Diseases of the Pharynx Practice Questions

Q: What condition is associated with Lemierre's syndrome?

Thrombophlebitis of IJV. ***Thrombophlebitis of IJV*** - **Lemierre's syndrome** is classically defined as **septic thrombophlebitis of the internal jugular vein (IJV)** following an oropharyngeal infection [1]. - The infection, most commonly caused by *Fusobacterium necrophorum*, spreads from the pharynx to the parapharyngeal space, leading to IJV inflammation and thrombosis [1]. *Carotid sinus aneurysm* - A **carotid sinus aneurysm** is an abnormal focal dilation of the carotid sinus, often associated with atherosclerosis or connective tissue disorders. - It is not directly linked to the pathogenesis or complications of **Lemierre's syndrome**. *Traumatic occlusion of IJV* - **Traumatic occlusion of the IJV** results from direct injury to the neck, leading to vessel compression or damage. - While it affects the IJV, it does not involve the septic thrombophlebitis or preceding oropharyngeal infection characteristic of **Lemierre's syndrome**. *Any of the above* - This option is incorrect because **Lemierre's syndrome** is specifically associated with **septic thrombophlebitis of the IJV**, not with other unrelated vascular conditions affecting the neck.

Q: Early tonsillectomy is not done in?

Thyroid storm. ***Thyroid storm*** - **Thyroid storm** is a life-threatening medical emergency caused by exaggerated hyperthyroidism, requiring immediate medical stabilization to control hormone levels and systemic effects. - Early tonsillectomy is **contraindicated** in this scenario because it would add significant surgical stress and anesthetic risks to an already critically unstable patient. *Peritonsillar abscess* - A **quinsy tonsillectomy** (abscess tonsillectomy) is often performed acutely, especially if drainage is difficult or if it's the first episode, to resolve the abscess and remove the infected tissue. - This procedure can be done in the acute phase of a peritonsillar abscess to relieve symptoms and reduce the risk of recurrence. *Rheumatic fever* - Patients with recurrent **acute tonsillitis** who are at risk of developing **rheumatic fever** are strong candidates for tonsillectomy to prevent further streptococcal infections and subsequent autoimmune complications. - Tonsillectomy is considered a prophylactic intervention in cases of recurrent strep throat leading to rheumatic fever. *Suspected malignancy* - If tonsillar asymmetry or other signs raise suspicion of **tonsillar malignancy**, prompt tonsillectomy is often performed for **diagnostic biopsy** and initial tumor removal. - Early surgical intervention is crucial for diagnosing and staging potential tonsil cancer, which can guide subsequent treatment.

Q: Moure's sign (lateral displacement of the soft palate) is associated with which of the following conditions?

Peritonsillar abscess. ***Peritonsillar abscess (Quinsy)*** - **Moure's sign** refers to the **lateral displacement of the soft palate** toward the affected side, which is a classic finding in **peritonsillar abscess**. - This occurs due to the **accumulation of pus** between the tonsillar capsule and the superior constrictor muscle, causing the soft palate to bulge and deviate. - Other features include **severe throat pain**, trismus, drooling, and a "hot potato" voice. *Laryngeal carcinoma* - **Laryngeal carcinoma** presents with **hoarseness**, dysphagia, and potential airway obstruction. - While laryngeal examination may show mass lesions or vocal cord fixation, **soft palate displacement is not a feature** of laryngeal malignancy. *Chronic tonsillitis* - **Chronic tonsillitis** involves recurrent throat infections with tonsillar hypertrophy and cryptic debris. - It does **not cause acute soft palate displacement** like peritonsillar abscess does. *Acute epiglottitis* - **Acute epiglottitis** is characterized by **supraglottic inflammation** causing severe dysphagia, drooling, and stridor. - The pathology is at the **epiglottis level**, not the peritonsillar space, so **Moure's sign is absent**.

Q: What is the investigation of choice for nasopharyngeal angiofibroma?

Contrast-enhanced CT. ***Contrast-enhanced CT*** - A **contrast-enhanced CT** scan is the investigation of choice for **nasopharyngeal angiofibroma** due to its ability to clearly delineate the extent of the tumor, its vascularity, and its bony involvement. - The contrast highlights the **highly vascular nature** of the angiofibroma, which is crucial for surgical planning and embolization. *X-ray* - **X-rays** provide limited detail of soft tissue structures and mass lesions in the complex anatomy of the nasopharynx. - They are generally not sensitive enough to characterize a tumor like **angiofibroma** or determine its exact extent. *Plain CT* - A **plain CT** (non-contrast CT) can show soft tissue masses and bony erosion but lacks the ability to assess the **vascularity** of the tumor. - Without contrast, it's difficult to differentiate the tumor from surrounding tissues or identify its blood supply, which is critical for **angiofibroma** management. *MRI* - While **MRI** offers excellent soft tissue contrast and is valuable for assessing intracranial extension or perineural spread, **contrast-enhanced CT** is generally preferred as the primary imaging modality for angiofibroma. - **CT with contrast** is superior for demonstrating **bony erosion** and the characteristic **vascularity** of this tumor.

Q: Which of the following conditions is commonly associated with trismus?

Peritonsillar abscess. ***Peritonsillar abscess*** - **Trismus**, or difficulty opening the mouth, is a **classic and most characteristic symptom** of a **peritonsillar abscess** due to inflammation and reflex spasm of the pterygoid muscles adjacent to the infection. - The abscess typically causes significant pain and swelling around the tonsil, with inflammation irradiating to muscles of **mastication**. - Among all deep neck space infections, peritonsillar abscess has the **strongest association with trismus**. *Ludwig's angina* - While a severe infection of the submandibular and sublingual spaces, **Ludwig's angina** is primarily characterized by painful "bull neck" swelling of the mouth floor, elevation of the tongue, and risk of airway compromise. - **Mild to moderate trismus** can occur in some cases, but it is not the most prominent or defining feature compared to peritonsillar abscess. *Retropharyngeal abscess* - A **retropharyngeal abscess** is located behind the pharynx and primarily causes symptoms like **dysphagia**, **odynophagia**, **muffled voice**, **torticollis**, and airway compromise. - The infection's location in the retropharyngeal space usually doesn't directly affect the muscles of mastication, so **trismus is not a characteristic feature**. *Parapharyngeal abscess* - A **parapharyngeal abscess** (especially in the prestyloid space) **can cause trismus** due to its proximity to the pterygoid muscles and lateral pharyngeal wall. - However, it presents more variably with symptoms including neck swelling, medial displacement of the lateral pharyngeal wall, and potential involvement of great vessels. - While trismus may occur, it is **less consistently present and less severe** than in peritonsillar abscess, which remains the most classic association.

Q: All are absolute indications of tonsillectomy except which of the following?

Chronic tonsillitis. ***Chronic tonsillitis*** - **Chronic tonsillitis** is a **relative indication** for tonsillectomy, not an **absolute indication**. - It becomes an indication based on frequency criteria (e.g., Paradise criteria: ≥7 episodes in 1 year, ≥5 episodes per year for 2 years, or ≥3 episodes per year for 3 years). - Absolute indications involve conditions requiring urgent surgical intervention. *Suspicious malignancy* - Suspected **malignancy** is an **absolute indication** for tonsillectomy to obtain tissue for histopathological diagnosis. - Early diagnosis and treatment of tonsillar malignancy is critical for patient outcomes. *Peritonsillar abscess* - **Peritonsillar abscess** (quinsy) is typically managed with needle aspiration or incision & drainage plus antibiotics, NOT immediate tonsillectomy. - Acute tonsillectomy during active infection ("hot tonsillectomy") is generally **contraindicated** due to increased bleeding risk and surgical complications. - **Recurrent peritonsillar abscess** may warrant **interval tonsillectomy** (4-6 weeks after resolution) as a **relative indication**, not an absolute one. *Tonsils causing obstructive sleep apnea* - **Obstructive sleep apnea (OSA)** caused by tonsillar hypertrophy is an **absolute indication** for tonsillectomy, particularly in children. - Untreated OSA can lead to serious complications including failure to thrive, cor pulmonale, developmental delays, and neurocognitive problems.

Q: Most common cause of retropharyngeal abscess in adults?

Lymphadenitis. ***Lymphadenitis*** - **Lymphadenitis** in the retropharyngeal space, often secondary to an upper respiratory tract infection, is the most common cause of retropharyngeal abscesses in adults. - The infection spreads from inflamed lymph nodes to form a **purulent collection** in the potential space behind the pharynx. *TB* - **Tuberculosis (TB)** can cause retropharyngeal abscesses, particularly in immunocompromised individuals or endemic areas, but it is less common than pyogenic infections [1]. - TB abscesses tend to be more **chronic** and may be associated with vertebral involvement (Pott's disease) [1]. *Tooth extraction* - While dental infections, including complications from **tooth extraction**, can lead to deep neck space infections, they are not the most common cause of retropharyngeal abscess specifically. - Infections from teeth more often spread to the **submandibular** or **parapharyngeal spaces**. *Tonsillitis* - **Tonsillitis** is a common cause of pharyngeal inflammation and can lead to peritonsillar abscesses, which are distinct from retropharyngeal abscesses. - While severe tonsillitis can occasionally spread to the retropharyngeal space, it is primarily local and less common than direct lymphatic seeding.

Q: Which of the following statements about Grisel syndrome is false?

A neurosurgeon is never needed.. ***A neurosurgeon is never needed.*** - This statement is false because severe cases of **Grisel syndrome** may require surgical intervention, necessitating consultation with a **neurosurgeon**. - Surgical management, such as **cervical fusion**, may be indicated in cases of irreducible subluxation or neurological compromise. *It can occur after adenoidectomy.* - This statement is true; **Grisel syndrome** is a rare complication that may occur following **adenoidectomy** or other head and neck surgeries. - The postulated mechanism involves inflammation spreading from the pharynx to the alar and transverse ligaments, leading to **atlantoaxial subluxation**. *It involves inflammation of cervical spine ligaments.* - This statement is true; **Grisel syndrome** is characterized by non-traumatic **atlantoaxial subluxation** resulting from inflammatory laxity of the cervical ligaments. - Specifically, the **transverse and alar ligaments** become inflamed and weakened, leading to instability between the atlas (C1) and axis (C2). *Conservative treatment is the first-line approach in most cases.* - This statement is true; initial management of **Grisel syndrome** typically involves conservative measures such as **neck immobilization**, pain control, and muscle relaxants. - Early diagnosis and conservative treatment are crucial to prevent progression and potential neurological complications.

Q: Which objective test is most effective for examining adenoids?

Posterior rhinoscopy. ***Posterior rhinoscopy*** - This method allows for **direct visualization of the nasopharynx** where the adenoids are located, using a post-nasal mirror or flexible endoscope. - It provides an **objective assessment** of adenoid size, extent, and any associated obstruction by direct observation. - Among the clinical examination methods listed, this is the most effective for **visualizing adenoid tissue** and assessing hypertrophy. - In modern practice, flexible nasopharyngoscopy has largely replaced mirror examination, but posterior rhinoscopy remains the principle of direct nasopharyngeal visualization. *Anterior rhinoscopy* - This technique examines the **anterior nasal cavity**, nasal septum, and inferior turbinates. - It **cannot visualize the nasopharynx** where adenoids are located due to anatomical limitations. - Useful for anterior nasal pathology but inadequate for adenoid assessment. *Manual palpation* - This is a **subjective, not objective** method that relies on examiner's tactile sensation. - Highly uncomfortable for children, causing gagging and distress. - Carries risks of trauma, bleeding, and infection. - Does not provide measurable or reproducible data, hence not considered an objective test. - Largely abandoned in modern practice due to these limitations. *None of the options* - Incorrect because **posterior rhinoscopy is a recognized objective clinical examination** for adenoids. - It allows direct visualization which can be documented and is superior to subjective methods like palpation. - While radiological methods (lateral neck X-ray) also provide objective data, among the examination techniques listed, posterior rhinoscopy is the correct answer.

Question 1

What condition is associated with Lemierre's syndrome?

Accepted Answer

Thrombophlebitis of IJV

Answer

Carotid sinus aneurysm

Answer

Traumatic occlusion of IJV

Answer

Any of the above

Question 2

Early tonsillectomy is not done in?

Accepted Answer

Thyroid storm

Answer

Peritonsillar abscess

Answer

Rheumatic fever

Answer

Suspected malignancy

Question 3

Moure's sign (lateral displacement of the soft palate) is associated with which of the following conditions?

Accepted Answer

Peritonsillar abscess

Answer

Laryngeal carcinoma

Answer

Chronic tonsillitis

Answer

Acute epiglottitis

Question 4

What is the investigation of choice for nasopharyngeal angiofibroma?

Accepted Answer

Contrast-enhanced CT

Answer

Plain CT

Answer

X-ray

Answer

MRI

Question 5

Which of the following statements about acute retropharyngeal abscess is true?

Accepted Answer

Acute retropharyngeal abscess is often due to lymphadenitis.

Answer

Treatment often involves incision and drainage.

Answer

Acute retropharyngeal abscess is common in adults.

Answer

Swelling typically occurs unilaterally.

Question 6

Which of the following conditions is commonly associated with trismus?

Accepted Answer

Peritonsillar abscess

Answer

Ludwig's angina

Answer

Retropharyngeal abscess

Answer

Parapharyngeal abscess

Question 7

All are absolute indications of tonsillectomy except which of the following?

Accepted Answer

Chronic tonsillitis

Answer

Peritonsillar abscess

Answer

Tonsils causing obstructive sleep apnea

Answer

Suspicious malignancy

Question 8

Most common cause of retropharyngeal abscess in adults?

Accepted Answer

Lymphadenitis

Answer

Tonsillitis

Answer

Tooth extraction

Answer

TB

Question 9

Which of the following statements about Grisel syndrome is false?

Accepted Answer

A neurosurgeon is never needed.

Answer

It can occur after adenoidectomy.

Answer

It involves inflammation of cervical spine ligaments.

Answer

Conservative treatment is the first-line approach in most cases.

Question 10

Which objective test is most effective for examining adenoids?

Accepted Answer

Posterior rhinoscopy

Answer

Anterior rhinoscopy

Answer

Manual palpation

Answer

None of the options

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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