Tonsillitis — MCQs

10 questions

A patient presented with 2 days history of fever. On examination there was a swelling in the neck and one side tonsil was pushed to midline. What is the most likely diagnosis:-

Acute tonsillitis affects which nerve:

A 21-year-old college student presents with hot potato voice and trismus. Clinical diagnosis is?

What is the most common cause of acute tonsillitis?

A 12-year-old boy develops a sore throat of 4-day duration. On examination, a yellow-grayish patch is seen over both tonsils, and a foul smell is coming from his mouth. Which non-suppurative complication is most commonly associated with streptococcal throat infections?

A patient presents with fever and dysphagia. An image shows a tonsil that is pushed medially. What is the most likely diagnosis?

A 3-year-old boy presents with fever, throat pain, and difficulty swallowing. On examination, there is unilateral tonsillar swelling with deviation of the uvula. What is the most likely diagnosis?

A 15 years old Male presented with history of fever since 2 days, unable to swallow the food with muffled voice. On examination it is noted right tonsil is shifted to midline. What is the diagnosis:

Which is incorrect about the instrument shown?

Q10Medium

All of the following are true regarding Zenker's diverticulum EXCEPT?

Tonsillitis Indian Medical PG Practice Questions and MCQs

Question 1: A patient presented with 2 days history of fever. On examination there was a swelling in the neck and one side tonsil was pushed to midline. What is the most likely diagnosis:-

A. Retropharyngeal abscess
B. Parapharyngeal abscess
C. Tonsillitis
D. Quinsy (Correct Answer)

Explanation: ***Quinsy (Peritonsillar abscess)*** - **Quinsy** is a **peritonsillar abscess** that presents with fever, severe throat pain, and the pathognomonic sign of **unilateral tonsil pushed toward the midline**. - The abscess forms in the **peritonsillar space** (between the tonsillar capsule and superior constrictor muscle), causing **medial displacement of the tonsil** and **bulging of the soft palate**. - Patients typically have **trismus, dysphagia, "hot potato voice"** and may have visible neck swelling. - This clinical presentation exactly matches the description: tonsil pushed to midline is the **classic finding for peritonsillar abscess**. *Parapharyngeal abscess* - A **parapharyngeal abscess** involves the deep parapharyngeal space lateral to the pharynx. - While it can cause neck swelling and fever, it typically causes **fullness and induration of the lateral pharyngeal wall** rather than prominent medial displacement of the tonsil itself. - The **tonsil is usually NOT pushed to the midline** in parapharyngeal abscess; instead, there is lateral pharyngeal wall bulging. - Often presents with more prominent external neck swelling below the angle of mandible. *Retropharyngeal abscess* - A **retropharyngeal abscess** occurs in the retropharyngeal space behind the posterior pharyngeal wall. - Presents with **posterior pharyngeal wall bulge**, neck stiffness, and dysphagia. - Does **NOT cause medial displacement of the tonsil** as the abscess is posterior, not lateral to the tonsil. *Tonsillitis* - **Acute tonsillitis** causes bilateral tonsillar inflammation with erythema and exudates. - While both tonsils may be enlarged, there is **no unilateral medial displacement** of one tonsil. - Less likely to cause significant neck swelling compared to deep space infections.

Question 2: Acute tonsillitis affects which nerve:

A. Glossopharyngeal Nerve (Correct Answer)
B. Facial Nerve
C. Trigeminal nerve
D. Vagus Nerve

Explanation: ***Correct: Glossopharyngeal Nerve*** - The **glossopharyngeal nerve (CN IX)** provides the **primary sensory innervation** to the palatine tonsils - This innervation is responsible for the sensation of **sore throat** and **referred otalgia** (ear pain) commonly experienced during acute tonsillitis - The tonsillar branch of CN IX specifically innervates the tonsillar region *Incorrect: Facial Nerve* - The **facial nerve (CN VII)** is primarily responsible for **facial expression**, taste sensation from the anterior two-thirds of the tongue, and innervation of tear and salivary glands - It has no direct sensory or motor innervation of the tonsils *Incorrect: Trigeminal Nerve* - The **trigeminal nerve (CN V)** provides sensory innervation to the **face**, sinuses, and teeth, and motor innervation to the muscles of mastication - It does not directly innervate the tonsils *Incorrect: Vagus Nerve* - The **vagus nerve (CN X)** innervates structures in the pharynx, larynx, and abdominal organs through the pharyngeal plexus - While it contributes to pharyngeal sensation, the **glossopharyngeal nerve** is the primary sensory innervation for the tonsils themselves in acute tonsillitis

Question 3: A 21-year-old college student presents with hot potato voice and trismus. Clinical diagnosis is?

A. Chronic Tonsillitis
B. Epiglottitis
C. Quinsy (Correct Answer)
D. Infectious mononucleosis

Explanation: ***Quinsy*** - **Quinsy**, or **peritonsillar abscess**, is characterized by a "hot potato" or muffled voice and **trismus** (difficulty opening the mouth) due to inflammation and muscle spasm. - The abscess typically forms adjacent to the palatine tonsil, causing severe unilateral throat pain and difficulty swallowing. *Chronic Tonsillitis* - **Chronic tonsillitis** is characterized by recurrent episodes of throat pain, fever, and enlarged tonsils, but does not typically present with acute **trismus** or a "hot potato" voice. - It results from persistent or repeated bacterial infections of the tonsils, often without significant abscess formation. *Epiglottitis* - **Epiglottitis** presents with rapid onset of severe sore throat, **dysphagia**, drooling, and inspiratory stridor, and can be life-threatening due to airway obstruction. - While it causes significant throat pain and difficulty swallowing, it does not typically present with a "hot potato" voice or **trismus**, but rather a muffled voice and tripod positioning. *Infectious mononucleosis* - **Infectious mononucleosis** leads to swollen tonsils with exudates, fatigue, and lymphadenopathy, but usually does not cause **trismus** or the distinctive "hot potato" voice. - It is caused by the **Epstein-Barr virus** and can lead to significant pharyngitis, but is not associated with peritonsillar abscess formation.

Question 4: What is the most common cause of acute tonsillitis?

A. Streptococcus pneumoniae
B. H. influenzae
C. Staphylococcus aureus
D. Group A beta-hemolytic streptococci (Correct Answer)

Explanation: ***Group A beta-hemolytic streptococci*** - **Group A Streptococcus (GAS)**, specifically *Streptococcus pyogenes*, is the most frequent bacterial cause of **acute tonsillitis** and pharyngitis, especially in school-aged children. - Infection can lead to complications such as **rheumatic fever** and **post-streptococcal glomerulonephritis** if not appropriately treated. *Streptococcus pneumoniae* - While *S. pneumoniae* is a common cause of **otitis media**, **sinusitis**, and **pneumonia**, it is less commonly the primary cause of acute tonsillitis. - It typically causes respiratory infections involving the lower airways or adjacent structures rather than primarily tonsillar inflammation. *H. Influenza* - *Haemophilus influenzae* is a significant pathogen for **otitis media**, **epiglottitis**, and **meningitis**, particularly in unvaccinated children. - It is not a common primary cause of acute tonsillitis, which is predominantly bacterial or viral. *Staphylococcus aureus* - *Staphylococcus aureus* is often associated with **skin and soft tissue infections**, as well as more serious conditions like **sepsis** and **endocarditis**. - Although it can cause pharyngeal infections, it is an infrequent cause of acute tonsillitis compared to Group A Streptococcus.

Question 5: A 12-year-old boy develops a sore throat of 4-day duration. On examination, a yellow-grayish patch is seen over both tonsils, and a foul smell is coming from his mouth. Which non-suppurative complication is most commonly associated with streptococcal throat infections?

A. Acute glomerulonephritis
B. Acute rheumatic fever (Correct Answer)
C. Scarlet fever
D. Both acute rheumatic fever and acute glomerulonephritis

Explanation: ***Acute rheumatic fever*** - **Acute rheumatic fever (ARF)** is a serious **non-suppurative complication** of streptococcal pharyngitis, primarily caused by **Group A Streptococcus (GAS)** [1]. - It involves **inflammatory lesions** of the heart, joints, brain, and subcutaneous tissues [2]. *Acute glomerulonephritis* - This is also a **non-suppurative complication** of streptococcal infection but is typically less common than acute rheumatic fever following pharyngitis. - **Acute post-streptococcal glomerulonephritis** is more frequently associated with **streptococcal skin infections (impetigo)** than pharyngeal infections. *Scarlet fever* - **Scarlet fever** is a **toxin-mediated disease** that is a direct manifestation of a streptococcal infection, not a non-suppurative complication. - It presents with a characteristic **rash**, **strawberry tongue**, and fever, making it a different category of streptococcal sequela. *Both acute rheumatic fever and acute glomerulonephritis* - While both can be non-suppurative complications, **acute rheumatic fever** is the **most commonly associated** non-suppurative complication specifically with **streptococcal throat infections** [1]. - **Acute glomerulonephritis** has a stronger association with **skin infections** and is less common after pharyngitis compared to acute rheumatic fever.

Question 6: 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 7: A 3-year-old boy presents with fever, throat pain, and difficulty swallowing. On examination, there is unilateral tonsillar swelling with deviation of the uvula. What is the most likely diagnosis?

A. Parapharyngeal abscess
B. Ludwig's angina
C. Peritonsillar abscess (Correct Answer)
D. Retropharyngeal abscess

Explanation: ***Peritonsillar abscess*** - This is the most common deep neck infection and typically presents with **unilateral tonsillar swelling**, **uvular deviation**, fever, and severe sore throat with difficulty swallowing (dysphagia) or speaking (muffled voice). - It usually develops as a complication of **acute tonsillitis**, where infection spreads from the tonsil into the peritonsillar space. *Parapharyngeal abscess* - While it can cause fever and severe throat pain, it typically presents with **trismus**, neck swelling below the angle of the mandible, and medial displacement of the lateral pharyngeal wall, rather than direct uvula deviation. - This type of abscess is located in the **parapharyngeal space**, which is lateral to the pharynx, and causes more diffuse swelling. *Ludwig's angina* - This is a rapidly spreading cellulitis of the **submandibular** and **sublingual spaces** and does not primarily involve the tonsils or cause uvular deviation. - Patients typically present with **symmetrical submental swelling**, painful swallowing, and tongue elevation, which can lead to airway obstruction. *Retropharyngeal abscess* - This abscess forms in the space behind the posterior pharyngeal wall and is more common in young children. - It often causes **neck stiffness**, muffled voice, stridor, and difficulty breathing, but less commonly presents with unilateral tonsillar swelling and uvular deviation.

Question 8: A 15 years old Male presented with history of fever since 2 days, unable to swallow the food with muffled voice. On examination it is noted right tonsil is shifted to midline. What is the diagnosis:

A. Quincy (Correct Answer)
B. Acute tonsillitis
C. Parapharyngeal abscess
D. Acute retropharyngeal abscess

Explanation: ***Quincy (Peritonsillar abscess)*** - This patient's presentation with **fever**, **dysphagia**, **muffled voice** (hot potato voice), and **tonsil shifted to the midline** is classic for a **peritonsillar abscess (Quincy)**. - The affected tonsil is pushed **medially toward the midline** by the collection of pus between the tonsillar capsule and the superior constrictor muscle. - The uvula is typically deviated to the **contralateral side**, and patients often have **trismus** and difficulty opening the mouth. - This is the **most common deep neck space infection** and typically follows acute tonsillitis. *Parapharyngeal abscess* - A **parapharyngeal abscess** would present with **severe trismus**, **neck swelling**, **torticollis**, and **bulging of the lateral pharyngeal wall**. - While it can push the tonsil medially, it more characteristically causes **anterolateral displacement** of the entire pharyngeal wall rather than isolated tonsillar displacement. - Patients typically have more pronounced **systemic toxicity** and **neck involvement** than seen with peritonsillar abscess. *Acute tonsillitis* - **Acute tonsillitis** presents with **bilateral tonsillar enlargement**, exudates, and pharyngeal erythema. - It does not cause **displacement of the tonsil to the midline** or significant **muffled voice**. - While fever and dysphagia are present, the physical examination finding of tonsillar shift indicates a suppurative complication (abscess formation). *Acute retropharyngeal abscess* - An **acute retropharyngeal abscess** occurs in the retropharyngeal space behind the posterior pharyngeal wall. - It presents with **neck stiffness**, **stridor**, **drooling**, **bulging of the posterior pharyngeal wall**, and **reluctance to extend the neck**. - It would **not cause visible displacement of the tonsil to the midline** as the abscess is in a different anatomical space. - More common in **young children** (under 5 years) than adolescents.

Question 9: Which is incorrect about the instrument shown?

A. Boyle Davis gag
B. Uses a draffin bipod stand (Correct Answer)
C. Used in uvulopalatopharyngoplasty
D. Used to perform procedures on the tongue

Explanation: ***Uses a draffin bipod stand*** - The image shows a **Boyle-Davis mouth gag** being used, which is typically self-retaining and **does not require an additional stand** such as a Draffin bipod. - The Draffin bipod stand is primarily used with a **Draffin mouth gag** or similar instruments to provide stability and hands-free retraction. *Boyle Davis gag* - The instrument shown suspending the tongue and keeping the mouth open is indeed a **Boyle-Davis self-retaining mouth gag**, commonly used in tonsillectomies and other oral cavity procedures. - Its design includes a central part that keeps the jaws apart and a tongue blade to depress the tongue. *Used in uvulopalatopharyngoplasty* - The Boyle-Davis mouth gag provides excellent exposure of the **oropharynx**, making it suitable for procedures like **uvulopalatopharyngoplasty (UPPP)**, which aims to improve breathing by reshaping the soft palate and uvula. - It allows for clear visualization and access to the surgical area in the back of the throat. *Used to perform procedures on the tongue* - While its primary function is to retract the tongue and keep the mouth open, it also provides good access for procedures directly on the tongue, such as **tongue base reduction** or biopsy. - The tongue blade component directly depresses the tongue, facilitating its manipulation for surgical access.

Question 10: 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.

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