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.

Question 1

A 13-year-old boy has a 3-day history of low-grade fever, symptoms of upper respiratory infection, and a sore throat. A few hours before his presentation to the emergency room, he has an abrupt onset of high fever, difficulty swallowing, and poor handling of his secretions. He indicates that he has a marked worsening in the severity of his sore throat. His pharynx has a fluctuant bulge in the posterior wall. A soft tissue radiograph of his neck is shown. Which of the following is the most appropriate initial therapy for this patient?

Accepted Answer

Surgical consultation for incision and drainage under general anesthesia

Answer

Narcotic analgesics

Answer

Rapid streptococcal screen

Answer

Trial of oral penicillin V

Question 2

Treatment of choice for nasopharyngeal carcinoma T1 is:

Accepted Answer

Radiation therapy

Answer

Chemotherapy

Answer

Observation

Answer

Surgery

Question 3

Adenoidectomy is contraindicated in:

Accepted Answer

Bleeding disorder

Answer

SOM

Answer

CSOM

Answer

None of the options

Question 4

Peritonsilar abscess is also called:

Accepted Answer

Quinsy

Answer

Thornwaldt's abscess

Answer

Ludwig's angina

Answer

Vincent's angina

Question 5

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 6

Trotter's triad is seen with:

Accepted Answer

Nasopharyngeal carcinoma

Answer

Nasopharyngeal angiofibroma

Answer

Cancer tongue

Answer

Adenoid cystic carcinoma of parotid gland

Question 7

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 8

Most common presentation in nasopharyngeal carcinoma is with:

Accepted Answer

Cervical lymphadenopathy

Answer

Epistaxis

Answer

Hoarseness of voice

Answer

Nasal stuffiness

Question 9

Hynes pharyngoplasty is used to improve a child's?

Accepted Answer

Speech

Answer

Teething

Answer

Feeding

Answer

Appearance

Question 10

Time of occurrence of secondary haemorrhage after tonsillectomy -

Accepted Answer

6 days

Answer

24 hrs

Answer

12 hrs

Answer

12 days

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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