Diseases of the Pharynx Practice Questions

Q: What is the investigation of choice for Zenker's diverticulum?

Barium Swallow. **Explanation:** **Zenker’s Diverticulum** (Pharyngeal Pouch) is a pulsion diverticulum occurring through **Killian’s dehiscence**, a weak muscular area between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor muscle. **Why Barium Swallow is the Investigation of Choice:** Barium swallow is the gold standard because it clearly outlines the size, shape, and position of the pouch. It typically reveals a "flask-shaped" or "club-shaped" sac filled with contrast, located posteriorly at the level of the C5-C6 vertebrae. It is non-invasive and provides a definitive diagnosis without the risks associated with instrumentation. **Analysis of Incorrect Options:** * **Endoscopy:** This is generally **contraindicated** as the initial investigation. The endoscope can easily enter the diverticulum instead of the esophagus, leading to an accidental **perforation**, as the pouch is thin-walled and lacks a muscular layer. * **Esophageal Manometry:** While it may show incoordination of the upper esophageal sphincter, it is technically difficult to perform in these patients and is not used for primary diagnosis. * **CECT:** While CT can show a fluid-filled sac, it is not as sensitive or specific as a dynamic barium study for visualizing the diverticulum's anatomy. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Dysphagia, halitosis (foul breath due to undigested food), and regurgitation. * **Boyce’s Sign:** A gurgling sound heard on pressing the side of the neck. * **Treatment of Choice:** Endoscopic Dohlman’s procedure (Stapling/Laser) or external diverticulectomy with cricopharyngeal myotomy. * **Complication:** Recurrent aspiration pneumonia is the most common serious complication.

Q: Which of the following is false about sideropenic dysphagia?

Pre-cricoid webs. **Sideropenic Dysphagia**, also known as **Plummer-Vinson Syndrome** (in the US) or **Paterson-Brown-Kelly Syndrome** (in the UK), is a classic triad of iron-deficiency anemia, glossitis, and esophageal webs. ### Explanation of Options: * **Option B (Correct Answer):** The statement is false because the webs in this condition are **post-cricoid**, not pre-cricoid. They are typically found at the junction of the hypopharynx and the upper esophagus. * **Option A:** This is a true statement. It is considered a **pre-malignant** condition. Chronic irritation and mucosal atrophy predispose patients to **Squamous Cell Carcinoma** of the post-cricoid region and upper esophagus. * **Option C:** This is a true statement. "Sideropenic" refers to iron deficiency. Patients present with microcytic hypochromic **anemia**, often accompanied by spoon-shaped nails (koilonychia). * **Option D:** This is a true statement. The condition classically affects **middle-aged (perimenopausal) women**, with a female-to-male ratio of approximately 9:1. ### High-Yield Clinical Pearls for NEET-PG: * **The Triad:** Iron deficiency anemia + Dysphagia + Post-cricoid webs. * **Clinical Features:** Glossitis (smooth red tongue), angular cheilitis, and koilonychia. * **Diagnosis:** **Barium Swallow** is the investigation of choice to visualize the thin, mucosal webs (best seen in the lateral view). * **Treatment:** Iron supplementation (often resolves the dysphagia) and endoscopic dilatation if the web is significant. * **Follow-up:** Essential due to the high risk of post-cricoid malignancy.

Q: What is a potential cause of cervical lymphadenopathy in a 70-year-old man?

Nasopharyngeal carcinoma. **Explanation:** **1. Why Nasopharyngeal Carcinoma (NPC) is correct:** In an elderly patient (70 years old) presenting with cervical lymphadenopathy, the primary concern is a metastatic malignancy from the head and neck. **Nasopharyngeal carcinoma** is notorious for its "silent" primary site; the most common presenting symptom (up to 75% of cases) is a painless, firm, upper cervical lymph node mass (typically Level II or Level V). Due to the rich lymphatic network of the nasopharynx, nodal metastasis often occurs early, even when the primary tumor is small. **2. Why the other options are incorrect:** * **Angiofibroma (Juvenile Nasopharyngeal Angiofibroma):** This is a benign but locally aggressive vascular tumor. It almost exclusively affects **adolescent males** (10–20 years). It presents with profuse epistaxis and nasal obstruction, not cervical lymphadenopathy. * **Acoustic Neuroma (Vestibular Schwannoma):** This is a benign tumor of the 8th cranial nerve. It presents with unilateral sensorineural hearing loss, tinnitus, and dysequilibrium. It does not involve the lymphatic system. * **Otosclerosis:** This is a metabolic bone disease of the otic capsule leading to stapes fixation. it presents with progressive **conductive hearing loss** in young to middle-aged adults with a normal tympanic membrane. It has no association with lymphadenopathy. **Clinical Pearls for NEET-PG:** * **Trotter’s Triad (for NPC):** 1. Conductive hearing loss (due to Eustachian tube blockage), 2. Ipsilateral palatal paralysis, 3. Trigeminal neuralgia (facial pain). * **Fossa of Rosenmüller:** The most common site of origin for NPC. * **EBV Association:** Nasopharyngeal carcinoma (Type II and III) is strongly associated with the **Epstein-Barr Virus**. * **Rule of Thumb:** Any adult with unilateral serous otitis media must be evaluated for NPC to rule out a mass obstructing the Eustachian tube.

Q: Epstein Barr virus is associated with which of the following carcinomas?

Carcinoma of the nasopharynx. **Explanation:** **Nasopharyngeal Carcinoma (NPC)**, particularly the undifferentiated type (WHO Type 3), has a strong and consistent causal association with the **Epstein-Barr Virus (EBV)**. The virus infects the nasopharyngeal epithelial cells, and the expression of viral proteins like LMP-1 (Latent Membrane Protein-1) promotes oncogenesis by inhibiting apoptosis and stimulating cell proliferation. * **Why Option C is correct:** EBV DNA is found in almost 100% of undifferentiated NPC cases regardless of geographical location. It is especially prevalent in Southern China and Southeast Asia. Serum titers of IgA antibodies against EBV viral capsid antigen (VCA) are used as a diagnostic and screening marker. * **Why Options A, B, and D are incorrect:** * **Carcinoma of the larynx and maxilla:** These are primarily associated with risk factors like tobacco smoking, alcohol consumption, and certain strains of Human Papillomavirus (HPV), but not EBV. * **Carcinoma of the bladder:** This is strongly linked to smoking, occupational exposure to aromatic amines (aniline dyes), and *Schistosoma haematobium* infection. **High-Yield Clinical Pearls for NEET-PG:** 1. **Bimodal Age Distribution:** NPC shows two peaks—one in adolescence/young adulthood and another in the 5th–6th decades. 2. **Trotter’s Triad:** Conductive hearing loss (due to Eustachian tube blockage), Ipsilateral palatal paralysis, and Trigeminal neuralgia (V2 involvement). 3. **Fossa of Rosenmüller:** The most common site of origin for NPC. 4. **Treatment of Choice:** Radiotherapy is the primary treatment as NPC is highly radiosensitive. 5. **Other EBV Associations:** Burkitt Lymphoma, Hodgkin Lymphoma, and Oral Hairy Leukoplakia.

Q: Tonsillectomy is contraindicated in which of the following conditions?

Poliomyelitis epidemic. **Explanation:** The correct answer is **C. Poliomyelitis epidemic.** **Why it is the correct answer:** Performing a tonsillectomy during a poliomyelitis epidemic is strictly contraindicated. The procedure involves trauma to the pharyngeal mucosa, which exposes nerve endings (specifically the glossopharyngeal and vagus nerves). This provides a direct portal for the poliovirus to enter the nervous system, significantly increasing the risk of the patient developing the **bulbar form of poliomyelitis**, which is the most severe and life-threatening manifestation of the disease. **Analysis of Incorrect Options:** * **A. Small atrophic tonsils:** These are not a contraindication. While they may be harder to dissect, they can still be a source of chronic infection or focal sepsis, necessitating removal. * **B. Quinsy (Peritonsillar Abscess):** While traditional teaching suggested waiting 4–6 weeks after an infection, "Quinsy Tonsillectomy" (abscess tonsillectomy) is now a recognized procedure performed during the acute phase to provide immediate drainage and prevent recurrence. * **D. Tonsillolith:** Tonsil stones are a common indication for tonsillectomy if they cause persistent halitosis, foreign body sensation, or recurrent discomfort. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications:** Bleeding disorders (e.g., Hemophilia, Leukemia), uncontrolled systemic disease (Diabetes, HTN), and acute infections (unless it's a Quinsy tonsillectomy). * **Relative Contraindications:** Cleft palate (risk of velopharyngeal insufficiency), age below 3 years, and menstruation (due to increased vascularity/bleeding risk). * **Most common complication:** Hemorrhage (Reactionary: within 24 hours; Secondary: 5–10 days due to infection). * **Most common nerve injured:** Glossopharyngeal nerve (leads to loss of taste on the posterior 1/3 of the tongue).

Question 1

What is the investigation of choice for Zenker's diverticulum?

Accepted Answer

Barium Swallow

Answer

CECT

Answer

Endoscopy

Answer

Esophageal manometry

Question 2

Unilateral posterior pharyngeal wall swelling is due to which of the following?

Accepted Answer

Acute retropharyngeal abscess

Answer

Peritonsillar abscess

Answer

Prevertebral abscess

Answer

Parapharyngeal abscess

Question 3

Which of the following is false about sideropenic dysphagia?

Accepted Answer

Pre-cricoid webs

Answer

Pre-malignant potential

Answer

Associated with anemia

Answer

Common in perimenopausal women

Question 4

A 9-year-old boy presents with nasal obstruction, proptosis, and recurrent epistaxis for 3-4 years. What is the appropriate management?

Accepted Answer

Embolisation followed by surgery

Answer

Routine radiological investigations

Answer

Embolisation alone should be done

Answer

Surgery is the treatment of choice

Question 5

What is a potential cause of cervical lymphadenopathy in a 70-year-old man?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Angiofibroma

Answer

Acoustic neuroma

Answer

Otosclerosis

Question 6

Epstein Barr virus is associated with which of the following carcinomas?

Accepted Answer

Carcinoma of the nasopharynx

Answer

Carcinoma of the larynx

Answer

Carcinoma of the bladder

Answer

Carcinoma of the maxilla

Question 7

A child presents with high fever and hoarseness of voice and is found to have a retropharyngeal abscess. All of the following statements are true about acute retropharyngeal abscess, EXCEPT:

Accepted Answer

Infection is posterior to the prevertebral fascia.

Answer

It is usually restricted to one side of the midline.

Answer

Causes difficulty in deglutition and respiration.

Answer

Can be easily palpated by placing a fingertip on the posterior pharyngeal wall.

Question 8

Tonsillectomy is contraindicated in which of the following conditions?

Accepted Answer

Poliomyelitis epidemic

Answer

Small atrophic tonsils

Answer

Quinsy

Answer

Tonsillolith

Question 9

Which of the following statements regarding adenoids is FALSE?

Accepted Answer

Immediate surgery is indicated even for minor symptoms related to adenoids.

Answer

Adenoids can be associated with failure to thrive.

Answer

Adenoids can contribute to a high-arched palate.

Answer

Adenoids commonly lead to mouth breathing.

Question 10

Which of the following statements is NOT true about nasopharyngeal carcinoma?

Accepted Answer

Nasopharyngectomy and lymph node dissection are the mainstay of treatment.

Answer

It has a bimodal age distribution.

Answer

EBV is implicated as an etiological agent.

Answer

Squamous cell carcinoma is the most common histological type.

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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