Diseases of the Pharynx Practice Questions

Q: Which nerve is liable to get injured during the removal of a fish bone from the pyriform fossa?

Internal laryngeal nerve. **Explanation:** The **internal laryngeal nerve** is the correct answer due to its specific anatomical location relative to the pyriform fossa. **1. Why the Internal Laryngeal Nerve is correct:** The pyriform fossa is a mucosal-lined depression located on either side of the laryngeal inlet. The **internal laryngeal nerve** (a branch of the Superior Laryngeal Nerve) runs submucosally beneath the mucous membrane of the **floor of the pyriform fossa**. It pierces the thyrohyoid membrane to provide sensory innervation to the larynx above the vocal cords. Because it lies just beneath the thin mucosa, it is highly vulnerable to injury during the removal of impacted foreign bodies (like fish bones) or during the accidental penetration of the fossa by instruments. **2. Why other options are incorrect:** * **Superior Laryngeal Nerve (SLN):** This is the parent trunk. While it is related, it divides into internal and external branches before reaching the fossa. The internal branch is the specific structure at risk within the fossa itself. * **External Laryngeal Nerve:** This nerve remains outside the larynx to supply the cricothyroid muscle. It does not enter the pyriform fossa. * **Recurrent Laryngeal Nerve (RLN):** This nerve ascends in the tracheoesophageal groove and enters the larynx near the cricothyroid joint. It is not located in the floor of the pyriform fossa. **Clinical Pearls for NEET-PG:** * **Sensory Innervation:** The internal laryngeal nerve mediates the **cough reflex**. Injury leads to anesthesia of the supraglottic larynx, increasing the risk of aspiration. * **Foreign Bodies:** The pyriform fossa is the most common site for impacted fish bones in the throat. * **Nerve Block:** The internal laryngeal nerve can be intentionally blocked via the pyriform fossa using topical anesthesia for awake intubation.

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 primary treatment for adenoid hypertrophy?

Nasal decongestants. ### Explanation **Primary Treatment Approach:** The management of adenoid hypertrophy follows a step-ladder approach. The **primary (initial) treatment** is conservative medical management. Since the main symptom is nasal obstruction caused by inflammatory edema and lymphoid hyperplasia, **nasal decongestants** (often combined with nasal steroid sprays like Mometasone or Fluticasone) are used to reduce mucosal swelling and improve the airway. This provides symptomatic relief and may prevent the need for surgery in mild to moderate cases. **Analysis of Options:** * **A. Nasal decongestants (Correct):** They act as the first line of management to shrink the nasal mucosa and improve drainage, addressing the immediate obstructive symptoms. * **B. Antibiotics:** While used if there is evidence of secondary bacterial infection (adenoiditis), they are not the primary treatment for simple hypertrophy unless an active infection is present. * **C. Beta-blockers:** These have no role in the management of lymphoid tissue or upper airway obstruction. * **D. None of the above:** Incorrect, as medical management is the standard initial protocol. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Diagnostic nasal endoscopy (DNE) is the most accurate; however, X-ray soft tissue nasopharynx (lateral view) is the classic screening tool showing a soft tissue mass narrowing the nasopharyngeal airway. * **Adenoid Facies:** Characterized by an open mouth, elongated face, high-arched palate, and crowded teeth due to chronic mouth breathing. * **Definitive Treatment:** If medical management fails or if there are complications like Obstructive Sleep Apnea (OSA) or recurrent Otitis Media with Effusion (OME), **Adenoidectomy** is the treatment of choice. * **Associated Condition:** Adenoid hypertrophy is the most common cause of **Otitis Media with Effusion (Glue Ear)** in children due to Eustachian tube blockage.

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: The most common site for lodging of a foreign body in the esophagus is:

Upper esophagus. The esophagus has four physiological constrictions where foreign bodies (FBs) are most likely to get trapped. **1. Why the Upper Esophagus is Correct:** The most common site for foreign body lodging (approx. 70-75% of cases) is the **Cricopharyngeal sphincter** (the upper esophageal sphincter). This is the narrowest part of the entire esophagus, located at the level of the **C6 vertebra**. In children, coins are the most common FB found here, while in adults, it is often boluses of meat or fish bones. **2. Analysis of Incorrect Options:** * **B. Trachea bifurcation:** This corresponds to the second constriction (level of T4) where the left main bronchus crosses the esophagus. While a site of narrowing, it is wider than the cricopharyngeus. * **C. Aortic arch area:** This is the third constriction (level of T4). Like the tracheal bifurcation, it is a potential site for impaction but statistically less common than the upper sphincter. * **D. Lower esophagus:** This refers to the fourth constriction where the esophagus pierces the diaphragm (level of T10). While FBs can lodge here, it is more common in patients with underlying pathology like achalasia or peptic strictures. **Clinical Pearls for NEET-PG:** * **Most common FB in children:** Coins. * **Most common FB in adults:** Meat bolus/bones. * **Radiology:** On X-ray (Lateral view), a foreign body in the **esophagus** lies posterior to the trachea. On AP view, a coin in the esophagus appears as a **circular disc**, whereas in the trachea, it appears as a **vertical line** (due to the trachealis muscle). * **Management:** Rigid esophagoscopy is the gold standard for removal.

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: What is the distance from the central incisor to the cricopharyngeal sphincter?

15 cm. **Explanation:** The distance from the **central incisors** is a standard clinical measurement used in endoscopy (esophagoscopy) to locate anatomical landmarks and constrictions of the esophagus. **1. Why 15 cm is correct:** The **cricopharyngeal sphincter** (upper esophageal sphincter) is the first and narrowest constriction of the esophagus. It is located at the level of the **C6 vertebra**, which corresponds to a distance of approximately **15 cm** from the upper central incisor teeth in an average adult. This is a critical landmark for endoscopists, as it represents the most common site for accidental perforation during instrumentation. **2. Analysis of Incorrect Options:** * **25 cm (Option B):** This represents the distance from the incisors to the **mid-esophagus**, specifically where the left main bronchus and the arch of the aorta cross the esophagus (the second constriction). * **40 cm (Option C):** This is the distance from the incisors to the **gastroesophageal junction** (lower esophageal sphincter), where the esophagus pierces the diaphragm at the level of T10. * **50 cm (Option D):** This distance extends beyond the stomach and is not a standard anatomical landmark for esophageal constrictions. **High-Yield Clinical Pearls for NEET-PG:** * **Total Length of Esophagus:** 25 cm. * **Four Constrictions (Distance from Incisors):** 1. **Cricopharyngeal Sphincter:** 15 cm (Narrowest part). 2. **Aortic Arch:** 22 cm. 3. **Left Main Bronchus:** 27 cm. 4. **Diaphragmatic Hiatus:** 40 cm. * **Killian’s Dehiscence:** A potential weak spot between the thyropharyngeus and cricopharyngeus muscles, often the site for **Zenker’s Diverticulum** formation. * **Foreign Bodies:** Most commonly lodge at the level of the cricopharyngeus (15 cm mark).

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.

Question 1

Which nerve is liable to get injured during the removal of a fish bone from the pyriform fossa?

Accepted Answer

Internal laryngeal nerve

Answer

Superior laryngeal nerve

Answer

External laryngeal nerve

Answer

Recurrent laryngeal nerve

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 primary treatment for adenoid hypertrophy?

Accepted Answer

Nasal decongestants

Answer

Antibiotics

Answer

Beta-blockers

Answer

None of the above

Question 4

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

Accepted Answer

Lateral wall

Answer

Roof

Answer

Posterior wall

Answer

Anterior wall

Question 5

What is the most common cause of parapharyngeal abscess?

Accepted Answer

Removal of tonsil

Answer

Hematogenous spread

Answer

Penetrating trauma

Answer

Blunt trauma

Question 6

The most common site for lodging of a foreign body in the esophagus is:

Accepted Answer

Upper esophagus

Answer

Trachea bifurcation

Answer

Aortic arch area

Answer

Lower esophagus

Question 7

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

Accepted Answer

Jugulo-digastric

Answer

Jugulo-omohyoid

Answer

Posterior cervical

Answer

Submandibular

Question 8

What is the distance from the central incisor to the cricopharyngeal sphincter?

Accepted Answer

15 cm

Answer

25 cm

Answer

40 cm

Answer

50 cm

Question 9

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 10

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

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

On this page

Practice by Chapter

Want unlimited practice?