Diseases of the Pharynx Practice Questions

Q: Killian's dehiscence is found in which anatomical region?

Laryngopharynx. **Explanation:** **Killian’s dehiscence** is a potential weak area located in the posterior wall of the **laryngopharynx** (specifically the hypopharynx). It is a triangular gap situated between two parts of the inferior constrictor muscle: the upper oblique fibers (**thyropharyngeus**) and the lower horizontal fibers (**cricopharyngeus**). 1. **Why Laryngopharynx is Correct:** The inferior constrictor muscle is the lowermost muscle of the pharynx, forming the wall of the laryngopharynx. Killian’s dehiscence is clinically significant because it is the site of mucosal herniation in **Zenker’s diverticulum** (Pulsion diverticulum) due to high intrapharyngeal pressure during swallowing. 2. **Why other options are incorrect:** * **Oropharynx:** Located above the laryngopharynx; its muscles (middle constrictor) are well-supported and do not contain this specific dehiscence. * **Nasopharynx:** The uppermost part of the pharynx; the primary clinical concern here is the Fossa of Rosenmüller (site for nasopharyngeal carcinoma), not Killian's dehiscence. * **Lateral nasal wall:** This is an intranasal structure containing turbinates and meatuses, unrelated to the pharyngeal musculature. **High-Yield Clinical Pearls for NEET-PG:** * **Zenker’s Diverticulum:** Always occurs through Killian’s dehiscence. It is a "false" diverticulum (contains only mucosa and submucosa). * **Killian-Jamieson Area:** A separate weak area located *below* the cricopharyngeus, on the anterolateral aspect of the esophagus. * **Perforation Risk:** Killian’s dehiscence is the most common site for accidental pharyngeal perforation during rigid esophagoscopy.

Q: What is the most common site of origin for nasopharyngeal carcinoma?

Lateral wall. **Explanation:** **Nasopharyngeal Carcinoma (NPC)** is a unique malignancy with a strong association with the **Epstein-Barr Virus (EBV)**. **Why the Lateral Wall is Correct:** The most common site of origin for NPC is the **lateral wall** of the nasopharynx, specifically within a mucosal depression known as the **Fossa of Rosenmüller**. This fossa is located posterior to the medial end of the Eustachian tube orifice. Because of this proximity, early-stage tumors often obstruct the Eustachian tube, leading to unilateral serous otitis media—a classic clinical presentation. **Analysis of Incorrect Options:** * **Roof and Posterior Wall:** While the tumor can involve the roof (junction of the basisphenoid and basiocciput) and the posterior wall as it grows, these are secondary sites of extension rather than the primary site of origin. * **Anterior Wall:** The anterior wall of the nasopharynx is essentially the posterior choanae (opening into the nasal cavity). Primary malignancy rarely originates here; instead, tumors from the lateral wall may invade anteriorly into the nasal cavity. **High-Yield Clinical Pearls for NEET-PG:** * **Histology:** The most common type (WHO Type 3) is **Undifferentiated Carcinoma** (lymphoepithelioma), which is highly radiosensitive. * **Trotter’s Triad:** A classic diagnostic triad for NPC consisting of: 1. Conductive deafness (Eustachian tube blockage). 2. Ipsilateral temporofacial neuralgia (Trigeminal nerve involvement). 3. Palatal paralysis (Vagus nerve involvement). * **Presentation:** The most common presenting symptom is often a **painless upper deep cervical lymph node mass** (Level II/III). * **Treatment:** Radiotherapy is the primary treatment of choice for the local site and the neck.

Q: What is the commonest lymph node to enlarge in acute tonsillitis?

Jugulo-digastric. ### Explanation **Correct Option: B. Jugulo-digastric** The palatine tonsils are primarily drained by the deep cervical lymph nodes. The **Jugulo-digastric lymph node** (also known as the **"Tonsillar node"**) is a member of the upper deep cervical group, located just below the angle of the mandible, where the posterior belly of the digastric muscle crosses the internal jugular vein. Because it receives the direct lymphatic drainage from the tonsils, it is the first and most common node to become enlarged and tender during acute tonsillitis. **Analysis of Incorrect Options:** * **A. Jugulo-omohyoid:** This node is located where the omohyoid muscle crosses the internal jugular vein. It primarily drains the **tongue** (specifically the lateral margins and tip), not the tonsils. * **C. Posterior cervical:** These nodes are located along the spinal accessory nerve. They are typically enlarged in conditions like **Rubella** (Post-auricular/Occipital) or **Infectious Mononucleosis**, rather than isolated acute bacterial tonsillitis. * **D. Submandibular:** These nodes drain the submandibular salivary glands, floor of the mouth, gums, and anterior part of the tongue. While they may enlarge in oral cavity infections, they are not the primary drainage site for the tonsils. **Clinical Pearls for NEET-PG:** * **Phorbe’s Node:** Another name for the Jugulo-digastric node. * **Waldeyer’s Ring:** The palatine tonsils are part of this lymphoid ring, which also includes the adenoids (nasopharyngeal tonsil), lingual tonsils, and tubal tonsils. * **Blood Supply:** The main artery of the tonsil is the **Tonsillar branch of the Facial Artery**. * **Pain Referral:** Pain from acute tonsillitis is often referred to the ear via the **Glossopharyngeal nerve (CN IX)**.

Q: A child presented with high fever, severe sore throat, and painful swallowing. Her voice was abnormal. Quinsy was diagnosed. What is referred to as Quinsy?

Peritonsillar abscess. **Explanation:** **Quinsy** is the clinical term for a **Peritonsillar Abscess (PTA)**. It is a collection of pus in the potential space between the tonsillar capsule and the superior constrictor muscle. It typically occurs as a complication of acute follicular tonsillitis. **Why Option A is correct:** The clinical presentation described—high fever, severe odynophagia (painful swallowing), and an abnormal voice—is classic for Quinsy. The "abnormal voice" is specifically known as a **"Hot Potato Voice"** (muffled speech) due to edema and restricted movement of the soft palate. Other hallmark signs include **trismus** (difficulty opening the mouth due to irritation of the medial pterygoid muscle) and uvular deviation to the opposite side. **Why other options are incorrect:** * **Retropharyngeal Abscess:** This occurs in the space behind the pharynx (Prevertebral space). It is more common in infants and presents with neck stiffness and inspiratory stridor rather than trismus. * **Parapharyngeal Abscess:** This involves the lateral pharyngeal space. While it also causes trismus and fever, the swelling is typically located behind the posterior pillar and at the angle of the mandible, rather than the peritonsillar region. **NEET-PG High-Yield Pearls:** * **Most common organism:** *Streptococcus pyogenes* (Group A Strep). * **Site of infection:** Usually starts in the **Crypta Magna**. * **Management:** The gold standard is **Incision and Drainage (I&D)** at the point of maximum bulge (usually lateral to the junction of the anterior pillar and a horizontal line through the base of the uvula). * **Interval Tonsillectomy:** Performed 4–6 weeks after the abscess resolves to prevent recurrence.

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

All of the above. **Explanation:** Adenoidectomy is a common pediatric surgical procedure, but it carries specific contraindications that are frequently tested in the NEET-PG exam. The correct answer is **All of the above** because each option represents a critical clinical scenario where surgery is either unsafe or leads to poor functional outcomes. 1. **Bleeding Disorders (A):** Adenoidectomy is a highly vascular procedure performed in a space where direct pressure is difficult to apply. Conditions like Hemophilia or Von Willebrand disease are absolute contraindications unless the clotting factors are adequately replaced, as they pose a high risk of life-threatening primary or reactionary hemorrhage. 2. **Infection (B):** Surgery should not be performed during an acute upper respiratory tract infection (URTI). Acute infection increases the vascularity of the lymphoid tissue, significantly raising the risk of intraoperative bleeding. It also increases the risk of postoperative complications like pneumonia or septicemia. 3. **Submucous Cleft Palate (C):** This is a **classic high-yield contraindication**. In these patients, the adenoid mass acts as a "plug" that helps the short or weak palate achieve velopharyngeal closure. Removing the adenoids creates a large gap, leading to **Velopharyngeal Insufficiency (VPI)**, which results in hypernasal speech (rhinolalia aperta) and nasal regurgitation of food. **Clinical Pearls for NEET-PG:** * **Most common complication:** Postoperative hemorrhage (Primary or Reactionary). * **Velopharyngeal Insufficiency:** Always palpate the hard palate for a "notch" and look for a bifid uvula before surgery to rule out submucous cleft palate. * **Age Factor:** Generally avoided in children under 3 years unless there is severe obstructive sleep apnea (OSA). * **Other contraindications:** Severe anemia and uncontrolled systemic diseases.

Q: What is the recommended treatment for a peritonsillar abscess?

Abscess drainage followed by interval tonsillectomy. ### Explanation **Peritonsillar Abscess (Quinsy)** is a collection of pus between the tonsillar capsule and the superior constrictor muscle. **Why Option D is Correct:** The standard management of Quinsy involves immediate **Incision and Drainage (I&D)** or needle aspiration to relieve pressure and prevent complications like airway obstruction or parapharyngeal space spread. However, because Quinsy has a high recurrence rate (approx. 10-15%), an **Interval Tonsillectomy** is performed 4–6 weeks after the acute infection has subsided. This "interval" allows the inflammation to resolve, making the surgery safer and reducing the risk of intraoperative hemorrhage. **Analysis of Incorrect Options:** * **A. Tonsillectomy:** While "Quinsy Tonsillectomy" (hot tonsillectomy) can be done during the acute phase, it is not the standard recommendation due to the high risk of bleeding and systemic spread of infection. * **B. Conservative management:** Antibiotics alone are insufficient for a formed abscess; surgical drainage is mandatory. * **C. Drainage using Hilton's method:** This method is specifically used for **deep neck space abscesses** (like parapharyngeal or submandibular abscesses) to avoid injuring vital structures. Quinsy is drained via a mucosal incision at the point of maximum bulge. **Clinical Pearls for NEET-PG:** * **Site of Incision:** The most common site for drainage is at the intersection of a horizontal line through the base of the uvula and a vertical line through the anterior pillar. * **Clinical Sign:** **Trismus** (due to irritation of the medial pterygoid muscle) is a hallmark sign of Quinsy. * **Uvular Deviation:** The uvula is typically pushed to the **contralateral** (opposite) side. * **Organism:** Most common aerobic organism is *Streptococcus pyogenes*; however, it is often a mixed infection including anaerobes.

Question 1

A case presenting with a gray-colored pseudomembrane whose removal is difficult and painful can be indicative of which of the following conditions?

Accepted Answer

Diphtheritic lesion

Answer

Acute necrotizing ulcerative gingivitis (ANUG)

Answer

Secondary stage of syphilis

Answer

Desquamative gingivitis

Question 2

Killian's dehiscence is found in which anatomical region?

Accepted Answer

Laryngopharynx

Answer

Oropharynx

Answer

Nasopharynx

Answer

Lateral nasal wall

Question 3

What is the most common site of origin for nasopharyngeal carcinoma?

Accepted Answer

Lateral wall

Answer

Roof

Answer

Posterior wall

Answer

Anterior wall

Question 4

What is the most common cause of parapharyngeal abscess?

Accepted Answer

Removal of tonsil

Answer

Hematogenous spread

Answer

Penetrating trauma

Answer

Blunt trauma

Question 5

What is the commonest lymph node to enlarge in acute tonsillitis?

Accepted Answer

Jugulo-digastric

Answer

Jugulo-omohyoid

Answer

Posterior cervical

Answer

Submandibular

Question 6

What is true about Angiofibroma?

Accepted Answer

Recurrence rate is high

Answer

Radiotherapy is the main treatment

Answer

Exclusively in females

Answer

Biopsy is must before initiating treatment

Question 7

A 70-year-old smoker presents with a 3-month history of dysphagia and weight loss. Flexible nasoendoscopy shows pooling of saliva in the pyriform fossae, with restricted mobility of the right hemi-larynx. Malignancy is suspected. At surgery, you find a 3 cm tumour affecting the right pyriform fossa and extending into the post-cricoid region. According to the TNM staging, what T-stage is this malignancy?

Accepted Answer

T2

Answer

T1

Answer

T4a

Answer

T3

Question 8

A child presented with high fever, severe sore throat, and painful swallowing. Her voice was abnormal. Quinsy was diagnosed. What is referred to as Quinsy?

Accepted Answer

Peritonsillar abscess

Answer

Retropharyngeal abscess

Answer

Parapharyngeal abscess

Answer

Any of the above

Question 9

Adenoidectomy is contraindicated in which of the following conditions?

Accepted Answer

All of the above

Answer

Bleeding disorder

Answer

Infection

Answer

Submucous cleft palate

Question 10

What is the recommended treatment for a peritonsillar abscess?

Accepted Answer

Abscess drainage followed by interval tonsillectomy

Answer

Tonsillectomy

Answer

Conservative management

Answer

Drainage using Hilton's method

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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