Diseases of the Pharynx — MCQs
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A 6-year-old female child presents with severe throat pain and odynophagia for one week. General examination reveals cervical lymphadenopathy, but no signs or symptoms of upper airway obstruction. Intra-oral examination reveals swelling and redness with protrusion of both tonsils. What is the most common causative agent?
Nasal angiofibroma is typically seen in which demographic group?
Fiberoptic endoscopy is contraindicated in which of the following conditions?
What is the usual number of tonsillar crypts?
Which of the following are contraindications for adenotonsillectomy?
The Gerlach tonsil, located in Waldeyer's ring, is also known as which tonsil?
Which of the following statements are true about Quinke disease?
A 10-year-old child presents with recurrent epistaxis. What is the most likely cause?
Which tonsil is characterized by the presence of the crypta magna?
Which of the following does not form part of Waldeyer's ring?
Diseases of the Pharynx Indian Medical PG Practice Questions and MCQs
Question 21: A 6-year-old female child presents with severe throat pain and odynophagia for one week. General examination reveals cervical lymphadenopathy, but no signs or symptoms of upper airway obstruction. Intra-oral examination reveals swelling and redness with protrusion of both tonsils. What is the most common causative agent?
- A. Haemolytic streptococcus (Correct Answer)
- B. Non-haemolytic streptococcus
- C. H. influenza
- D. Staphylococci
Explanation: **Explanation:** The clinical presentation of severe throat pain, odynophagia, cervical lymphadenopathy, and bilateral tonsillar protrusion in a 6-year-old child is characteristic of **Acute Membranous Tonsillitis** or severe **Acute Follicular Tonsillitis**. 1. **Why Option A is correct:** **Group A Beta-Haemolytic Streptococcus (GABHS)**, specifically *Streptococcus pyogenes*, is the most common bacterial cause of acute tonsillitis and pharyngitis in the pediatric age group (5–15 years). It is responsible for nearly 30% of cases of acute sore throat in children. The "haemolytic" nature refers to its ability to completely clear red blood cells on agar, a hallmark of its virulence. 2. **Why other options are incorrect:** * **Option B:** Non-haemolytic streptococci (like *S. mutans*) are generally commensals of the oral cavity and rarely cause acute exudative tonsillitis. * **Option C:** *H. influenzae* can cause respiratory infections and epiglottitis, but it is a less common primary cause of acute tonsillitis compared to GABHS. * **Option D:** *Staphylococci* are often secondary invaders or associated with peritonsillar abscesses (Quinsy) rather than being the primary causative agent of acute tonsillitis in children. **Clinical Pearls for NEET-PG:** * **Centor Criteria:** Used to clinically diagnose GABHS pharyngitis (Fever, Tonsillar exudates, Tender anterior cervical lymphadenopathy, and Absence of cough). * **Complications:** Untreated GABHS tonsillitis can lead to non-suppurative complications like **Rheumatic Fever** and **Post-Streptococcal Glomerulonephritis (PSGN)**. * **Drug of Choice:** Penicillin remains the treatment of choice for GABHS due to its high sensitivity. * **Differential Diagnosis:** In a child with bilateral tonsillar membranes and lymphadenopathy, always consider **Infectious Mononucleosis** (EBV) and **Diphtheria**.
Question 22: Nasal angiofibroma is typically seen in which demographic group?
- A. Adolescent males (Correct Answer)
- B. Adult males
- C. Elderly males
- D. Elderly females
Explanation: **Explanation:** **Juvenile Nasopharyngeal Angiofibroma (JNA)** is a histologically benign but locally aggressive, highly vascular tumor. **1. Why Adolescent Males?** The correct answer is **Adolescent males** because JNA is an **androgen-dependent** tumor. It almost exclusively affects young males, typically between the ages of 10 and 20 years. The tumor expresses androgen receptors, and its growth is stimulated by the hormonal surge during puberty. It originates in the sphenopalatine foramen at the posterolateral wall of the nasal cavity. **2. Why other options are incorrect:** * **Adult/Elderly Males:** While the tumor can persist into adulthood if not treated, it rarely originates in older age groups. As androgen levels stabilize or decline, the stimulus for growth diminishes. * **Elderly Females:** JNA is virtually never seen in females. If a similar vascular mass is found in a female, a genetic analysis (karyotyping) is often recommended to rule out chromosomal abnormalities or an alternative diagnosis like a hemangioma or pyogenic granuloma. **3. High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Adolescent male + Profuse recurrent epistaxis + Nasal obstruction. * **Holman-Miller Sign:** Anterior bowing of the posterior wall of the maxillary antrum seen on CT scan (pathognomonic). * **Frog-face deformity:** Seen in advanced stages due to widening of the nasal bridge. * **Contraindication:** **Biopsy is strictly contraindicated** in the OPD setting due to the risk of torrential, life-threatening hemorrhage. Diagnosis is clinical and radiological. * **Treatment of choice:** Surgical excision (usually preceded by preoperative embolization to reduce blood loss).
Question 23: Fiberoptic endoscopy is contraindicated in which of the following conditions?
- A. Children
- B. Aneurysm of the aortic arch (Correct Answer)
- C. Cervical spondylosis
- D. Hemoptysis
Explanation: **Explanation:** The correct answer is **Aneurysm of the aortic arch**. **Why it is the correct answer:** Fiberoptic endoscopy (specifically esophagoscopy or bronchoscopy) involves the passage of a scope through the pharynx and esophagus. The esophagus lies in close anatomical proximity to the arch of the aorta. In patients with an aortic aneurysm, the vessel wall is thin, dilated, and fragile. The mechanical pressure of the endoscope, or the physiological stress (tachycardia and hypertension) induced by the procedure, carries a high risk of **aneurysmal rupture**, which is almost always fatal. Therefore, it is considered a classic contraindication. **Analysis of incorrect options:** * **Children:** Endoscopy is not contraindicated in children; it is frequently performed for foreign body removal or diagnostic purposes using pediatric-sized flexible or rigid scopes under general anesthesia. * **Cervical Spondylosis:** While severe spondylosis (osteophytes) may make **rigid** endoscopy difficult or risky due to limited neck extension, **fiberoptic (flexible)** endoscopy is generally safe as it does not require neck maneuvering. * **Hemoptysis:** Endoscopy (Bronchoscopy) is actually a primary diagnostic and therapeutic tool used to localize the site of bleeding in hemoptysis. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications for Esophagoscopy:** Recent myocardial infarction (MI), suspected perforated viscus, and unstable cervical spine. * **Killian's Dehiscence:** The most common site for esophageal perforation during endoscopy, located between the thyropharyngeus and cricopharyngeus muscles. * **Aortic Arch Anatomy:** It crosses the esophagus at the level of the **T4 vertebra**, which is a common site for physiological constriction and potential impaction of foreign bodies.
Question 24: What is the usual number of tonsillar crypts?
- A. 5-Feb
- B. 15-Dec (Correct Answer)
- C. 50-100
- D. 1500-3000
Explanation: **Explanation:** The palatine tonsils are masses of lymphoid tissue located in the lateral wall of the oropharynx. The medial surface of the tonsil is covered by non-keratinized stratified squamous epithelium, which invaginates into the substance of the tonsil to form **tonsillar crypts**. 1. **Why Option B is correct:** In a normal palatine tonsil, there are approximately **12 to 15 crypts**. These crypts significantly increase the surface area for the lymphoid tissue to come into contact with inhaled or ingested antigens. The largest and deepest of these is the **Crypta Magna** (intratonsillar cleft), which represents the remains of the second pharyngeal pouch. 2. **Why other options are incorrect:** * **Option A (2-5):** This number is too low; it does not account for the complex branching nature of the tonsillar surface. * **Option C (50-100):** This exceeds the anatomical count found in a standard palatine tonsil. * **Option D (1500-3000):** This is an extreme value, likely confused with the number of taste buds or other microscopic structures. **Clinical Pearls for NEET-PG:** * **Crypta Magna:** This is the primary site where infection often starts and where "tonsilloliths" (tonsil stones) frequently form due to the accumulation of food particles, bacteria, and epithelial debris. * **Epithelium:** The crypts are lined by the same stratified squamous epithelium as the surface, but it is thinner and often "reticulated" to allow antigen sampling. * **Bed of the Tonsil:** Formed mainly by the **Superior Constrictor** and **Styloglossus** muscles. * **Blood Supply:** The main artery is the **Tonsillar branch of the Facial Artery**.
Question 25: Which of the following are contraindications for adenotonsillectomy?
- A. Age less than 4 years, Poliomyelitis, Haemophilus infection
- B. Poliomyelitis, Haemophilus infection, Upper respiratory tract infection (Correct Answer)
- C. Age less than 4 years, Upper respiratory tract infection
- D. Age less than 4 years, Poliomyelitis
Explanation: ### Explanation The decision to perform an adenotonsillectomy requires careful screening for contraindications to minimize perioperative morbidity and mortality. **Why Option B is Correct:** 1. **Poliomyelitis:** Surgery during a polio epidemic is a classic contraindication. Trauma to the oropharynx (like tonsillectomy) can predispose the patient to the **bulbar form of polio** due to the exposure of nerve endings to the virus. 2. **Upper Respiratory Tract Infection (URTI):** Surgery during an active infection increases the risk of intraoperative bleeding (due to hyperemic tissues) and postoperative pulmonary complications (laryngospasm or bronchospasm) under general anesthesia. Surgery should be deferred for 3–4 weeks post-recovery. 3. **Haemophilus infection:** Acute infections, including those caused by *Haemophilus influenzae*, are absolute contraindications until the infection has completely resolved to prevent systemic spread (septicemia). **Analysis of Incorrect Options:** * **Age less than 4 years (Options A, C, D):** While surgeons are cautious with very young children due to the risk of blood loss and metabolic upset, age is a **relative contraindication**, not an absolute one. If there is severe Obstructive Sleep Apnea (OSA) or cor pulmonale, surgery is performed even in infants. * **Haemophilus/URTI/Polio (Options A, C, D):** While these are correct contraindications, Option B is the most comprehensive list among the choices provided that excludes the "relative" age factor. **High-Yield Clinical Pearls for NEET-PG:** * **Bleeding Disorders:** Hemophilia, leukemia, and purpura are major contraindications. Always check PT/INR and bleeding time pre-operatively. * **Cleft Palate/Bifid Uvula:** Adenoidectomy is contraindicated here as it can lead to **Velopharyngeal Insufficiency (VPI)** and hypernasal speech. * **Menstruation:** Surgery is traditionally avoided during menses due to the theoretical risk of increased fibrinolytic activity and excessive bleeding.
Question 26: The Gerlach tonsil, located in Waldeyer's ring, is also known as which tonsil?
- A. Tubal tonsil (Correct Answer)
- B. Palatine tonsil
- C. Pharyngeal tonsil
- D. Lingual tonsil
Explanation: **Explanation:** The **Gerlach tonsil** is the eponym for the **Tubal tonsil**. It is a collection of lymphoid tissue located in the submucosa of the lateral wall of the nasopharynx, specifically within the **Fossa of Rosenmüller**, surrounding the opening of the Eustachian tube. **Why Option A is correct:** The tubal tonsil forms the lateral component of **Waldeyer’s Ring**, a circular band of lymphoid tissue at the entrance of the aerodigestive tract. Its primary function is to provide local mucosal immunity against inhaled or ingested pathogens. **Analysis of Incorrect Options:** * **B. Palatine tonsil:** These are the "true" tonsils located in the oropharynx between the palatoglossal and palatopharyngeal arches. They are the most common site for tonsillitis. * **C. Pharyngeal tonsil:** Also known as the **Adenoid**, this is a single midline mass of lymphoid tissue located in the roof and posterior wall of the nasopharynx. Hypertrophy can lead to mouth breathing and Eustachian tube blockage. * **D. Lingual tonsil:** This refers to the lymphoid tissue located on the posterior one-third of the tongue (base of the tongue). **High-Yield Clinical Pearls for NEET-PG:** * **Waldeyer’s Ring Components:** Pharyngeal tonsil (superior), Tubal tonsils (lateral), Palatine tonsils (lateral), and Lingual tonsil (inferior). * **Eustachian Tube Relation:** Hypertrophy of the Gerlach tonsil can lead to Eustachian tube dysfunction, potentially causing **Otitis Media with Effusion (OME)**. * **Fossa of Rosenmüller:** This is the most common site for **Nasopharyngeal Carcinoma**; it lies just posterior to the tubal tonsil.
Question 27: Which of the following statements are true about Quinke disease?
- A. Bacterial infection
- B. Peritonsillar abscess (Correct Answer)
- C. Vocal cord edema
- D. Edema of uvula
Explanation: **Explanation:** **Quinke Disease** (also known as Quincke’s edema) is a clinical condition characterized by isolated, rapid-onset **edema of the uvula**. It is typically considered a localized form of angioedema. 1. **Why Option D is the most accurate clinical definition:** Quinke disease specifically refers to the swelling of the uvula caused by increased vascular permeability. It can be triggered by allergies, trauma, inhalation of irritants, or thermal injury. Patients often present with a "foreign body" sensation in the throat, gagging, or muffled speech. 2. **Analysis of Options:** * **Option B (Peritonsillar Abscess):** While the provided key marks this as correct, in standard ENT textbooks, Quinke disease is the specific term for **isolated uvular edema**. However, in some clinical contexts or older question banks, it is associated with the collateral edema seen in a **Peritonsillar Abscess (Quinsy)**. In a Quinsy, the uvula is often edematous and pushed to the contralateral side. * **Option A (Bacterial Infection):** Quinke disease is primarily an angioneurotic/allergic phenomenon, not a primary bacterial infection (though infection can be a secondary trigger). * **Option C (Vocal Cord Edema):** This refers to Reinke’s edema or laryngeal edema, which involves the glottic area and causes hoarseness, unlike the oropharyngeal involvement in Quinke disease. **High-Yield Clinical Pearls for NEET-PG:** * **Quinsy (Peritonsillar Abscess):** Collection of pus between the tonsillar capsule and the superior constrictor muscle. Key signs: Trismus, "Hot potato" voice, and uvular deviation. * **Management of Quinke Disease:** Usually treated with steroids, antihistamines, and occasionally adrenaline if airway compromise is suspected. * **Differential Diagnosis:** Must be distinguished from **Epiglottitis** (Thumb sign on X-ray) which is a life-threatening emergency.
Question 28: A 10-year-old child presents with recurrent epistaxis. What is the most likely cause?
- A. Hypertension
- B. Arteriosclerosis
- C. Angiofibroma (Correct Answer)
- D. Surgery
Explanation: **Explanation:** **Juvenile Nasopharyngeal Angiofibroma (JNA)** is the most likely cause in this scenario. It is a benign but locally aggressive, highly vascular tumor that typically affects **adolescent males** (usually between 10–20 years of age). The hallmark presentation is **painless, profuse, and recurrent epistaxis** often accompanied by progressive nasal obstruction. Because the tumor is non-encapsulated and rich in blood vessels (lacking a muscular coat), it bleeds easily upon provocation or spontaneously. **Analysis of Incorrect Options:** * **A & B (Hypertension and Arteriosclerosis):** These are common causes of epistaxis in the **elderly** population. Hypertension is the most frequent systemic cause of epistaxis in adults, while arteriosclerotic vessels fail to contract, leading to persistent bleeding. They are extremely rare causes in a 10-year-old. * **D (Surgery):** While postoperative bleeding is a known complication of nasal surgeries (like septoplasty or FESS), it is a situational cause rather than a primary diagnosis for recurrent, spontaneous epistaxis in a child. **NEET-PG High-Yield Pearls:** * **Origin:** Most commonly arises from the superior margin of the **sphenopalatine foramen**. * **Classic Sign:** **Holman-Miller Sign** (Antral Sign) – anterior bowing of the posterior wall of the maxillary sinus seen on CT/MRI. * **Diagnosis:** Contrast-enhanced CT (CECT) is the investigation of choice. **Biopsy is contraindicated** due to the risk of torrential hemorrhage. * **Blood Supply:** Primarily from the **Internal Maxillary Artery** (branch of the External Carotid). * **Treatment:** Surgical excision (often preceded by preoperative embolization to reduce blood loss).
Question 29: Which tonsil is characterized by the presence of the crypta magna?
- A. Nasopharyngeal tonsil
- B. Lingual tonsil
- C. Tubal tonsil
- D. Palatine tonsil (Correct Answer)
Explanation: **Explanation:** The **Palatine tonsils** (commonly referred to as "the tonsils") are masses of lymphoid tissue located in the lateral wall of the oropharynx within the tonsillar fossa. A characteristic feature of the palatine tonsil is the presence of **12–15 tonsillar crypts**. The largest and deepest of these, located in the upper part of the tonsil, is known as the **crypta magna** (or intratonsillar cleft). It represents the remnant of the second pharyngeal pouch. **Analysis of Options:** * **Nasopharyngeal tonsil (Adenoids):** Located in the roof of the nasopharynx. Unlike palatine tonsils, they are covered by pseudostratified ciliated columnar epithelium and **lack true crypts**. Instead, the surface shows longitudinal mucosal folds. * **Lingual tonsil:** Located on the posterior one-third of the tongue. While they possess single, wide-mouthed crypts, they do not feature a "crypta magna." * **Tubal tonsil:** Located in the fossa of Rosenmüller near the opening of the Eustachian tube. These are smaller lymphoid collections and do not possess a crypta magna. **Clinical Pearls for NEET-PG:** * **Epithelium:** Palatine tonsils are lined by **non-keratinized stratified squamous epithelium**. * **Blood Supply:** The main artery is the **tonsillar branch of the facial artery**. * **Quinsy (Peritonsillar Abscess):** Pus typically collects in the peritonsillar space, often originating from infection in the **crypta magna**. * **Waldeyer’s Ring:** The palatine tonsils form the lateral part of this lymphoid ring, which serves as the first line of defense against ingested or inhaled pathogens.
Question 30: Which of the following does not form part of Waldeyer's ring?
- A. Adenoids
- B. Eustachian tonsil
- C. Palatine tonsil
- D. None of the above (Correct Answer)
Explanation: **Explanation:** **Waldeyer’s Ring** is a circular arrangement of lymphoid tissue located in the pharynx at the entrance of the respiratory and digestive tracts. It functions as a primary defense mechanism against inhaled or ingested pathogens. **Why "None of the above" is correct:** The ring is composed of several lymphoid aggregates. All three options listed (Adenoids, Eustachian tonsils, and Palatine tonsils) are integral components of this ring. Since all options are part of the ring, "None of the above" is the correct choice for a question asking which does *not* form part of it. **Breakdown of Components:** * **Adenoids (Nasopharyngeal Tonsil):** Located in the roof and posterior wall of the nasopharynx. (Option A is part of the ring). * **Eustachian Tonsil (Tubal Tonsil):** Located in the Fossa of Rosenmüller, near the opening of the Eustachian tube. (Option B is part of the ring). * **Palatine Tonsils:** Often referred to simply as "the tonsils," these are located in the oropharynx between the palatoglossal and palatopharyngeal arches. (Option C is part of the ring). * **Lingual Tonsil:** Located on the posterior one-third of the tongue (base of the tongue). **NEET-PG High-Yield Pearls:** * **Passavant’s Ridge:** This is a mucosal ridge formed by the contraction of the palatopharyngeal sphincter; it is *not* part of Waldeyer’s ring. * **Lymphatic Drainage:** Unlike lymph nodes, the components of Waldeyer’s ring possess **no afferent lymphatics**; they only have efferent drainage. * **Clinical Significance:** Hypertrophy of the adenoids can lead to "Adenoid Facies" and Serous Otitis Media due to Eustachian tube obstruction.
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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