Diseases of the Pharynx Practice Questions

Q: Treatment of choice for nasopharyngeal carcinoma T1 is:

Radiation therapy. ***Radiation therapy*** - **Radiation therapy** (RT) is the primary treatment modality for early-stage (T1) nasopharyngeal carcinoma due to the tumor's high radiosensitivity and its anatomical location, which makes surgical resection challenging. - The goal is to deliver a definitive dose of radiation to the tumor with curative intent, often using techniques like intensity-modulated radiation therapy (IMRT) to spare surrounding critical structures. - T1 NPC has excellent cure rates (>90%) with RT alone. *Chemotherapy* - **Chemotherapy** is generally used in combination with radiation for locally advanced nasopharyngeal carcinoma (stage II-IVB) or for metastatic disease, not typically as monotherapy for T1 tumors. - While concurrent chemoradiotherapy improves outcomes in more advanced stages, it's not the primary curative treatment for early-stage disease and adds unnecessary toxicity. *Observation* - **Observation** or watchful waiting is not appropriate for nasopharyngeal carcinoma, even at T1 stage, as NPC is an aggressive malignancy requiring active treatment. - Unlike some indolent tumors, NPC has potential for local progression and early lymphatic spread, necessitating definitive treatment at diagnosis. *Surgery* - **Surgery** plays a very limited role in the primary treatment of nasopharyngeal carcinoma, especially for T1 lesions. - The nasopharynx's deep anatomical location, proximity to skull base, critical neurovascular structures, and the tumor's infiltrative nature make surgical resection technically challenging with high morbidity. - Surgery might be considered for salvage in selected cases of recurrent disease after radiation failure, but it is not the first-line treatment.

Q: Adenoidectomy is contraindicated in:

Bleeding disorder. ***Bleeding disorder*** - Adenoidectomy involves surgical removal of tissue, which carries a risk of **intraoperative and postoperative bleeding**. - In individuals with a **pre-existing bleeding disorder**, this risk is significantly elevated, potentially leading to serious complications. *SOM* - **Serous otitis media (SOM)**, or otitis media with effusion, is often caused by Eustachian tube dysfunction, which can be exacerbated by adenoid hypertrophy. - Adenoidectomy can actually be a **treatment for recurrent SOM**, as it can relieve obstruction of the Eustachian tube. *CSOM* - **Chronic suppurative otitis media (CSOM)** involves a persistent perforation of the tympanic membrane with chronic ear discharge. - While adenoid hypertrophy can contribute to Eustachian tube dysfunction and recurrent acute otitis media that might lead to CSOM, an adenoidectomy is **not directly contraindicated** for CSOM itself. *None of the options* - This option is incorrect because **bleeding disorder** is a clear contraindication for adenoidectomy due to the increased risk of hemorrhagic complications.

Q: Peritonsilar abscess is also called:

Quinsy. ***Quinsy*** - This is the traditional and **common medical term** used to refer to a peritonsillar abscess. - It describes a **collection of pus** located between the tonsillar capsule and the superior constrictor muscle. *Thornwaldt's abscess* - This refers to an abscess in **Thornwaldt's cyst**, which is a **pharyngeal bursa** located in the nasopharynx. - It is distinct from a peritonsillar abscess, which is located in the oropharynx. *Ludwig's angina* - This is a **severe cellulitis** of the **floor of the mouth**, often originating from an infected tooth. - It is a life-threatening condition involving deep neck spaces, not the peritonsillar region. *Vincent's angina* - This is also known as **necrotizing ulcerative gingivitis** or **trench mouth**. - It is an infection of the **gums and oral mucosa**, characterized by painful ulcers, necrosis, and halitosis, and is not an abscess in the peritonsillar space.

Q: A 21-year-old college student presents with hot potato voice and trismus. Clinical diagnosis is?

Quinsy. ***Quinsy*** - **Quinsy**, or **peritonsillar abscess**, is characterized by a "hot potato" or muffled voice and **trismus** (difficulty opening the mouth) due to inflammation and muscle spasm. - The abscess typically forms adjacent to the palatine tonsil, causing severe unilateral throat pain and difficulty swallowing. *Chronic Tonsillitis* - **Chronic tonsillitis** is characterized by recurrent episodes of throat pain, fever, and enlarged tonsils, but does not typically present with acute **trismus** or a "hot potato" voice. - It results from persistent or repeated bacterial infections of the tonsils, often without significant abscess formation. *Epiglottitis* - **Epiglottitis** presents with rapid onset of severe sore throat, **dysphagia**, drooling, and inspiratory stridor, and can be life-threatening due to airway obstruction. - While it causes significant throat pain and difficulty swallowing, it does not typically present with a "hot potato" voice or **trismus**, but rather a muffled voice and tripod positioning. *Infectious mononucleosis* - **Infectious mononucleosis** leads to swollen tonsils with exudates, fatigue, and lymphadenopathy, but usually does not cause **trismus** or the distinctive "hot potato" voice. - It is caused by the **Epstein-Barr virus** and can lead to significant pharyngitis, but is not associated with peritonsillar abscess formation.

Q: Trotter's triad is seen with:

Nasopharyngeal carcinoma. ***Nasopharyngeal carcinoma*** - **Trotter's triad** is a classic presentation of nasopharyngeal carcinoma, particularly when the tumor involves the pharyngeal recess (fossa of Rosenmüller) and extends to involve surrounding structures. - The triad consists of: 1. **Unilateral conductive deafness** (due to Eustachian tube obstruction by the tumor) 2. **Ipsilateral trigeminal neuralgia** (usually V2 or V3 distribution, from mandibular nerve involvement) 3. **Ipsilateral palatal immobility** (due to involvement of the levator veli palatini muscle or its nerve supply) - This triad indicates advanced disease with invasion of adjacent structures. *Nasopharyngeal angiofibroma* - This is a **benign, highly vascular, locally aggressive tumor** typically found in adolescent males. - While it can cause nasal obstruction, epistaxis, and cranial nerve palsies due to extension, it does not specifically present with Trotter's triad. - The tumor arises from the sphenopalatine foramen region and extends differently than nasopharyngeal carcinoma. *Cancer tongue* - **Tongue cancer** typically presents with a **non-healing ulcer**, pain, dysphagia, and cervical lymphadenopathy. - It primarily affects the oral cavity and involves neck lymphatic drainage. - It does not involve the nasopharynx or Eustachian tube, so Trotter's triad would not occur. *Adenoid cystic carcinoma of parotid gland* - This is a malignant tumor of the salivary glands with characteristic **perineural invasion**, which can lead to pain and facial nerve palsy. - While it can involve cranial nerves (particularly CN VII), it does not affect the nasopharynx, Eustachian tube, or palatal muscles in the manner that produces Trotter's triad.

Q: True about Trotter's triad - a) Conductive deafness b) Involvement of CN VI c) Involvement of CN X d) Palatal paralysis e) Associated with nasopharyngeal angiofibroma

acd. ***acd*** - Trotter's triad consists of **conductive deafness** (option a) due to Eustachian tube obstruction, **ipsilateral trigeminal neuralgia** (CN V involvement), and **soft palate paralysis** (option d) caused by tumor infiltration. - Option c refers to **CN X (vagus nerve) involvement**, which can contribute to palatal paralysis, making it part of the clinical presentation. - The combination of **conductive deafness**, **CN X involvement** causing palatal issues, and **palatal paralysis** are correct components of Trotter's triad. - This triad is classically associated with **nasopharyngeal carcinoma**. *Incorrect Option: bde* - This option incorrectly includes CN VI involvement (abducens nerve), which is **not part of Trotter's triad**. - It also incorrectly associates the triad with **nasopharyngeal angiofibroma** rather than carcinoma. - While option d (palatal paralysis) is correct, the combination is incorrect due to options b and e. *Incorrect Option: bc* - Option b refers to **CN VI (abducens nerve) involvement**, which is **not part of the classic Trotter's triad**. - The triad involves **CN V (trigeminal)** for neuralgia, not CN VI. - While CN X involvement (option c) can be present, this combination misses the essential conductive deafness and includes the wrong cranial nerve. *Incorrect Option: ad* - This option correctly includes **conductive deafness** (a) and **palatal paralysis** (d). - However, it **misses option c (CN X involvement)**, which is important for explaining the mechanism of palatal paralysis. - While partially correct, it's incomplete compared to option acd.

Q: Most common presentation in nasopharyngeal carcinoma is with:

Cervical lymphadenopathy. ***Cervical lymphadenopathy*** - **Cervical lymphadenopathy** is the most frequent initial symptom, with over 75% of patients presenting with a palpable neck mass, often a **painless, firm mass** in the upper deep cervical chain. - This is due to the rich lymphatic drainage of the nasopharynx to the cervical lymph nodes, leading to early metastasis. *Epistaxis* - While **epistaxis** (nosebleeds) can occur in nasopharyngeal carcinoma, it is generally not the most common presenting symptom. - It usually presents as recurrent, mild **epistaxis** or bloody discharge rather than severe bleeding. *Hoarseness of voice* - **Hoarseness of voice** is typically associated with laryngeal involvement or recurrent laryngeal nerve palsy, which is a less common and usually later manifestation of nasopharyngeal carcinoma. - Primary nasopharyngeal tumors do not directly cause hoarseness unless they extend significantly or metastasize to structures affecting vocal cord function. *Nasal stuffiness* - **Nasal stuffiness** or obstruction can be a symptom due to tumor growth within the nasopharynx. - However, it is a less specific symptom and often overshadowed by the more prominent presentation of cervical lymphadenopathy.

Q: Hynes pharyngoplasty is used to improve a child's?

Speech. ***Speech*** - Hynes pharyngoplasty is a surgical procedure specifically designed to correct **velopharyngeal insufficiency (VPI)**, which is a common cause of **hypernasal speech**. - By reshaping the soft palate and pharynx, it helps create a better seal during speech, thus improving **oral resonance** and reducing air escaping through the nose. *Teething* - **Teething** refers to the process of teeth erupting through the gums, which is a normal developmental stage in infants. - Surgical intervention like Hynes pharyngoplasty is unrelated to the **eruption of teeth**. *Feeding* - While velopharyngeal insufficiency can sometimes contribute to **feeding difficulties** (e.g., nasal regurgitation), Hynes pharyngoplasty's primary goal is not to improve overall feeding mechanics. - Surgical interventions for feeding issues often address different anatomical structures or neurological deficits impacting **swallowing** or suck-swallow-breathe coordination. *Appearance* - Although some craniofacial anomalies that lead to VPI might also affect appearance (e.g., cleft palate), Hynes pharyngoplasty is solely focused on **functional improvement of speech**. - It does not significantly alter the **external facial appearance** of the child.

Q: Time of occurrence of secondary haemorrhage after tonsillectomy -

6 days. ***6 days*** - **Secondary hemorrhage** after tonsillectomy typically occurs **5-10 days post-surgery**, making 6 days a common presentation time. - This timing is often due to **infection** causing vessel erosion or sloughing of the **fibrin clot** before mucosal healing is complete. *24 hrs* - Hemorrhage within the first **24 hours** is classified as **primary or reactionary hemorrhage** and is usually due to inadequate hemostasis during surgery or dislodgement of a clot. - This occurs much earlier than secondary hemorrhage. *12 hrs* - Similar to 24 hours, **12 hours** post-surgery falls within the window for **primary or reactionary hemorrhage**. - This timeframe is too early for the typical onset of secondary hemorrhage. *12 days* - While late bleeding can occur, **12 days** post-tonsillectomy is **less common** for secondary hemorrhage compared to the 5-10 day window. - By this point, significant mucosal healing would have usually occurred, reducing the risk of a secondary bleed.

Q: In Stylalgia, the most common nerve affected is:

Glossopharyngeal nerve. ***Glossopharyngeal nerve*** - Stylalgia, also known as **Eagle syndrome**, classically involves pain that is commonly attributed to irritation of the **glossopharyngeal nerve**. - This is due to an elongated **styloid process** or calcification of the **stylohyoid ligament** compressing the nerve. *Greater petrosal nerve* - The greater petrosal nerve is primarily involved in **parasympathetic innervation** to the lacrimal gland and mucous glands of the nose and palate. - It is not typically implicated in the pain pathway of stylalgia. *Abducent nerve* - The abducent nerve is responsible for the **lateral rectus muscle** of the eye, controlling eye movement. - Its dysfunction would lead to **diplopia** or strabismus, not the throat or facial pain characteristic of stylalgia. *Auditory nerve* - The auditory nerve (vestibulocochlear nerve) is responsible for **hearing and balance**. - Problems with this nerve would cause **tinnitus**, hearing loss, or vertigo, and is not directly involved in stylalgia.

Question 1

Treatment of choice for nasopharyngeal carcinoma T1 is:

Accepted Answer

Radiation therapy

Answer

Chemotherapy

Answer

Observation

Answer

Surgery

Question 2

Adenoidectomy is contraindicated in:

Accepted Answer

Bleeding disorder

Answer

SOM

Answer

CSOM

Answer

None of the options

Question 3

Peritonsilar abscess is also called:

Accepted Answer

Quinsy

Answer

Thornwaldt's abscess

Answer

Ludwig's angina

Answer

Vincent's angina

Question 4

A 21-year-old college student presents with hot potato voice and trismus. Clinical diagnosis is?

Accepted Answer

Quinsy

Answer

Chronic Tonsillitis

Answer

Epiglottitis

Answer

Infectious mononucleosis

Question 5

Trotter's triad is seen with:

Accepted Answer

Nasopharyngeal carcinoma

Answer

Nasopharyngeal angiofibroma

Answer

Cancer tongue

Answer

Adenoid cystic carcinoma of parotid gland

Question 6

True about Trotter's triad - a) Conductive deafness b) Involvement of CN VI c) Involvement of CN X d) Palatal paralysis e) Associated with nasopharyngeal angiofibroma

Accepted Answer

acd

Answer

bde

Answer

bc

Answer

ad

Question 7

Most common presentation in nasopharyngeal carcinoma is with:

Accepted Answer

Cervical lymphadenopathy

Answer

Epistaxis

Answer

Hoarseness of voice

Answer

Nasal stuffiness

Question 8

Hynes pharyngoplasty is used to improve a child's?

Accepted Answer

Speech

Answer

Teething

Answer

Feeding

Answer

Appearance

Question 9

Time of occurrence of secondary haemorrhage after tonsillectomy -

Accepted Answer

6 days

Answer

24 hrs

Answer

12 hrs

Answer

12 days

Question 10

In Stylalgia, the most common nerve affected is:

Accepted Answer

Glossopharyngeal nerve

Answer

Greater petrosal nerve

Answer

Abducent nerve

Answer

Auditory nerve

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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