyogenic) is common in children; Chronic (TB) is common in adults. * **Treatment of choice for TB Retropharyngeal Abscess:** Systemic ATT + Aspiration through the **lateral side of the neck** (posterior to Sternocleidomastoid). * **Avoid:** Never drain a TB abscess trans-orally, as it leads to secondary infection and potential aspiration of pus.

Question 1

All of the following are true about Thornwaldt's abscess except?

Accepted Answer

Antitubercular treatment is given

Answer

Also called as pharyngeal bursitis

Answer

Presents as persistent postnasal drip

Answer

Marsupialization is done

Question 2

An 80-year-old female presents with complaints of difficulty swallowing and foul breath for 4 months. On auscultation, her lung fields have crepitations. A barium swallow finding is shown. What is your diagnosis?

Accepted Answer

Zenker's diverticulum

Answer

Plummer-Vinson syndrome

Answer

Schatzki's ring

Answer

Corkscrew esophagus

Question 3

Which of the following statements is NOT true about Glossopharyngeal neuralgia?

Accepted Answer

Syncope is not seen

Answer

Eagle's syndrome

Answer

Reichert syndrome

Answer

Tonsillectomy has to be done to approach and treat glossopharyngeal neuralgia

Question 4

Hot potato voice is seen in all of the following conditions EXCEPT:

Accepted Answer

Glottic cancer

Answer

Tonsillar malignancy

Answer

Posterior tongue malignancy

Answer

Peritonsillar abscess

Question 5

Which of the following statements is true regarding Plummer-Vinson syndrome?

Accepted Answer

Associated vitamin B12 deficiency may be present.

Answer

Higher incidence in males.

Answer

Distinct from Paterson-Brown-Kelly syndrome.

Answer

Does not increase the risk of malignant transformation.

Question 6

A marked area in the nasopharynx gives rise to which of the following diseases?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Angiofibroma

Answer

Antrochoanal polyp

Answer

Inverted papilloma

Question 7

The association of membranous tonsillitis with petechial eruption on the palate and generalized lymphadenopathy should suggest which diagnosis?

Accepted Answer

Infectious mononucleosis

Answer

Cat scratch disease

Answer

Measles

Answer

Scarlet fever

Question 8

A 70-year-old man presents with regurgitation of food, dysphagia, halitosis, and a sensation of 'lump in the throat'. What is the most likely diagnosis?

Accepted Answer

Pharyngeal pouch

Answer

Carcinoma esophagus

Answer

Diffuse esophageal spasm

Answer

Esophageal dysmotility

Question 9

Anti-gravity aspiration is done in which of the following conditions?

Accepted Answer

TB abscess

Answer

Quinsy

Answer

Parapharyngeal abscess

Answer

Ludwig's Angina

Question 10

Radiotherapy is used in the treatment of angiofibroma when it involves which of the following structures?

Accepted Answer

Middle cranial fossa

Answer

Cheek

Answer

Orbit

Answer

Cavernous sinus

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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