Diseases of the Pharynx Practice Questions

Q: Paucity of pus is seen in which condition?

Ludwig's angina. **Explanation:** **Ludwig’s Angina** is a rapidly spreading cellulitis of the submandibular, sublingual, and submental spaces. The hallmark of this condition is that it is a **brawny, woody edema** rather than a localized abscess. Because the infection spreads along fascial planes as a diffuse cellulitis, there is a characteristic **paucity of pus** (minimal or no frank pus formation). If any fluid is present, it is usually serosanguinous or foul-smelling ichor. **Analysis of Options:** * **Quinsy (Peritonsillar Abscess):** By definition, an abscess is a localized collection of pus. Quinsy involves significant pus formation between the tonsillar capsule and the superior constrictor muscle, requiring incision and drainage. * **Carbuncle:** This is a cluster of interconnected furuncles (boils) caused by *Staphylococcus aureus*. It is characterized by multiple inflammatory nodules that discharge pus through several follicular openings (sieve-like appearance). * **Milroy Disease:** This is a congenital form of primary lymphedema. It involves a lymphatic transport failure leading to swelling, but it is a non-infectious, non-inflammatory condition and does not involve pus. **High-Yield Clinical Pearls for NEET-PG:** * **Source:** Most common cause is dental infection (usually the 2nd or 3rd mandibular molars). * **Organisms:** Usually a mixed infection (Alpha-hemolytic streptococci, Staphylococci, and anaerobes). * **Clinical Features:** "Woody" hard swelling of the neck, elevation and protrusion of the tongue (causing airway obstruction), and trismus. * **Management:** Airway maintenance is the priority. Treatment involves high-dose IV antibiotics and, if necessary, surgical decompression via a wide "necklace" incision.

Q: All of the following are true about nasopharyngeal angiofibroma except:

X-ray is the investigation of choice. **Explanation:** Juvenile Nasopharyngeal Angiofibroma (JNA) is a benign but locally aggressive, highly vascular tumor. **Why Option D is the correct answer (The "Except"):** X-ray is **not** the investigation of choice. While a lateral view X-ray may show the "Holman-Miller sign" (anterior bowing of the posterior wall of the maxillary sinus), it lacks the detail required for surgical planning. * **Contrast-Enhanced CT (CECT)** is the investigation of choice to assess bone destruction and tumor extent. * **MRI** is superior for evaluating intracranial extension. * **Angiography** is the gold standard for assessing blood supply and for preoperative embolization. **Analysis of other options:** * **Option A & B:** JNA is classically seen **exclusively in adolescent males** (typically 10–20 years). It is thought to be testosterone-dependent; its occurrence in females should prompt genetic testing (karyotyping). * **Option C:** The most common clinical presentation is **painless, progressive nasal obstruction** followed closely by **recurrent, profuse epistaxis** (bleeding). **Clinical Pearls for NEET-PG:** * **Site of Origin:** Sphenopalatine foramen (posterior part of the nasal cavity). * **Holman-Miller Sign (Antral Sign):** Pathognomonic radiological sign showing anterior bowing of the posterior maxillary wall. * **Contraindication:** **Biopsy is strictly contraindicated** in an office setting due to the risk of torrential, life-threatening hemorrhage. * **Treatment:** Surgical excision (Preceded by embolization 24–48 hours prior to reduce blood loss). * **Classification:** Fisch or Radkowski classifications are used for staging.

Q: Rigid esophagoscopy is contraindicated in which of the following conditions?

Cervical spine rigidity and Esophageal web. **Explanation:** Rigid esophagoscopy requires the patient to be in the **"sniffing position"** (extension of the head at the atlanto-occipital joint and flexion of the neck at the lower cervical spine) to create a straight path for the rigid instrument. 1. **Cervical Spine Rigidity:** Conditions such as cervical spondylosis, ankylosing spondylitis, or spinal trauma prevent the necessary neck extension. Attempting rigid esophagoscopy in these patients carries a high risk of **cervical spine fracture** or **esophageal perforation** due to the excessive force required to pass the scope. 2. **Esophageal Web:** While an esophageal web is an *indication* for dilation, it is often considered a relative contraindication for blind or forceful rigid esophagoscopy because the web makes the esophageal wall extremely thin and friable (especially in **Plummer-Vinson Syndrome**), significantly increasing the risk of **instrumental perforation**. **Analysis of Incorrect Options:** * **Aortic Aneurysm:** While a large aneurysm can cause extrinsic compression, it is generally considered a *relative* contraindication or a condition requiring extreme caution rather than an absolute contraindication compared to spinal rigidity. * **Lung Abscess:** This is not a contraindication for esophagoscopy; however, if a tracheoesophageal fistula is suspected, care must be taken to prevent aspiration. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of perforation** during rigid esophagoscopy: **Cricopharyngeus** (the narrowest part of the esophagus). * **Killian’s Dehiscence:** The potential gap between the thyropharyngeus and cricopharyngeus where Zenker’s diverticulum occurs and where the risk of esophagoscopy-induced perforation is highest. * **Choice of Scope:** If rigid esophagoscopy is contraindicated, **Flexible Esophagoscopy** is the preferred alternative as it does not require specific neck positioning.

Q: A patient presents with a one-week history of sore throat, dysphagia, and palatal ulcers. Examination reveals vesicles over the soft palate and tonsillar pillars. The ulcers have a gray base and an inflamed periphery. What is the most likely diagnosis?

Herpangina. **Explanation:** The clinical presentation of acute onset sore throat, dysphagia, and characteristic **vesicles/ulcers localized to the posterior oral cavity** (soft palate, uvula, and tonsillar pillars) is classic for **Herpangina**. **1. Why Herpangina is correct:** Herpangina is caused primarily by **Coxsackie A virus** (and occasionally Coxsackie B or Echovirus). It typically affects children but can occur in adults. The hallmark is the appearance of small (1–2 mm) vesicles that rupture to form shallow ulcers with a **grayish-white base and an erythematous (inflamed) halo**. Crucially, these lesions are confined to the **posterior pharynx**, sparing the buccal mucosa and gingiva. **2. Why the other options are incorrect:** * **Pharyngitis:** This is a general term. While Herpangina is a form of viral pharyngitis, the specific description of vesicles and gray-based ulcers points to a more definitive diagnosis. * **Chickenpox (Varicella):** While it causes vesicles, they are usually widespread across the body (centripetal distribution) and involve the skin more prominently than the isolated posterior oropharynx. * **Primary Herpetic Gingivostomatitis:** Caused by HSV-1, this typically involves the **anterior** mouth (gingiva, tongue, and buccal mucosa). It is characterized by diffuse gum swelling (gingivitis) and bleeding, which are absent in Herpangina. **Clinical Pearls for NEET-PG:** * **Causative Agent:** Coxsackie **A** Virus (High-yield). * **Site Specificity:** Herpangina = Posterior Pharynx; Herpes = Anterior Mouth/Gingiva. * **Hand-Foot-Mouth Disease (HFMD):** Also caused by Coxsackie A16; look for similar oral ulcers plus a maculopapular rash on palms and soles. * **Seasonality:** Most common in summer and autumn months. * **Management:** Supportive (hydration and analgesics), as it is self-limiting.

Q: All of the following are true about adenoid hypertrophy EXCEPT?

Unilateral hearing loss. **Explanation:** Adenoid hypertrophy refers to the pathological enlargement of the nasopharyngeal tonsils. To understand the clinical presentation, one must consider the anatomical location of the adenoids in the midline of the nasopharynx. **Why Option D is the Correct Answer (The Exception):** Adenoids are located in the midline of the nasopharynx, directly between the openings of the right and left Eustachian tubes. Hypertrophy typically causes **bilateral** Eustachian tube obstruction, leading to bilateral negative middle ear pressure and **bilateral** Otitis Media with Effusion (OME). Therefore, **unilateral hearing loss** is atypical for adenoid hypertrophy and should instead raise suspicion of a localized pathology, such as a juvenile nasopharyngeal angiofibroma or nasopharyngeal carcinoma in adults. **Analysis of Incorrect Options:** * **A. Adenoid Facies:** Chronic mouth breathing due to nasal obstruction leads to characteristic facial features: an elongated face, dull expression, open mouth, crowded teeth, and a high-arched palate. * **B. Rhinolalia Clausa:** Nasal obstruction prevents normal nasal resonance during speech, resulting in "hyponasality" or *rhinolalia clausa* (e.g., "m" sounds like "b"). * **C. Apnea:** Severe hypertrophy can lead to Obstructive Sleep Apnea (OSA), characterized by snoring, gasping, and periods of apnea during sleep. **High-Yield Clinical Pearls for NEET-PG:** * **Investigation of Choice:** X-ray soft tissue nasopharynx (lateral view) shows narrowing of the nasopharyngeal airway. * **Gold Standard Investigation:** Flexible Nasopharyngoscopy. * **Treatment:** Adenoidectomy is indicated if there is OSA, recurrent otitis media, or craniofacial growth anomalies. * **St. John’s Sign:** A radiological sign on a lateral X-ray where the soft tissue shadow of the adenoids obliterates the nasopharyngeal air space.

Q: A patient complains of sharp shooting pain in the pharynx and tonsil. On examination, a trigger zone is found in the tonsillar area. What is the diagnosis?

Glossopharyngeal neuralgia. **Explanation:** The clinical presentation of **sharp, shooting (paroxysmal) pain** localized to the **pharynx and tonsillar area**, initiated by a **trigger zone** in the tonsil, is the classic hallmark of **Glossopharyngeal Neuralgia**. **1. Why Glossopharyngeal Neuralgia is correct:** This condition involves the 9th cranial nerve. The pain is typically unilateral and occurs in the distribution of the glossopharyngeal nerve (posterior third of the tongue, tonsillar fossa, pharynx, and beneath the angle of the jaw). Common triggers include swallowing, talking, coughing, or touching the tonsillar area. **2. Why other options are incorrect:** * **Sphenopalatine neuralgia (Sluder’s Neuralgia):** Characterized by pain in the lower face, nose, and orbit, often associated with nasal congestion or rhinorrhea, rather than pharyngeal triggers. * **Paratrigeminal neuralgia (Raeder’s Syndrome):** Presents as trigeminal pain (usually V1/V2 distribution) accompanied by oculosympathetic palsy (Horner’s syndrome). * **Trigeminal neuralgia (Tic Douloureux):** The most common facial neuralgia, but the pain is located in the distribution of the 5th cranial nerve (usually maxillary or mandibular branches). Trigger zones are typically on the skin of the face or the gingiva, not the pharynx. **High-Yield Clinical Pearls for NEET-PG:** * **Eagle’s Syndrome:** A key differential diagnosis where an elongated styloid process irritates the glossopharyngeal nerve, causing similar pain. * **Treatment:** Medical management is the first line, primarily using **Carbamazepine**. * **Surgical Management:** If medical therapy fails, **Microvascular Decompression (MVD)** of the 9th nerve or rhizotomy is performed. * **Vagal Association:** In rare cases, glossopharyngeal neuralgia can trigger the carotid sinus reflex, leading to bradycardia or syncope.

Q: Zenker's diverticulum is also known as which of the following?

Hypopharyngeal diverticulum. **Explanation:** **Zenker’s Diverticulum** is a pulsion diverticulum caused by the herniation of the pharyngeal mucosa through a point of weakness in the muscular wall of the hypopharynx. 1. **Why the correct answer is right:** Zenker’s diverticulum occurs specifically at **Killian’s dehiscence**, a triangular area of weakness located between the thyropharyngeus and cricopharyngeus muscles. Both these muscles are components of the inferior constrictor muscle of the **hypopharynx**. Because the pouch originates in the hypopharyngeal wall just above the upper esophageal sphincter, it is anatomically classified as a **hypopharyngeal diverticulum**. 2. **Why the incorrect options are wrong:** * **Prepharyngeal diverticulum:** This is not a standard anatomical term. Zenker’s is located posteriorly, not anteriorly (pre-). * **Pharyngobasilar diverticulum:** The pharyngobasilar fascia is located at the uppermost part of the pharynx, near the skull base (nasopharynx). Zenker’s occurs much lower, at the junction of the pharynx and esophagus. * **Pharyngotympanic diverticulum:** This term refers to the Eustachian tube (pharyngotympanic tube) and is unrelated to esophageal pouches. **High-Yield Clinical Pearls for NEET-PG:** * **Type:** It is a **false diverticulum** because it involves only the mucosa and submucosa (not the muscular layer). * **Mechanism:** Caused by neuromuscular incoordination (failure of the cricopharyngeus to relax during swallowing). * **Clinical Features:** Dysphagia, **halitosis** (due to rotting food in the pouch), and **regurgitation** of undigested food. * **Boyce’s Sign:** A gurgling sound heard on pressing the side of the neck. * **Investigation of Choice:** Barium Swallow (shows the pouch). * **Management:** Endoscopic Dohlman’s procedure (stapling) or open cricopharyngeal myotomy.

Q: What is the cause of unilateral secretory otitis media in an adult?

Nasopharyngeal carcinoma. **Explanation:** The presence of **unilateral secretory otitis media (SOM)** in an adult is a classic clinical "red flag" that must be considered **Nasopharyngeal Carcinoma (NPC)** until proven otherwise. **1. Why Nasopharyngeal Carcinoma is correct:** The underlying mechanism is **Eustachian tube dysfunction**. NPC typically arises from the **Fossa of Rosenmüller**, which is located adjacent to the pharyngeal opening of the Eustachian tube. As the tumor grows, it mechanically obstructs the tube, preventing middle ear ventilation. This leads to negative pressure and the subsequent accumulation of sterile fluid (effusion) in the middle ear. In adults, while SOM is often preceded by an upper respiratory infection, a persistent unilateral presentation requires a mandatory endoscopic examination of the nasopharynx. **2. Why other options are incorrect:** * **CSOM (A):** This involves a permanent perforation of the tympanic membrane with active or inactive infection; it does not present as an intact drum with fluid (secretory). * **Mastoiditis (C):** This is a complication of acute suppurative otitis media (ASOM) characterized by retroauricular pain, fever, and bone destruction, rather than painless fluid accumulation. * **Foreign body (D):** This affects the external auditory canal and may cause conductive hearing loss or discharge, but it does not cause fluid collection behind an intact tympanic membrane. **Clinical Pearls for NEET-PG:** * **Trotter’s Triad (for NPC):** 1. Conductive hearing loss (due to SOM), 2. Ipsilateral facial/temporoparietal pain (Trigeminal nerve involvement), 3. Palatal paralysis (Vagus nerve involvement). * **Most common symptom of NPC:** Cervical lymphadenopathy (often the upper deep cervical/jugulodigastric nodes). * **Investigation of choice:** Nasopharyngoscopy and biopsy; MRI is preferred for assessing local extent.

Question 1

Paucity of pus is seen in which condition?

Accepted Answer

Ludwig's angina

Answer

Quinsy

Answer

Carbuncle

Answer

Milroy disease

Question 2

All of the following are true about nasopharyngeal angiofibroma except:

Accepted Answer

X-ray is the investigation of choice

Answer

Seen exclusively in the age group of 10-20 years

Answer

Seen exclusively in males

Answer

Recurrent bleeding is the most common presentation

Question 3

A 6-year-old boy presented with recurrent upper respiratory tract infections, mouth breathing, and impaired hearing. He was diagnosed with adenoid hypertrophy and underwent adenoidectomy with grommet insertion. One week after surgery, the boy was brought back to the clinic with torticollis. Which of the following is true regarding this condition?

Accepted Answer

Atlantoaxial subluxation is the cause of his torticollis.

Answer

Adenoidectomy should not have been performed as adenoids typically regress spontaneously.

Answer

Torticollis is not a complication after adenoid surgery; this presentation is coincidental.

Answer

This condition is most common in children with Down's syndrome.

Question 4

Rigid esophagoscopy is contraindicated in which of the following conditions?

Accepted Answer

Cervical spine rigidity and Esophageal web

Answer

Cervical spine rigidity and Aortic aneurysm

Answer

Cervical spine rigidity and Lung abscess

Answer

Aortic aneurysm and Esophageal web

Question 5

A patient presents with a one-week history of sore throat, dysphagia, and palatal ulcers. Examination reveals vesicles over the soft palate and tonsillar pillars. The ulcers have a gray base and an inflamed periphery. What is the most likely diagnosis?

Accepted Answer

Herpangina

Answer

Pharyngitis

Answer

Chickenpox

Answer

Primary herpetic gingivostomatitis

Question 6

Which of the following is NOT true about nasopharyngeal angiofibroma?

Accepted Answer

Commonly seen in adolescent males

Answer

Hormonal etiology is suspected

Answer

Miller's sign may be positive

Answer

Radiotherapy can be considered as a treatment option

Question 7

All of the following are true about adenoid hypertrophy EXCEPT?

Accepted Answer

Unilateral hearing loss

Answer

Adenoid facies

Answer

Rhinolalia clausa

Answer

Apnea

Question 8

A patient complains of sharp shooting pain in the pharynx and tonsil. On examination, a trigger zone is found in the tonsillar area. What is the diagnosis?

Accepted Answer

Glossopharyngeal neuralgia

Answer

Sphenopalatine neuralgia

Answer

Paratrigeminal neuralgia

Answer

Trigeminal neuralgia

Question 9

Zenker's diverticulum is also known as which of the following?

Accepted Answer

Hypopharyngeal diverticulum

Answer

Prepharyngeal diverticulum

Answer

Pharyngobasilar diverticulum

Answer

Pharyngotympanic diverticulum

Question 10

What is the cause of unilateral secretory otitis media in an adult?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Chronic suppurative otitis media (CSOM)

Answer

Mastoiditis

Answer

Foreign body of the external ear

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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