Pharynx

Question 1

Pharynx extends from …..to …..
Length of pharynx.

Answer 1

Base of skull to C6 vertebrae

10cm

Question 2

Parts of pharynx

Answer 2

1. Nasopharynx:
   Skull base to palatal sphincter & passavant’s ridge at C2.
2. Oropharynx:
   Level of Palatal sphincter to tip of epiglotitis-C4
3. Hypopharynx:
   C4- C6 lower border.

Question 3

3 sub regions of hypopharynx

Answer 3

1. Piriform sinus ( fossa)
2. Posterior cricoid region
3. Posterior pharyngeal wall

Question 4

Extrinsic muscles of pharynx is …..layer
Contains ….muscles (5)

Answer 4

Circular layer

Superior constrictor
Middle constrictor: thyropharyngeus
Cricopharyngeus
Inferior constrictor

Question 5

Intrinsic muscles of pharynx are ……..layer.
Contains ….(3)

Answer 5

Longitudinal layer
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus

Question 6

Sinus of morgagni is present in ….
How does nasopharynx differ from oro or laryngopharynx?

Answer 6

Nasopharynx

Np Always patent

Question 7

What is sinus of morgagni? Structures passing through this sinus?

Answer 7

Space between base of skull and upper border of superior constrictor muscle.

1. Auditory tube
2. Lavator palatine muscle
3. Ascending palatine artery

Question 8

Contents of nasopharynx (5)

Absent NP bursa causes ….

Answer 8

1. Adenoid tissue: lymphoid tissue more prominent in children
2. ET tube opening
3. NP bursa
4. Ratke’s pouch
5. Sinus of morgagni

Thornwald disease

Question 9

What is killian dehiscence?

Answer 9

Area between thyropharyngeus and cricopharyngeus. Weak area-no muscular support.

Zenkers diverticulum: pharyngeal muscle herniation through pharyngeal diverticulum or pharyngeal pouch.

Question 10

What is waldeyers lymphatic ring?
Consists of : (4)

Answer 10

In nasopharynx isthmus, several aggregates of lymphoid tissue constitute waldeyers ring.
Consists of :
Pharyngeal tonsil
Tubal tonsil
Palatine tonsil
Lingual tonsil

Question 11

Importance of waldeyers ring?

What is Gerlach’s tonsil?

Answer 11

Guards oropharynx and nasopharynx from foreign pathogens launching immune response.

Tubal tonsil

Question 12

Palatine tonsil lined by …..
Largest crypt in tonsil is …..

Answer 12

Stratified squamous

Intra tonsillar cleft-crypta magna

Question 13

Main blood supply of tonsil is …..

5 arteries supply tonsil (5)

Answer 13

Tonsillar branch of facial artery

1. Ascending pharyngeal a
2. Ascending palatine a
3. Descending palatine a
4. Branch of lingual a
5. Tonsillar branch of facial a

Question 14

Main blood vessel bleed during tonsillectomy.

Features of adenoid hypertrophy.

Answer 14

Paratonsillar vein

School aged child 6-7 yrs having mouth breathing pattern + adenoid facies- protrusion of teeth, high palate, pinched nose.

Question 15

Mouth breathing in child plus HL s/o…

Rx of adenoid hypertrophy.
Position for sx is …

Answer 15

Adenoid hypertrophy+ glue ear.

Rx: surgery
Adenoidectomy under GA

Rose position

Question 16

What is grisel syndrome?

Answer 16

Atlantoaxial subluxation of C1-C2- if overextension of neck during adenoidectomy/ tonsillectomy.

Question 17

……….adenoid curette is used.

Mc cause of tonsillitis in:
<5 yr old
5-15yrs old:

Answer 17

St claire thomson

Viral tonsillitis

GpA beta hemolytic streptococcus

Question 18

C/f of acute tonsillitis

Answer 18

Fever, dysphagia,foul breath, odynophagia, tender cervical LN.

Question 19

Anatomy structure where quinsy happens?
C/f (5)

Answer 19

Collection of pus between fibrous capsule of tonsil and superior constrictor muscle of pharynx.

Severe throat pain
Fever, drooling, foul breath
Trismus, hot potato voice.

Question 20

In peritonsillar abscess ……not present
If present it’s …..

Answer 20

Neck swelling not seen
If +ve: parapharyngeal abscess

Question 21

Define quienke’s disease

2 structures that lie in bed of tonsils

Answer 21

Angioneurotic edema of uvula

Styloid process
Cn9

Question 22

What is eagle syndrome?

What is tonsillolith?

Answer 22

Styalgia
Long styloid process touching cn9–> throat pain referred to ear.

Tonsils have crypts.
Invagination of epithelium of tonsils—>crypts; where keratinaceous debris is stuck up.

Question 23

Causes and Rx for snoring

Answer 23

1. Palatal weakness- Palatal flutter
   Rx: strengthen palate->laser palatoplasty
2. Adenoid/ tonsillar hypertrophy:
   Rx: uveopalatopharyngeoplasty.

Question 24

Whitish membrane over tonsils (7)

Answer 24

1. Acute membranous tonsils-
   Caused by Strept pyogenes
2. Infectious mononucleosis -EBV
3. Diphtheria:
4. Pseudomembranes
5. Bleeds on removal.
6. Candida
7. Vincent angina
8. Malignancy of tonsil
9. Leukemia

Question 25

Rx for diphtheria Neck features seen in diphtheria

Answer 25

Conservative -6mo for spontaneous recovery Bull neck

Question 26

Complications of tonsillectomy

Answer 26

1. Primary : during surgery 2. Reactionary: <24hrs Due to disruption of ligature Emergency reexploration. 3. Secondary: >24hrs -within 5days Mild bleeding only when pt spits. Due to infection of tonsillar fossa. Rx: readmit and give iv antibiotics.

Question 27

Vincent angina due to ……org (2)

Answer 27

Fusiform bacteria Spirochete denticola

Question 28

Retropharyngeal abscess seen in …..region Pathology of retropharyngeal abscess

Answer 28

Posterior wall of nasopharynx Retropharyngeal space—> prevertevral space—>vertebrae-retropharyngeal LN increased —> acute retropharyngeal abscess.

Question 29

C/f of retropharyngeal abscess (4)

Answer 29

Young sick child with: 1. Respiratory distress 2. Inspiratory stridor 3. Drooling of saliva 4. Hot potato voice

Question 30

Xray feature of retropharyngeal abscess Rx: Prevertebral abscess is …..

Answer 30

Widening of prevertebral shadow. Cervical spine normal Immediate airway mgt Tb cervical spine -Potts spine