Diseases of the Pharynx — MCQs

Diseases of the Pharynx Indian Medical PG Practice Questions and MCQs

Question 281: Not true about parapharyngeal abscess?

A. Torticollis
B. Trismus
C. Drooling of saliva
D. Horner's syndrome (Correct Answer)

Explanation: ***Horner's syndrome*** - While parapharyngeal abscess is close to the **sympathetic chain**, Horner's syndrome (ptosis, miosis, anhydrosis) is a **rare complication**, not a common or typical presentation, making this statement the most likely to be false regarding usual clinical features. - The inflammatory process usually affects the adjacent structures, such as pterygoid muscles, pharyngeal muscles, and carotid sheath, rather than directly compressing the **sympathetic fibers** in the majority of cases. *Torticollis* - **Torticollis**, or neck stiffness and deviation, is a common symptom due to irritation and spasm of the neck muscles adjacent to the inflamed parapharyngeal space. - The inflammatory process can cause pain and muscle guarding, leading to the characteristic head tilt. *Drooling of saliva* - **Drooling of saliva** occurs due to odynophagia (painful swallowing) and dysphagia (difficulty swallowing) making patients reluctant to swallow, allowing saliva to accumulate and spill from the mouth. - The inflammation and swelling in the parapharyngeal space can obstruct the pharynx, making swallowing difficult and painful. *Trismus* - **Trismus**, or difficulty opening the mouth, is a characteristic feature of parapharyngeal abscess due to inflammation and spasm of the **medial pterygoid muscle**, which is located near the parapharyngeal space. - The abscess can directly irritate or compress the **masticatory muscles**, limiting jaw movement.

Question 282: Which of the following arises from the pharyngeal bursa?

A. Tornwaldt's disease (Correct Answer)
B. Craniopharyngioma
C. Chordoma
D. Lymphoma

Explanation: ***Tornwaldt's disease*** - This condition involves a **retropharyngeal cyst** that forms from the persistent embryological remnant of the **pharyngeal bursa**. - Symptoms arise from the cyst's location in the **nasopharynx**, causing drainage, halitosis, and occasionally Eustachian tube dysfunction. *Craniopharyngioma* - This is a **benign brain tumor** that arises from remnants of Rathke's pouch, which is an embryonic anlage of the anterior pituitary gland. - It is typically located in the **suprasellar region** and is not derived from the pharyngeal bursa. *Chordoma* - This is a rare, **malignant bone tumor** that originates from remnants of the **notochord**. - It most commonly occurs at the base of the skull (clivus) or in the sacrum, separate from the pharyngeal bursa. *Lymphoma* - Lymphoma is a **cancer of the lymphocytes**, which are a type of white blood cell. - It typically originates in **lymph nodes** or other lymphoid tissues throughout the body, not from a specific embryonic remnant like the pharyngeal bursa.

Question 283: Which of the following statements about juvenile nasopharyngeal angiofibroma is true?

A. It commonly occurs in females
B. It is a malignant tumor
C. Hormones are not used in the treatment
D. Surgery is the treatment of choice (Correct Answer)

Explanation: ***Surgery is the treatment of choice*** - **Surgical resection** is the preferred and most effective treatment for juvenile nasopharyngeal angiofibroma (JNA) due to its high vascularity and propensity for local recurrence. - While other modalities like embolization may be used pre-operatively to reduce bleeding, **complete surgical removal** is usually necessary. *It is a malignant tumor* - Juvenile nasopharyngeal angiofibroma is a **benign, locally aggressive tumor** originating in the nasopharynx. - Despite its benign nature, it can cause significant morbidity due to its **vascularity** and tendency to invade surrounding structures like the skull base and orbit. *It commonly occurs in females* - This statement is incorrect; **juvenile nasopharyngeal angiofibroma almost exclusively affects adolescent males**, with a peak incidence between 10 and 20 years of age. - The disease is **extremely rare in females**, and its occurrence in a female should prompt investigation for conditions like androgen insensitivity syndrome. *Hormones are not used in the treatment* - This statement is incorrect; **anti-androgen therapy** (e.g., flutamide) or estrogen therapy has been explored in managing JNA given its androgen receptor sensitivity. - However, **hormonal treatment is generally not the primary modality** but may be considered in specific cases, such as unresectable tumours or for recurrence control, although its efficacy is variable.

Question 284: Which of the following is the most characteristic symptom of a peritonsillar abscess?

A. Trismus (difficulty opening the mouth) (Correct Answer)
B. Difficulty swallowing (dysphagia)
C. Muffled or 'hot potato' voice
D. Severe sore throat

Explanation: ***Trismus (difficulty opening the mouth)*** - **Trismus** is a hallmark symptom of a peritonsillar abscess, resulting from irritation and spasm of the **pterygoid muscles** due to inflammation and pus accumulation. - Its presence is a strong indicator, often more specific than generalized symptoms, aiding in the differentiation from simple tonsillitis. *Difficulty swallowing (dysphagia)* - While **dysphagia** is common with a peritonsillar abscess due to pain and swelling, it is also a feature of severe tonsillitis or pharyngitis, making it less specific than trismus. - The pain associated with swallowing is typically **odynophagia**, though both are related to inflammation. *Muffled or 'hot potato' voice* - A **muffled** or "hot potato" voice is characteristic of a peritonsillar abscess due to swelling in the oral pharynx, affecting vocal resonance. - However, this symptom can also be present in other conditions causing significant pharyngeal swelling, making it less unique than trismus. *Severe sore throat* - A **severe sore throat** is a common and prominent symptom, often unilateral, but it is present in many other throat infections such as **strep throat** or severe tonsillitis. - Its presence, though significant, does not specifically point to a peritonsillar abscess over other inflammatory conditions of the throat.

Question 285: In which of the following locations is a collection of pus found in quinsy?

A. Peritonsillar space (Correct Answer)
B. Parapharyngeal space
C. Retropharyngeal space
D. Within the tonsil

Explanation: ***Peritonsillar space*** - **Quinsy is the clinical term for peritonsillar abscess**, defined as a collection of pus in the peritonsillar space between the tonsillar capsule and the superior constrictor muscle. - Typically develops as a complication of **acute bacterial tonsillitis** (often Streptococcus pyogenes), with pus extending beyond the tonsillar capsule. - Clinically presents with severe unilateral throat pain, trismus, "hot potato" voice, and deviation of the uvula away from the affected side. *Parapharyngeal space* - The **parapharyngeal (lateral pharyngeal) space** is a deeper potential space lateral to the pharynx, extending from skull base to hyoid bone. - Contains the carotid sheath with major vessels and cranial nerves IX, X, XI, XII. - Parapharyngeal abscess is a serious deep neck infection but is **not** called quinsy. *Retropharyngeal space* - The **retropharyngeal space** lies between the posterior pharyngeal wall and prevertebral fascia. - Retropharyngeal abscess is more common in children under 5 years and can cause airway obstruction. - This is a distinct entity from quinsy. *Within the tonsil* - Pus confined **within the tonsil parenchyma** represents severe acute tonsillitis or intratonsillar abscess, not quinsy. - Quinsy specifically requires extension **beyond the tonsillar capsule** into the peritonsillar space. - This distinction is clinically important for management decisions.

Question 286: Biphasic stridor is characteristically seen in:

A. Bronchial foreign body
B. None of the options
C. Tracheal foreign body
D. Laryngeal foreign body (Correct Answer)

Explanation: ***Laryngeal foreign body*** - **Biphasic stridor** is the hallmark finding in laryngeal/subglottic foreign bodies as they obstruct airflow during **both inspiration and expiration**. - The obstruction at the **glottic or subglottic level** causes turbulent airflow in both phases of respiration, producing the characteristic biphasic quality. - Often accompanied by **hoarseness**, **croupy cough**, **dysphagia**, and **respiratory distress**. *Tracheal foreign body* - Tracheal foreign bodies typically produce **expiratory stridor** or **monophonic wheeze** rather than biphasic stridor. - May present with **Holzknecht's sign** (slapping sound with respiration), **palpable thud**, and **audible slap**. - **Cough** and **dyspnea** are more prominent than stridor. *Bronchial foreign body* - Bronchial foreign bodies cause **wheezing**, **diminished breath sounds** on the affected side, and **obstructive emphysema**. - Located beyond the carina, they rarely cause stridor as stridor originates from **laryngotracheal** obstruction. - May present with **persistent cough**, **recurrent pneumonia**, or **atelectasis**. *None of the options* - This is incorrect as **laryngeal foreign body** is the classic cause of biphasic stridor in medical literature. - **Glottic and subglottic obstructions** characteristically produce biphasic stridor affecting both respiratory phases.

Question 287: Which of the following statements is false regarding peritonsillar abscess?

A. It causes bulge of the uvula/soft palate
B. It can involve the floor of the mouth. (Correct Answer)
C. Usually presents with trismus and difficulty swallowing.
D. The accumulation of pus is medial to the superior constrictor muscle

Explanation: ***It can involve the floor of the mouth.*** - A **peritonsillar abscess** (quinsy) forms in the potential space between the **capsule of the palatine tonsil** and the **superior constrictor muscle**. - It does not extend to the **floor of the mouth**; that area is typically affected by conditions like **Ludwig's angina** or submandibular abscesses. *It causes bulge of the uvula/soft palate* - The inflammatory process and **pus accumulation** within the peritonsillar space push the **uvula** and **soft palate** towards the unaffected side. - This characteristic **bulge** is a key clinical sign helping to distinguish it from other throat infections. *Usually presents with trismus and difficulty swallowing.* - **Trismus**, or difficulty opening the mouth, results from **spasm of the pterygoid muscles** due to nearby inflammation and pain. - **Dysphagia** (difficulty swallowing) and **odynophagia** (painful swallowing) are common due to significant inflammation and pressure in the throat. *The accumulation of pus is lateral to the superior constrictor muscle* - The **peritonsillar space** is located **medial to the superior constrictor muscle**, between this muscle and the tough fibrous tonsillar capsule. - Accumulation of pus in this space pushes the tonsil **medially and anteriorly**, a key diagnostic feature.

Practice by Chapter

Pharyngitis

Practice Questions

Tonsillitis

Practice Questions

Peritonsillar Abscess

Practice Questions

Retropharyngeal Abscess

Practice Questions

Adenoid Hypertrophy

Practice Questions

Sleep-Disordered Breathing

Practice Questions

Obstructive Sleep Apnea

Practice Questions

Nasopharyngeal Carcinoma

Practice Questions

Oropharyngeal Carcinoma

Practice Questions

Hypopharyngeal Carcinoma

Practice Questions

Dysphagia

Practice Questions

Globus Pharyngeus

Practice Questions

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