Pharyngitis — MCQs
A patient presents with fever and dysphagia. An image shows a tonsil that is pushed medially. What is the most likely diagnosis?
A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?
What is the drug that can be used for rheumatic fever prophylaxis in a patient with a history of allergy to Penicillin?
Drug of choice for rheumatic fever prophylaxis in a penicillin-allergic patient is?
Which of the following is NOT typically associated with acute bacterial sinusitis?
All of the following are true regarding Zenker's diverticulum EXCEPT?
X-ray showing an air column between a soft tissue mass and the posterior wall of the nasopharynx is suggestive of which of the following conditions?
What is a possible cause of cervical lymphadenopathy in a 70-year-old man?
The parapharyngeal space is also known as which of the following?
Lingual tonsils arise from which of the following processes?
Pharyngitis Indian Medical PG Practice Questions and MCQs
Question 1: A patient presents with fever and dysphagia. An image shows a tonsil that is pushed medially. What is the most likely diagnosis?
- A. Parapharyngeal abscess
- B. Retropharyngeal abscess
- C. Peritonsillar abscess (Correct Answer)
- D. Ludwig's angina
Explanation: ***Peritonsillar abscess*** - The image clearly shows **unilateral bulging** of the soft palate and displacement of the tonsil medially, consistent with a peritonsillar abscess. - Patients typically present with **fever**, **dysphagia**, severe sore throat, and a "hot potato" voice. *Parapharyngeal abscess* - A parapharyngeal abscess involves the **deep neck spaces** lateral to the pharynx, often presenting with neck swelling, trismus, and systemic symptoms. - While it can cause pharyngeal bulging, the classic **medial displacement of the tonsil** is more indicative of a peritonsillar abscess. *Retropharyngeal abscess* - This involves the space behind the posterior pharyngeal wall, usually presenting with **dysphagia**, **neck stiffness**, and fever. - Imaging would reveal a **prevertebral soft tissue swelling**, not primarily a medially displaced tonsil. *Ludwig's angina* - Ludwig's angina is a **rapidly spreading cellulitis** of the submandibular and sublingual spaces, typically arising from an odontogenic infection. - It presents with **woody induration** of the neck and floor of the mouth, elevation of the tongue, and potential airway compromise, but not primarily a medially displaced tonsil.
Question 2: A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?
- A. Acute Laryngotracheobronchitis (Correct Answer)
- B. Acute Bacterial Tracheitis
- C. Acute Epiglottitis
- D. Foreign Body aspiration
Explanation: ***Acute Laryngotracheobronchitis*** - The combination of **low-grade fever** and **stridor** in a 2-year-old child strongly suggests **croup**, which is medically known as acute laryngotracheobronchitis. - Croup is characterized by **inflammation** of the larynx, trachea, and bronchi, often presenting with a **barking cough** and inspiratory stridor. The X-ray image would show the characteristic **steeple sign**. *Acute Bacterial Tracheitis* - This is a more severe bacterial infection that can present with stridor but typically shows **higher fever**, **toxic appearance**, and rapid clinical deterioration. - Unlike croup, bacterial tracheitis patients appear **more ill** and may have **purulent secretions** requiring more aggressive management. *Acute Epiglottitis* - A serious condition characterized by **rapid onset of high fever**, **dysphagia**, drooling, and a **"tripod" position**, which are not indicated by the given symptoms. - The stridor in epiglottitis is typically quieter and may indicate more severe airway obstruction compared to the characteristic stridor of croup. *Foreign Body aspiration* - While foreign body aspiration can cause stridor, it is typically an **acute event** with a sudden onset of choking, coughing, and respiratory distress. - There is no mention of a choking episode or sudden onset, and a low-grade fever is less typical for an uncomplicated foreign body aspiration.
Question 3: What is the drug that can be used for rheumatic fever prophylaxis in a patient with a history of allergy to Penicillin?
- A. Erythromycin (Correct Answer)
- B. Amoxicillin
- C. Streptomycin
- D. Sulfasalazine
Explanation: ***Erythromycin*** - **Erythromycin** is a macrolide antibiotic that is a suitable alternative for **rheumatic fever prophylaxis** in patients with a documented allergy to penicillin. - It effectively covers *Streptococcus pyogenes*, the causative agent of group A streptococcal (GAS) pharyngitis that precedes rheumatic fever. *Amoxicillin* - **Amoxicillin** is a penicillin-class antibiotic and would be contraindicated in a patient with a **penicillin allergy**, as it carries a high risk of cross-reactivity and allergic reaction. - Using amoxicillin in this scenario could lead to severe hypersensitivity reactions, compromising patient safety. *Streptomycin* - **Streptomycin** is an aminoglycoside antibiotic primarily used for infections like **tuberculosis** and severe bacterial endocarditis. - It is not indicated for the treatment of *Streptococcus pyogenes* infections or for **rheumatic fever prophylaxis**. *Sulfasalazine* - **Sulfasalazine** is an anti-inflammatory and immunomodulatory drug primarily used in the management of **inflammatory bowel disease** and **rheumatoid arthritis**. - It has no antimicrobial activity against *Streptococcus pyogenes* and is therefore not used for **rheumatic fever prophylaxis**.
Question 4: Drug of choice for rheumatic fever prophylaxis in a penicillin-allergic patient is?
- A. Vancomycin
- B. Gentamycin
- C. Erythromycin (Correct Answer)
- D. Clindamycin
Explanation: ***Erythromycin*** - **Erythromycin** is the **recommended alternative** for **rheumatic fever prophylaxis** in patients with **penicillin allergy** according to **American Heart Association (AHA) guidelines**. - Typical regimen: **Erythromycin estolate 250 mg BID** or **erythromycin ethylsuccinate 400 mg BID**. - Effective against **Streptococcus pyogenes** (Group A Streptococcus), the causative organism of acute rheumatic fever. - While macrolide resistance exists in some regions, erythromycin remains the **guideline-recommended choice** when penicillin cannot be used. *Clindamycin* - **Clindamycin** is **not recommended** by major guidelines (AHA, WHO) for routine rheumatic fever prophylaxis. - Lacks adequate evidence and official guideline support for this specific indication. - May be considered in specific cases but is not the standard alternative. *Vancomycin* - **Vancomycin** is reserved for **multidrug-resistant infections** such as **MRSA**. - Not indicated for rheumatic fever prophylaxis due to high cost, need for IV administration, and potential for resistance development. - Reserved for life-threatening infections where other options have failed. *Gentamycin* - **Gentamycin** is an **aminoglycoside** used primarily for **severe gram-negative infections**. - Lacks adequate activity against **Streptococcus pyogenes**. - Not appropriate for rheumatic fever prophylaxis.
Question 5: Which of the following is NOT typically associated with acute bacterial sinusitis?
- A. Purulent nasal discharge
- B. Epistaxis (Correct Answer)
- C. Facial pain
- D. Fever
Explanation: ***Epistaxis*** - While possible due to **mucosal inflammation** or irritation from forceful blowing, **epistaxis (nosebleeds)** is not considered a typical or primary symptom of acute bacterial sinusitis. - The main symptoms revolve around pressure, discharge, and systemic signs of infection. *Purulent nasal discharge* - This is a hallmark symptom of acute bacterial sinusitis, indicating the presence of **bacterial infection** and inflammation in the sinuses. - The discharge is often thick, colored (yellow, green), and can be accompanied by a **foul odor**. *Facial pain* - **Facial pain** or pressure, especially around the cheeks, forehead, or eyes, is a characteristic symptom stemming from inflammation and fluid accumulation within the **sinus cavities**. - This pain often worsens when bending forward. *Fever* - **Fever** is a systemic sign of infection and is commonly present in acute bacterial sinusitis, especially in more severe cases. - It indicates the body's immune response to the bacterial invasion.
Question 6: All of the following are true regarding Zenker's diverticulum EXCEPT?
- A. It is a false diverticulum
- B. It occurs in children (Correct Answer)
- C. It is a posterior pharyngeal pulsion diverticulum
- D. The most common site for the diverticulum is Killian's dehiscence
Explanation: **Explanation:** Zenker’s diverticulum is a **pulsion diverticulum** caused by the herniation of the pharyngeal mucosa through a site of weakness in the muscular wall. 1. **Why Option B is the correct answer (False statement):** Zenker’s diverticulum is a disease of the **elderly**, typically occurring in the 7th or 8th decade of life. It is almost never seen in children because it is an acquired condition resulting from long-term incoordination of the cricopharyngeal muscle and increased intraluminal pressure. 2. **Why Option A is wrong (True statement):** It is a **false diverticulum** because it consists only of the mucosa and submucosa. A "true" diverticulum would involve all layers of the visceral wall, including the muscularis. 3. **Why Option C is wrong (True statement):** It is a **pulsion diverticulum** (pushed out by pressure) and it occurs **posteriorly** in the midline of the pharynx. 4. **Why Option D is wrong (True statement):** The anatomical site of herniation is **Killian’s dehiscence**, a triangular area of weakness between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor muscle. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Regurgitation of undigested food, halitosis (foul breath due to stagnant food), dysphagia, and a gurgling sound in the neck (Boyce’s sign). * **Diagnosis:** The investigation of choice is a **Barium Swallow**, which shows a pouch behind the esophagus. * **Management:** Endoscopic Dohlman’s procedure (stapling the party wall) or open diverticulectomy with cricopharyngeal myotomy. * **Complication:** Aspiration pneumonia is the most common serious complication.
Question 7: X-ray showing an air column between a soft tissue mass and the posterior wall of the nasopharynx is suggestive of which of the following conditions?
- A. Ethmoidal polyp
- B. Antrochoanal polyp (Correct Answer)
- C. Nasal myiasis
- D. None of the above
Explanation: ### Explanation **Correct Answer: B. Antrochoanal polyp** The characteristic radiological sign described—an **air column between the soft tissue mass and the posterior pharyngeal wall**—is a classic diagnostic feature of an **Antrochoanal Polyp (ACP)**. **Why it is correct:** An Antrochoanal polyp originates from the maxillary sinus mucosa, exits through the accessory ostium, and extends into the choana and nasopharynx. Because the polyp is pedunculated and hangs down from the choana into the oropharynx, it does not typically adhere to the posterior pharyngeal wall. On a lateral neck or skull X-ray, air can pass behind the mass, creating a visible radiolucent "air gap" or column. This distinguishes it from other fixed nasopharyngeal masses. **Why the other options are incorrect:** * **Ethmoidal Polyp:** These are usually multiple, bilateral, and originate from the ethmoid air cells. They rarely grow large enough to present as a solitary mass in the nasopharynx with a distinct posterior air column. * **Nasal Myiasis:** This is a parasitic infestation of the nose by maggots (*Chrysomya bezziana*). It presents with foul-smelling discharge, pain, and tissue destruction, not as a discrete nasopharyngeal soft tissue mass on X-ray. **High-Yield Clinical Pearls for NEET-PG:** * **Origin:** ACP most commonly arises from the **maxillary sinus** (specifically the lateral wall or floor). * **Clinical Presentation:** Usually **unilateral** nasal obstruction in children and young adults. * **Radiology:** On X-ray (Water’s view), you will see opacification of the involved maxillary sinus. On CT, it shows a "dumbbell-shaped" mass extending through the ostium. * **Treatment:** The treatment of choice is **Functional Endoscopic Sinus Surgery (FESS)** to remove the polyp and its base to prevent recurrence. Historically, the Caldwell-Luc operation was used.
Question 8: What is a possible cause of cervical lymphadenopathy in a 70-year-old man?
- A. Nasopharyngeal carcinoma (Correct Answer)
- B. Angiofibroma
- C. Acoustic neuroma
- D. Otosclerosis
Explanation: **Explanation:** **1. Why Nasopharyngeal Carcinoma (NPC) is correct:** In an elderly patient (70 years old) presenting with an isolated neck lump (cervical lymphadenopathy), a malignancy of the upper aerodigestive tract must be the first suspicion. **Nasopharyngeal carcinoma** is notorious for being "clinically silent" in its early stages; the primary tumor is often small, but it metastasizes early to the cervical lymph nodes. In fact, **cervical lymphadenopathy is the most common presenting symptom (60-80% of cases)**, typically involving the upper deep cervical (Level II) and posterior triangle nodes (Level V). **2. Why the other options are incorrect:** * **Angiofibroma (Juvenile Nasopharyngeal Angiofibroma):** This is a benign but locally aggressive vascular tumor. It occurs almost exclusively in **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 metastasize to lymph nodes. * **Otosclerosis:** This is a metabolic bone disease of the otic capsule causing conductive hearing loss. It is a localized ear pathology with no lymphatic involvement. **NEET-PG High-Yield Pearls:** * **Trottier’s Triad (NPC):** 1. Conductive hearing loss (due to Eustachian tube blockage), 2. Ipsilateral facial pain/numbness (CN V involvement), 3. Palatal paralysis (CN X involvement). * **Risk Factor:** Strongly associated with **Epstein-Barr Virus (EBV)**. * **Node of Rouviere:** The lateral retropharyngeal node is often the first site of metastasis in NPC. * **Rule of Thumb:** In any adult with unilateral serous otitis media, always examine the nasopharynx to rule out NPC.
Question 9: The parapharyngeal space is also known as which of the following?
- A. Retropharyngeal space
- B. Pyriform sinus
- C. Lateral pharyngeal space (Correct Answer)
- D. Pterygomaxillary space
Explanation: ### Explanation The **parapharyngeal space** (also known as the **lateral pharyngeal space** or pharyngomaxillary space) is a potential space shaped like an inverted pyramid, located lateral to the pharynx. **1. Why "Lateral Pharyngeal Space" is Correct:** The space is anatomically situated lateral to the pharyngeal wall. It is bounded medially by the buccopharyngeal fascia (covering the superior constrictor muscle) and laterally by the mandible, medial pterygoid muscle, and the deep lobe of the parotid gland. Because of its lateral position relative to the pharynx, it is synonymous with the lateral pharyngeal space. **2. Why Other Options are Incorrect:** * **Retropharyngeal space:** This is located **posterior** to the pharynx, between the buccopharyngeal fascia and the prevertebral fascia. It is a midline space, not lateral. * **Pyriform sinus:** This is a physiological recess of the **laryngopharynx** located on either side of the laryngeal inlet. It is a mucosal space, not a deep fascial neck space. * **Pterygomaxillary space:** This is a small area located between the maxilla and the pterygoid process, often considered a subset or related area of the infratemporal fossa, but it does not encompass the entire parapharyngeal region. **3. Clinical Pearls for NEET-PG:** * **Shape:** Inverted pyramid with the apex at the **greater cornu of the hyoid bone** and the base at the **skull base**. * **Compartments:** Divided by the styloid process into the **Pre-styloid** (contains internal maxillary artery, fat, and deep lobe of parotid) and **Post-styloid** (contains carotid artery, internal jugular vein, cranial nerves IX, X, XI, XII, and cervical sympathetic chain). * **Clinical Sign:** Infection or tumors here cause **medial displacement of the tonsil** and lateral pharyngeal wall. * **Trismus:** Common in pre-styloid involvement due to irritation of the medial pterygoid muscle.
Question 10: Lingual tonsils arise from which of the following processes?
- A. Developmental anomalies (Correct Answer)
- B. Carcinomatous transformation
- C. Hyperplasia
- D. Repeated trauma in the area
Explanation: **Explanation:** The **lingual tonsils** are part of the **Waldeyer’s ring**, located on the posterior third of the tongue. While they are normal anatomical structures, their clinical presentation as symptomatic masses or significant enlargements is primarily attributed to **developmental anomalies** during embryogenesis. They arise from the endoderm of the second pharyngeal pouch. In the context of "ectopic" or "accessory" lymphoid tissue appearing in unusual locations or presenting as congenital masses, they are classified under developmental variations. **Analysis of Options:** * **A. Developmental anomalies (Correct):** The formation and distribution of lymphoid tissue in the base of the tongue are determined during fetal development. Variations in the size and extent of this tissue are developmental in nature. * **B. Carcinomatous transformation:** While Squamous Cell Carcinoma (SCC) can occur in the lingual tonsils, it is a malignant change, not the *origin* of the tissue itself. * **C. Hyperplasia:** Compensatory hyperplasia (e.g., after palatine tonsillectomy) can make lingual tonsils more prominent, but the *existence* of the tissue is developmental. * **D. Repeated trauma:** Chronic irritation may cause inflammation (tonsillitis), but it does not give rise to the tonsillar tissue. **High-Yield Clinical Pearls for NEET-PG:** * **Waldeyer’s Ring:** Comprises the Nasopharyngeal (adenoid), Tubal, Palatine, and Lingual tonsils. * **Lingual Tonsil Hypertrophy:** Can cause "Lump in the throat" sensation (Globus pharyngeus) and is a known cause of difficult intubation (obscuring the epiglottis). * **Symptom:** Large lingual tonsils can lead to **Obstructive Sleep Apnea (OSA)** in adults. * **Nerve Supply:** The posterior 1/3rd of the tongue (including lingual tonsils) is supplied by the **Glossopharyngeal nerve (CN IX)**.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free