Diseases of the Pharynx Practice Questions

Q: What is incorrect about the picture shown?

Trendelenburg position. ***Trendelenburg position*** - The image displays the **Rose position** (also known as the tonsillar position), characterized by neck extension and a pillow under the shoulders. - The **Trendelenburg position** involves placing the patient supine with the head lower than the feet, which is not depicted. *Rose position* - The patient's head is **extended** and the shoulders are elevated with a roll, which is characteristic of the Rose position. - This position is commonly used to improve surgical access and visualization for procedures involving the **oral cavity** and pharynx. *Contraindicated in atlantoaxial instability* - The **extreme neck extension** seen in the Rose position can place stress on the **cervical spine**. - This makes it **contraindicated** in conditions like **atlantoaxial instability**, where excessive neck movement could lead to spinal cord compression. *Used for tonsillectomy* - The Rose position is a standard position for **tonsillectomy** and adenoidectomy. - It provides optimal exposure of the **oropharynx** and allows for gravity to aid in drainage of blood away from the surgical site.

Q: Name the instrument shown below:

La Force Adenotome. ***La Force Adenotome*** - The image displays a **La Force Adenotome**, an instrument specifically designed for the removal of adenoid tissue. - It features a long shaft with a handle and an angled cutting blade at the tip, enclosed by a protective cage, allowing for precise and controlled adenoidectomy. *St. Clair Thomson Adenoid curette* - A St. Clair Thomson adenoid curette is typically a **smaller, scoop-shaped instrument** with a cutting edge, used for scraping adenoid tissue. - It does not have the elaborate hinged cage mechanism seen in the La Force adenotome. *Beckman adenoid curette* - The Beckman adenoid curette is another type of curette, similar in principle to the St. Clair Thomson, featuring a **sharp, often serrated, loop-shaped end** for adenoid removal. - It lacks the distinct design of a La Force adenotome, which is characterized by its guillotine-like action. *Sluder-Ballenger Tonsillectome* - A Sluder-Ballenger tonsillectome is used for **tonsillectomy**, not adenoidectomy, and has a different design altogether. - It typically consists of a loop or ring that encircles the tonsil, which is then removed by a cutting or crushing mechanism, making it distinct from an adenotome.

Q: A 3-year-old child presents with fever, unilateral throat pain and trismus. Throat examination shows:

Peritonsillar abscess. ***Peritonsillar abscess*** - The image shows a **unilateral bulge** of the soft palate and displacement of the **uvula**, consistent with a peritonsillar abscess. - Clinical features of **fever, unilateral throat pain, and trismus** are classic symptoms of a peritonsillar abscess. *Ludwig's angina* - This is a **bilateral cellulitis of the submandibular and sublingual spaces**, typically presenting with **swelling of the floor of the mouth** and elevation of the tongue. - It does not primarily present with unilateral throat bulging or uvula deviation as depicted. *Retropharyngeal abscess* - An abscess in the **retropharyngeal space** would cause a bulge in the posterior pharyngeal wall, which is not shown in the image. - While it can cause fever and difficulty swallowing, **trismus** and a visible pharyngeal bulge as shown are less typical. *Parapharyngeal abscess* - A parapharyngeal abscess is located laterally to the pharynx and typically presents with **external neck swelling**, fever, and possibly trismus. - It would not cause the **uvula deviation** and **bulging of the soft palate** seen in the image within the oral cavity.

Q: All are indications for the procedure shown except:

Cardiac valvulitis. ***Cardiac valvulitis*** - **Cardiac valvulitis** is a complication of **rheumatic fever**, which can occur after streptococcal pharyngitis. It is not an indication for tonsillectomy; established valvulitis is a disease state and not a reason to perform the surgery. - While recurrent **streptococcal pharyngitis** (which can lead to rheumatic fever) is an *indication* for tonsillectomy, the valvulitis itself is not. *More than 5 episodes per year for 2 years* - **Recurrent tonsillitis**, defined by frequent episodes (e.g., more than 5-7 episodes per year for several years), is a common indication for **tonsillectomy**. - This criterion is used to justify surgical intervention due to the significant impact on quality of life and potential for complications from chronic or recurrent infections. *Persistent symptomatic tonsillolithiasis despite conservative treatment* - **Tonsilloliths** (tonsil stones) can cause bad breath, throat irritation, and foreign body sensation. - If they are **symptomatic** and persistent despite conservative management, tonsillectomy can be performed to remove the source of the problem. *OSA due to hypertrophied tonsils* - **Obstructive sleep apnea (OSA)** in children (and sometimes adults) can be caused by enlarged tonsils and adenoids obstructing the airway during sleep. - When hypertrophied tonsils are a primary cause of **OSA**, tonsillectomy (often with adenoidectomy) is a common and effective treatment.

Q: The instrument set shown below is used for performing which surgery?

Septal surgery. ***Septal surgery*** - A standard septoplasty/submucous resection (SMR) set includes a **surgical mallet**, **osteotome**, and **periosteal elevator** for bone and cartilage manipulation. - Additional characteristic instruments include **Killian's nasal speculum**, **Freer's elevator**, **Jansen-Middleton nasal rongeurs** (straight and angled), **nasal retractors**, and a **Frazier suction cannula**. - These instruments collectively allow subperichondrial and subperiosteal dissection, cartilage and bone removal, and adequate visualisation of the nasal septum. *Adenotonsillectomy* - Adenotonsillectomy instruments typically include a **tonsil snare**, **Boyle-Davis mouth gag**, **adenoid curettes**, and **tonsil-holding forceps**, which are not part of a septal surgery set. - The instruments shown are dominated by nasal and bone-working tools not used in adenotonsillectomy. *Drainage of Quinsy* - Drainage of a peritonsillar abscess (Quinsy) primarily involves a **scalpel**, a **guarded blade**, and sometimes a **small bore suction catheter**. - The specialized nasal and bone instruments shown in the image are not typical for a simple incision and drainage procedure. *Tracheostomy* - A tracheostomy set includes specific instruments like **tracheal retractors**, **tracheal hooks**, **dilators**, and various sizes of **tracheostomy tubes**. - None of these specialized instruments for incising and maintaining an airway are part of a septal surgery set.

Q: A child presents with chronic nasal obstruction and mouth breathing. The facial features shown in the image are characteristic of:

Adenoid facies. ***Adenoid facies*** - The image displays characteristic features of adenoid facies, including a **long, open-mouthed face**, a **pinched nose**, and possibly a **high-arched palate** due to chronic mouth breathing from enlarged adenoids. - This chronic condition often leads to a dull expression and a forward head posture. *Frog face deformity* - This deformity is characterized by **facial widening** caused classically by **extensive bilateral ethmoidal polyposis**. - While there is some facial dysmorphology, the specific combination of features does not align with a typical frog face. *Ashen grey facies* - This refers to a **pale, grayish complexion**, often indicative of severe cardiovascular compromise like **circulatory collapse** or **shock**. - The child in the image has a normal skin tone for their ethnicity and does not show signs of acute circulatory distress. *Thyrotoxicosis* - **Thyrotoxicosis** (hyperthyroidism) in children can cause symptoms like **exophthalmos** (bulging eyes), **tachycardia**, weight loss, and an enlarged thyroid gland. - The features seen are more consistent with the long-term effects of chronic mouth breathing on facial development rather than acute thyroid dysfunction.

Q: Which is correct regarding the image provided?

Failure of lower esophageal sphincter relaxation. ***Failure of lower esophageal sphincter relaxation*** - The image shows a **barium swallow** demonstrating a markedly dilated esophagus with a characteristic smooth, progressive tapering ("bird's beak" or "rat tail" appearance) at the gastroesophageal (GE) junction, consistent with **achalasia**. - **Achalasia** is characterized by **failure of relaxation of the lower esophageal sphincter (LES)** along with aperistalsis of the esophageal body, leading to progressive dysphagia. *Associated with koilonychia* - Koilonychia (spoon-shaped nails) is an associated sign of **Plummer-Vinson syndrome**, whose defining triad is **iron-deficiency anemia, dysphagia, and an upper esophageal web**; it does not feature the distal tapering seen in this image. - The image does not depict a post-cricoid web. *Not a premalignant condition* - **Achalasia** is considered a **premalignant condition** with an increased risk of developing **squamous cell carcinoma** of the esophagus due to chronic stasis and inflammation. - Note: major guidelines generally do not recommend routine endoscopic surveillance for achalasia, as a clear benefit has not been established. *Episodic aphagia* - The dysphagia associated with achalasia is typically **progressive and chronic**, affecting both solids and liquids, rather than episodic complete inability to swallow (aphagia). - Aphagia implies complete obstruction, whereas achalasia causes functional outflow obstruction with progressive symptoms.

Q: A 35-year-old woman presents with progressive dysphagia to solids, fatigue, and pallor. Laboratory workup reveals iron deficiency anemia. A barium swallow study is performed. Which of the following is true regarding the condition shown in the image?

Associated with iron deficiency anemia. ***Associated with iron deficiency anemia*** - The image shows an **esophageal web** in the upper esophagus, characteristic of **Plummer-Vinson syndrome** (also known as **Paterson-Brown-Kelly syndrome**). - This syndrome consists of the classic triad: **iron deficiency anemia**, **dysphagia**, and **esophageal webs**. - The webs are thin membranes of tissue in the upper esophagus that cause intermittent dysphagia to solids. - Treatment involves **iron supplementation** and mechanical dilation of the web if symptomatic. - **Plummer-Vinson syndrome** is a **premalignant condition** with increased risk of **post-cricoid and upper esophageal squamous cell carcinoma**. *Increased tone of lower esophageal sphincter* - Increased tone of the **lower esophageal sphincter** is characteristic of **achalasia**, which presents with a **"bird's beak" appearance** on barium swallow. - Achalasia is a primary **motility disorder** caused by degeneration of the myenteric plexus, not a structural web. - The image shows a **web in the upper esophagus**, not LES pathology. *Not a premalignant condition* - **Plummer-Vinson syndrome**, characterized by esophageal webs in the setting of iron deficiency anemia, is considered a **premalignant condition**. - There is increased risk of developing **squamous cell carcinoma** of the post-cricoid region and upper esophagus in patients with **Plummer-Vinson syndrome**. - Regular **endoscopic surveillance** is recommended due to this malignant potential. *It is a normal phenomenon* - The presence of an **esophageal web** is an **abnormal anatomical structure** and pathological finding. - Esophageal webs cause **dysphagia** and are associated with underlying conditions like **iron deficiency anemia**. - Normal esophageal mucosa should be smooth without web-like strictures.

Q: Carcinoma of pyriform fossa usually presents with :

Dysphagia. ***Dysphagia*** - Carcinoma of the **pyriform fossa** is a type of hypopharyngeal cancer, and given its anatomical location, it commonly interferes with swallowing [1]. - The pyriform fossa lies immediately lateral to the laryngeal inlet, and involvement here directly impacts the ability to form a **food bolus** and propel it into the esophagus. *Lump in the neck* - A neck lump can occur, especially if there is **lymph node metastasis**, but it's often a later symptom [1]. - **Dysphagia** usually precedes the development of a palpable neck mass as the primary tumor expands within the pyriform fossa [1]. *Cough* - While aspiration might lead to coughing, it's not the primary presenting symptom. - Cough is more commonly associated with laryngeal involvement or **tracheal invasion**, which can occur with advanced disease. *Hoarseness* - **Hoarseness** is a prominent symptom if the **vocal cords** or recurrent laryngeal nerve are directly involved [2]. - The pyriform fossa is adjacent but distinct from the vocal cords, so hoarseness is not typically the initial or most common symptom unless the tumor extends medially.

Question 1

What is incorrect about the picture shown?

Accepted Answer

Trendelenburg position

Answer

Rose position

Answer

Contraindicated in atlantoaxial instability

Answer

Used for tonsillectomy

Question 2

All are correct about the image shown except:

Accepted Answer

Flexible endoscopy under conscious sedation is contraindicated and rigid esophagoscopy under GA is the only accepted modality of treatment

Answer

A coin in the esophagus typically appears en face (round) on the AP view

Answer

Most common site of impaction is cricopharynx

Answer

Foreign body in esophagus

Question 3

Name the instrument shown below:

Accepted Answer

La Force Adenotome

Answer

St. Clair Thomson Adenoid curette

Answer

Beckman adenoid curette

Answer

Sluder-Ballenger Tonsillectome

Question 4

A 3-year-old child presents with fever, unilateral throat pain and trismus. Throat examination shows:

Accepted Answer

Peritonsillar abscess

Answer

Ludwig's angina

Answer

Retropharyngeal abscess

Answer

Parapharyngeal abscess

Question 5

All are indications for the procedure shown except:

Accepted Answer

Cardiac valvulitis

Answer

OSA due to hypertrophied tonsils

Answer

Persistent symptomatic tonsillolithiasis despite conservative treatment

Answer

More than 5 episodes per year for 2 years

Question 6

The instrument set shown below is used for performing which surgery?

Accepted Answer

Septal surgery

Answer

Tracheostomy

Answer

Drainage of Quinsy

Answer

Adenotonsillectomy

Question 7

A child presents with chronic nasal obstruction and mouth breathing. The facial features shown in the image are characteristic of:

Accepted Answer

Adenoid facies

Answer

Thyrotoxicosis

Answer

Ashen grey facies

Answer

Frog face deformity

Question 8

Which is correct regarding the image provided?

Accepted Answer

Failure of lower esophageal sphincter relaxation

Answer

Associated with koilonychia

Answer

Not a premalignant condition

Answer

Episodic aphagia

Question 9

A 35-year-old woman presents with progressive dysphagia to solids, fatigue, and pallor. Laboratory workup reveals iron deficiency anemia. A barium swallow study is performed. Which of the following is true regarding the condition shown in the image?

Accepted Answer

Associated with iron deficiency anemia

Answer

Increased tone of lower esophageal sphincter

Answer

It is a normal phenomenon

Answer

Not a premalignant condition

Question 10

Carcinoma of pyriform fossa usually presents with :

Accepted Answer

Dysphagia

Answer

Lump in the neck

Answer

Cough

Answer

Hoarseness

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

On this page

Practice by Chapter

Want unlimited practice?