Diseases of the Pharynx Practice Questions

Q: Not true about parapharyngeal abscess?

Horner's syndrome. ***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.

Q: Which of the following arises from the pharyngeal bursa?

Tornwaldt's disease. ***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.

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

Surgery is the treatment of choice. ***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.

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

Trismus (difficulty opening the mouth). ***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.

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

Peritonsillar space. ***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.

Q: Biphasic stridor is characteristically seen in:

Laryngeal foreign body. ***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.

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

It can involve the floor of the mouth.. ***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.

Question 1

Not true about parapharyngeal abscess?

Accepted Answer

Horner's syndrome

Answer

Torticollis

Answer

Trismus

Answer

Drooling of saliva

Question 2

Which of the following arises from the pharyngeal bursa?

Accepted Answer

Tornwaldt's disease

Answer

Craniopharyngioma

Answer

Chordoma

Answer

Lymphoma

Question 3

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

Accepted Answer

Surgery is the treatment of choice

Answer

It commonly occurs in females

Answer

It is a malignant tumor

Answer

Hormones are not used in the treatment

Question 4

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

Accepted Answer

Trismus (difficulty opening the mouth)

Answer

Difficulty swallowing (dysphagia)

Answer

Muffled or 'hot potato' voice

Answer

Severe sore throat

Question 5

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

Accepted Answer

Peritonsillar space

Answer

Parapharyngeal space

Answer

Retropharyngeal space

Answer

Within the tonsil

Question 6

Biphasic stridor is characteristically seen in:

Accepted Answer

Laryngeal foreign body

Answer

Bronchial foreign body

Answer

None of the options

Answer

Tracheal foreign body

Question 7

Which of the following statements is false regarding peritonsillar abscess?

Accepted Answer

It can involve the floor of the mouth.

Answer

It causes bulge of the uvula/soft palate

Answer

Usually presents with trismus and difficulty swallowing.

Answer

The accumulation of pus is medial to the superior constrictor muscle

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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