NEET-PG 2013 Practice Questions

Q: Lymphatic drainage of oropharynx is mainly through?

Jugulodigastric node. ***Jugulodigastric node*** - The **jugulodigastric node** (also known as the principal node of Küttner) is the primary drainage site for infections and malignancies of the posterior third of the tongue and tonsils, which are key components of the oropharynx. - It is a prominent node within the **deep cervical lymph node** chain, specifically located in the superior deep cervical group. *Superficial cervical lymph nodes* - These nodes primarily drain the superficial structures of the neck, scalp, and ear, and are **not the main drainage pathway** for the oropharynx. - They form a chain along the external jugular vein. *Submandibular nodes* - The **submandibular nodes** mainly drain the anterior two-thirds of the tongue, gums, floor of the mouth, and anterior face. - While part of the oral cavity, they are **not the primary drainage** for the oropharynx itself. *Jugulo-omohyoid nodes* - The **jugulo-omohyoid node** is located lower in the deep cervical chain, near the intermediate tendon of the omohyoid muscle. - It is a key drainage node for the **anterior tongue**, but not the primary or main drainage for the entire oropharynx.

Q: Inlet of larynx is formed by:

Aryepiglottic fold. ***Aryepiglottic fold*** - The **inlet of the larynx** is the opening into the laryngeal cavity from the pharynx. - It is bordered anteriorly by the **epiglottis**, laterally by the **aryepiglottic folds**, and posteriorly by the **arytenoid cartilages** and **interarytenoid notch**. *False vocal cord* - The **false vocal cords** (ventricular folds) are located within the laryngeal cavity, inferior to the inlet. - They play a protective role but do not form the boundaries of the laryngeal inlet itself. *Folds from the base of the tongue to the epiglottis* - These folds, including the **glossoepiglottic folds**, connect the tongue to the epiglottis. - They are superior to the laryngeal inlet and are part of the oropharynx, not direct borders of the inlet. *Vocal cord* - The **true vocal cords** are responsible for voice production and are located deeper within the larynx, inferior to the false vocal cords. - They do not form any part of the laryngeal inlet.

Q: What is the most common cause of an oroantral fistula?

Tooth extraction. ***Tooth extraction*** - Extrinsic trauma, particularly during the **extraction of maxillary posterior teeth**, is the most frequent cause of an oroantral fistula. - The close anatomical relationship between the **roots of maxillary molars and premolars** and the floor of the maxillary sinus makes this a common complication. *TB* - While tuberculosis can cause various oral and maxillofacial lesions, it is an **extremely rare cause** of oroantral fistulas. - TB lesions typically present as **ulcerations or granulomas**, rather than direct fistulous tracts to the sinus. *Penetrating injury* - Penetrating injuries can certainly cause communication between the oral cavity and the maxillary sinus, but they are **less common than tooth extractions** in their overall incidence. - Such injuries are usually associated with **trauma or foreign bodies**, which are not the primary mechanism for most oroantral fistulas. *Maxillary sinusitis* - Maxillary sinusitis can occasionally lead to bone erosion and communication with the oral cavity, but it is **not the most common etiology** for an oroantral fistula. - Sinusitis more often causes **symptoms such as facial pain, pressure, and discharge**, rather than a direct fistula as a primary presentation.

Q: Which part of the larynx is most commonly involved in tuberculosis (TB)?

Posterior. ***Posterior*** - The **posterior larynx**, specifically the **arytenoids** and **interarytenoid area**, is the most common site for tuberculosis involvement. - This region is susceptible due to its rich **lymphatic supply** and direct exposure to infected secretions from the lungs. *Anterior* - While TB can affect any part of the larynx, the **anterior laryngeal structures** are less frequently the primary site of involvement. - The vocal cords, which are in the anterior-middle aspect, are less commonly affected initially compared to the posterior structures. *Middle* - The middle part of the larynx, including the **vocal cords**, is not the predominant site for initial tuberculous lesions. - Involvement here often occurs as the disease progresses from more commonly affected areas. *Anywhere* - Although TB can theoretically affect any part of the larynx, it demonstrates a strong predilection for the **posterior laryngeal region**. - Stating "anywhere" does not accurately reflect the statistically significant preference for specific anatomical sites.

Q: Laryngitis sicca is associated with ?

Klebsiella rhinoscleromatosis. ***Klebsiella rhinoscleromatis*** - **Laryngitis sicca** is characterized by extreme dryness and crusting of the laryngeal mucosa, which is a known manifestation of complications due to **Rhinoscleroma**. - **Rhinoscleroma** is a chronic granulomatous disease caused by *Klebsiella rhinoscleromatis* (formerly *K. rhinoscleromatosis*), primarily affecting the upper respiratory tract including the larynx. *Rhinosporidium* - **Rhinosporidium seeberi** is an aquatic protistan parasite that causes **rhinosporidiosis**, characterized by friable, polypoidal lesions, often in the nose, but typically not laryngitis sicca. - The lesions caused by Rhinosporidium are usually vascular and bleeding, rather than dry and crusting. *M. leprae* - **Mycobacterium leprae** is the causative agent of **leprosy**, a chronic infectious disease primarily affecting the skin, peripheral nerves, upper respiratory tract mucosa, eyes, and testes. - While *M. leprae* can affect the larynx, it typically causes **granulomatous infiltration** and nodule formation leading to hoarseness and stridor, not specifically laryngitis sicca. *Klebsiella ozaenae* - *Klebsiella ozaenae* is associated with **ozena**, a form of chronic atrophic rhinitis characterized by a foul odor, crusting, and atrophy of nasal mucosa. - While it causes dryness and crusting, its primary manifestation is in the **nasal cavity**, and it is not directly linked to laryngitis sicca in the context tested here.

Q: Most common cause of retropharyngeal abscess in adults?

Lymphadenitis. ***Lymphadenitis*** - **Lymphadenitis** in the retropharyngeal space, often secondary to an upper respiratory tract infection, is the most common cause of retropharyngeal abscesses in adults. - The infection spreads from inflamed lymph nodes to form a **purulent collection** in the potential space behind the pharynx. *TB* - **Tuberculosis (TB)** can cause retropharyngeal abscesses, particularly in immunocompromised individuals or endemic areas, but it is less common than pyogenic infections [1]. - TB abscesses tend to be more **chronic** and may be associated with vertebral involvement (Pott's disease) [1]. *Tooth extraction* - While dental infections, including complications from **tooth extraction**, can lead to deep neck space infections, they are not the most common cause of retropharyngeal abscess specifically. - Infections from teeth more often spread to the **submandibular** or **parapharyngeal spaces**. *Tonsillitis* - **Tonsillitis** is a common cause of pharyngeal inflammation and can lead to peritonsillar abscesses, which are distinct from retropharyngeal abscesses. - While severe tonsillitis can occasionally spread to the retropharyngeal space, it is primarily local and less common than direct lymphatic seeding.

Q: What is the most common cause of a peritonsillar abscess?

Group A beta-hemolytic streptococcus. ***Group A beta-hemolytic streptococcus*** - This bacterium, also known as **_Streptococcus pyogenes_**, is the most common cause of **streptococcal pharyngitis**, which is the precursor to most peritonsillar abscesses. - Peritonsillar abscesses are typically a complication of untreated or inadequately treated **tonsillitis**. *Streptococcus pneumoniae* - While **_Streptococcus pneumoniae_** can cause upper respiratory infections like sinusitis and otitis media, it is not the primary cause of peritonsillar abscesses. - Its infections are more commonly associated with **pneumonia** and **meningitis**. *Staphylococcus aureus* - **_Staphylococcus aureus_** is a common cause of skin and soft tissue infections, but it is less frequently isolated as the primary pathogen in peritonsillar abscesses. - It can be involved in **polymicrobial infections** or as a secondary invader. *H. influenzae* - **_Haemophilus influenzae_** can cause various infections, particularly in children, such as otitis media and epiglottitis. - However, it is not considered the most common cause of **peritonsillar abscesses**.

Q: Which of the following conditions is least likely to cause bilateral recurrent laryngeal nerve palsy?

Aortic aneurysm. ***Aortic aneurysm*** - An aortic aneurysm, especially of the ascending aorta, is **less likely to cause bilateral recurrent laryngeal nerve palsy** because the left recurrent laryngeal nerve typically hooks under the aortic arch, while the right nerve hooks under the subclavian artery. - For **bilateral involvement**, two separate and simultaneous lesions affecting both nerves would be required at different anatomical locations with this etiology, making it a rare cause. *Thyroid carcinoma* - An aggressive **thyroid carcinoma** can directly invade or compress the recurrent laryngeal nerves (RLNs) due to their proximity to the thyroid gland. - If the carcinoma is extensive or multifocal, it can lead to **bilateral involvement** by affecting both nerves. *Lymphadenopathy* - Significant **cervical or mediastinal lymphadenopathy** (e.g., due to metastatic disease or lymphoma) can compress or encase both recurrent laryngeal nerves. - This proximity allows for potential **bilateral compression or damage** to the nerves as they ascend in the tracheoesophageal grooves. *Thyroid surgery* - **Thyroidectomy** is a common cause of recurrent laryngeal nerve injury due to the nerves' close anatomical relationship with the thyroid gland. - **Bilateral recurrent laryngeal nerve palsy** can occur if both nerves are damaged during dissection, often due to surgical misidentification, thermal injury, or traction.

Question 1

Lymphatic drainage of oropharynx is mainly through?

Accepted Answer

Jugulodigastric node

Answer

Superficial cervical lymph nodes

Answer

Submandibular nodes

Answer

Jugulo-omohyoid nodes

Question 2

Inlet of larynx is formed by:

Accepted Answer

Aryepiglottic fold

Answer

Vocal cord

Answer

False vocal cord

Answer

Folds from the base of the tongue to the epiglottis

Question 3

What is the most common cause of an oroantral fistula?

Accepted Answer

Tooth extraction

Answer

TB

Answer

Penetrating injury

Answer

Maxillary sinusitis

Question 4

Which of the following statements about acute retropharyngeal abscess is true?

Accepted Answer

Acute retropharyngeal abscess is often due to lymphadenitis.

Answer

Treatment often involves incision and drainage.

Answer

Acute retropharyngeal abscess is common in adults.

Answer

Swelling typically occurs unilaterally.

Question 5

Which part of the larynx is most commonly involved in tuberculosis (TB)?

Accepted Answer

Posterior

Answer

Answer

Middle

Answer

Anywhere

Question 6

Laryngitis sicca is associated with ?

Accepted Answer

Klebsiella rhinoscleromatosis

Answer

Rhinosporidium

Answer

M. leprae

Answer

Klebsiella ozaenae

Question 7

Hot potato voice is characteristic of ?

Accepted Answer

Supraglottic carcinoma

Answer

Nasopharyngeal carcinoma

Answer

Glottic carcinoma

Answer

Subglottic carcinoma

Question 8

Most common cause of retropharyngeal abscess in adults?

Accepted Answer

Lymphadenitis

Answer

Tonsillitis

Answer

Tooth extraction

Answer

TB

Question 9

What is the most common cause of a peritonsillar abscess?

Accepted Answer

Group A beta-hemolytic streptococcus

Answer

Streptococcus pneumoniae

Answer

Staphylococcus aureus

Answer

H. influenzae

Question 10

Which of the following conditions is least likely to cause bilateral recurrent laryngeal nerve palsy?

Accepted Answer

Aortic aneurysm

Answer

Thyroid carcinoma

Answer

Lymphadenopathy

Answer

Thyroid surgery

NEET-PG 2013

Anatomy

Dental

ENT

Internal Medicine

Microbiology

Surgery