Previous year question on tonsils based on neet pg, usmle, plab and fmge or mci screening exams

A child presents with a white patch over the tonsils; diagnosis is best made by culture in:

A: Loeffler mediumB: LJ medium

C: Blood agarD: Tellurite mediumCorrect Ans:AExplanationIn the child presenting with a white patch over the tonsil, we suspect a diagnosis of 'diphtheria'. Usual media used for cultivation of Diphtheria are Loeffler’s serum slope & tellurite blood agar. Ref: Text Book of Microbilogy By Ananthanarayan, 6th Edition, Page 215 and 8th Edition, Page 233

Sample Previous Year Question on tonsil based on previous Year Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org for more such Quizzes

A febrile 23-year-old college student presents with fatigue and difficulty swallowing. Physical exam reveals exudative tonsillitis, palatal petechiae, cervical lymphadenopathy, and tender hepatosplenomegaly. A complete blood count reveals mild anemia, lymphocytosis with about 30% of the lymphocytes exhibiting atypical features, and a mild thrombocytopenia. Coombs' test is positive. Which of the following is the most likely complication of this syndrome?

A: Acute cholecystitisB: Ascending cholangitisC: DiarrheaD: Splenic ruptureCorrect Ans:DExplanation

The syndrome represented by the clinical vignette is infectious mononucleosis. Epstein-Barr virus (EBV) is the usual cause of heterophile-

positive infectious mononucleosis; cytomegalovirus is responsible for a minority of cases. Rarely, splenic rupture requiring splenectomy can result from splenomegaly and capsular swelling, usually occurring during the 2nd and 3rd weeks of the illness.

Acute cholecystitis is not associated with infectious mononucleosis. The most frequently isolated pathogens are E. coli, Klebsiella spp., group D Streptococcus, Staphylococcus spp., and Clostridium spp.

Ascending cholangitis is not associated with infectious mononucleosis. Cholangitis usually presents with biliary colic, jaundice, and spiking fever with chills (Charcot's triad). Blood cultures are usually positive (E. coli is a common isolate), with an accompanying leukocytosis.

AIDS-related cholangitis has been reported, presenting with abdominal pain and obstructive liver symptoms. Potential etiologic agents include Cytomegalovirus, Cryptosporidium parvum, and Microsporidia, including Enterocytozoon cuniculi.

Diarrhea is not usually produced by infectious mononucleosis.


Bilateral tonsillectomy is performed on an otherwise healthy 11-year-old female with recurrent upper respiratory tract infections. On pathologcal examination of the tonsils, numerous small, yellow granules are noted. A granule crushed between two slides have a dense, gram-positive center and numerous branching filaments at the periphery. The granules are most likely composed of which of the following organisms?

A: Actinomyces israeliiB: Aspergillus fumigatusC: Blastomyces dermatitidisD: Candida albicans

Correct Ans:AExplanation

Actinomyces are normal inhabitants of the gastrointestinal tract that grow under anaerobic and microaerophilic conditions. Although they are gram-positive rods, they grow as branching filaments and have been confused with fungi. The yellow colonies (sulfur granules) are found in low-oxygen niches like the tonsils and in actinomycotic abscesses.

Aspergillus fumigatus may be present in the respiratory tract as an opportunistic pathogen; however, fungus balls are generally seen only in pre-existing cavities (e.g., bronchiectasis, TB), not in the tonsils.

Blastomyces dermatitidis is a respiratory pathogen that is seen as thick-walled yeasts within granulomas.

Candida albicans, also a normal inhabitant of the oral cavity, would present as whitish plaques and would appear microscopically as budding yeasts.


An unimmunized child is brought to you with a history of URTI. On examination you find signs suggestive of diphtheria. Which type of diphtheria would suggest the worst prognosis?

A: TonsillopharyngealB: Laryngeal

C: NasalD: CutaneousCorrect Ans:BExplanation

Tonsillopharyngeal type of diphtheria is the commonest type of diphtheria infection. Here there is a small chance for bullneck and toxemia. In case of laryngeal diphtheria there is a real danger of asphyxia and urgent tracheostomy may be required to save the patient. Hence it is the most severe form of the disease and has got the worst prognosis. Nasal diphtheria is the mildest form of respiratory diphtheria. Cutaneous diphtheria is caused by non toxigenic strains.

Ref: Textbook of Microbiology by Ananthanarayan, Edition 6, Page 217; Harrison, Edition 17, Page 891, 892


Tonsillar carcinoma is associated with infection of:

A: HIVB: HPVC: HSVD: None of the aboveCorrect Ans:BExplanationHPV is an epitheliotropic virus that has been detected to varying degrees within samples of oral cavity squamous cell carcinoma. Infection alone is not considered sufficient for malignant conversion; however, results of multiple studies suggest a role of HPV in a subset of head and neck squamous cell carcinoma. Approximately 40% of tonsillar carcinomas demonstrate evidence of HPV types 16 and 18.

Ref: Schwartz’s principle of surgery 9th edition, chapter 18.


Tonsillectomy is recommended if number of acute infections in a year exceed:

A: 3B: 4

C: 5D: 6Correct Ans:AExplanationTonsillectomy and adenoidectomy are indicated for chronic or recurrent acute infection and for obstructive hypertrophy. The American Academy of Otolaryngology–Head and Neck Surgery Clinical Indicators Compendium suggests tonsillectomy after three or more infections per year despite adequate medical therapy. Some feel that tonsillectomy is indicated in children who miss 2 or more weeks of school annually secondary to tonsil infections. Ref: Schwartz’s principle of surgery 9th edition, chapter 18.


Ramavati a 40 years old female presented with a progressively increasing lump in the parotid region. On oral examination, the tonsil was pushed medially.Biopsy showed it to be pleomorphic adenoma. The appropriate treatment is:

A: Superficial parotidectomyB: LumpectomyC: Conservative total parotidectomyD: Enucleation

Correct Ans:CExplanation

Pleomorphic adenomas, or benign mixed tumors, are the most common neoplasms of the salivary glands. Complete surgical excision of the tumor with uninvolved margins is the recommended treatment. A superficial parotidectomy with clear margins is the treatment of a pleomorphic adenoma located in the superficial lobe of the parotid gland. The prognosis for pleomorphic adenomas is excellent, with a 95% rate of non-recurrence.

Although radiation is not indicated in the treatment of benign salivary tumors, it has been used occasionally to control recurrent pleomorphic adenomas.

Ref: Butt F.Y. (2012). Chapter 18. Benign Diseases of the Salivary Glands. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.


The commonest cause of death in diphtheritic child after few weeks of infection is:

A: IIIrd nerve palsyB: Myocarditis

C: TonsillitisD: SepticemiaCorrect Ans:BExplanation

Myocarditis and neuropathy are the most common and most serious complications. Deaths from diphtheria occur either from tracheobronchial obstruction by the pseudomembrane acutely or cardiac complications several weeks after the primary infection.

Diphtheritic myocarditis is characterized by a rapid, thready pulse; indistinct heart sounds, ST-T wave changes, conduction abnormalities, dysrhythmias, or cardiac failure; hepatomegaly; and fluid retention. Myocardial dysfunction may occur from 2 to 40 days after the onset of pharyngitis. Myocarditis is typically associated with dysrhythmia of the conduction tract and dilated cardiomyopathy.

Ref: Jauch E.C., Barbabella S.P., Fernandez F.J., Knoop K.J. (2010). Chapter 5. Ear, Nose, and Throat Conditions. In K.J. Knoop, L.B. Stack, A.B. Storrow, R.J. Thurman (Eds), The Atlas of Emergency Medicine, 3e.


What is the COMMONEST cause of death in diphtheritic child?

A: IIIrd cranial nerve palsyB: Myocarditis

C: TonsillitisD: SepticemiaCorrect Ans:BExplanationDiphtheria is an acute infection of the upper respiratory tract or skin caused by toxin-producing Corynebacterium diphtheriae. Important complications of diphtheria are diphtheritic myocarditis, polyneuritis and bronchopneumonia. Myocarditis is the most common cause of death in these children with mortality varying between 3-25% when associated with early myocarditis.

Myocardial dysfunction occur 2-40 days after the onset of pharyngitis. Diphtheritic myocarditis is characterized by rapid thready pulse, thready pulse, indistinct heart sounds, dysrhythmias, cardiac failure and ECG showing ST-T wave changes.

Ref: Ogle J.W., Anderson M.S. (2012). Chapter 42. Infections: Bacterial & Spirochetal. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.


An 8 year old child is referred to you with history of Mononeuritis multiplex. On examination you find that there is hepatosplenomegaly. Examination of the oral cavity and pharynx revealed enlarged orange coloured tonsils. Which of the following statement regarding the above condition is false?

A: It is a case of Tangier diaeseB: The plasma LDL - c levels will be lowC: It is an autosomal recessive conditionD: It is caused by ABCA1 deficiency


Tangier disease is an autosomal co dominant condition caused by mutation in the gene coding for ABCA 1. These patients have low levels of HDL-C, ApoA - I and LDL-C. There may be a slightly elevated triglyceride levels. The accumulation of cholesterol in the reticulo endothelial system is responsible for the findings described in the question.

Ref: Harrison, Edition 17, Page - 2423 ; Essential revision notes for MRCP by Philip A Kalra, Edition 3, Page - 333


Pathognomonic enlarged, grayish yellow or orange tonsils are seen in:

A: Familial hypercholesterolemiaB: LCAT deficiency

C: Tangier diseaseD: AbetalipoproteinemiaCorrect Ans:C

Explanation

Patients with Tangier disease have extremely low circulating plasma levels of HDL-C (<5 mg/dL). Cholesterol accumulates in the reticuloendothelial system of these patients, resulting in hepatosplenomegaly and pathognomonic enlarged, grayish yellow or orange tonsils.

Reference:Harrisons Principles of Internal Medicine, 18th Edition, Page 3154


What is the treatment of choice in a 6 year old child with recurrent URTI with mouth breathing having high arched palate, impaired hearing and growth failure?

A: TonsillectomyB: Grommet insertionC: Myringotomy with grommet insertionD: Adenoidectomy with grommet insertionCorrect Ans:DExplanation

Hypertrophic adenoid tissue causes nasal obstruction, mouth-breathing, and similarly, obstruction of the Eustachian tube orifices. Removing large adenoids enhances the patency of the nasopharyngeal airway, relieving the overall pressure in the nasopharynx, in turn allowing improved aeration of the middle ear cleft.

The goal of placement of tympanostomy tubes is to aerate the middle ear space and prevent accumulation of middle ear inflammation and effusion. In effect, ventilation of the middle ear enhances hearing thresholds.

Ref: Pai S., Parikh S.R. (2012). Chapter 49. Otitis Media. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.


Commonest causative organism for acute tonsillitis is which of the following?

A: B streptococciB: Parainfluenza virusC: H influenzaD: CorynebacteriumCorrect Ans:AExplanation

Parainfluenza virus causes tracheobronchitis and H influenza cause acute epiglottitis.


All of the following are absolute indications for tonsillectomy, except

A: Recurrent attacksB: Peritonsillar abscessC: Suspected malignancyD: Acute tonsillitis

Correct Ans:DExplanation

Recurrent throat infections, peritonsillar abcess, tonsillitis causing febrile seizures, hypertrophy of tonsils causing sleep apnoea or speech interference and any suspicion of malignancy are absolute indications for tonsillectomy.


A child with high fever, severe sore throat presented with painful swallowing. Her voice was abnormal. Quinsy was diagnosed. What is referred to as Quinsy?

A: Peritonsillar abscessB: Retropharyngeal abscessC: Parapharyngeal abscessD: Any of the above

Correct Ans:A

Explanation

When infection penetrates the tonsillar capsule and involves the surrounding tissues, peritonsillar cellulitis results.

Peritonsillar abscess otherwise known as ‘quinsy’ and cellulitis present with severe sore throat, odynophagia, trismus, medial deviation of the soft palate and peritonsillar fold, and an abnormal muffled ("hot potato") voice.

Ref: Lustig L.R., Schindler J.S. (2013). Chapter 8. Ear, Nose, & Throat Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013.


Tonsiloliths are best treated with:

A: AntibioticB: Hydrogen peroxideC: SteroidsD: None of the aboveCorrect Ans:BExplanation

The treatment for these tonsillar concretions or chronic tonsillitis is aggressive mouth care, which includes irrigation of the tonsils or cleaning them with a cotton swab soaked in 3% hydrogen peroxide. With time, the cellular debris is often retained in the branching crypts and with recurrent formation of focal bacterial abscesses in the tonsillar parenchyma, which later undergoes fibrosis and scarring; local care may not control these symptoms. Tonsillar surgery and elimination of these cryptic structures may be needed to control these infections.

Ref: Current diagnosis and treatment in otolaryngology, 2nd ed, Chapter 20.


Pus collection in “quinsy” usually gets collected in which location?

A: Peritonsillar spaceB: Within the tonsil

C: Parapharyngeal spaceD: Retropharyngeal spaceCorrect Ans:AExplanation

Quinsy usually follows an episode of acute tonsillitis. Parapharyngeal abscess is a complication of quinsy.

Ref: PL Dingra, (2010), Chapter 51, “Head and Neck Space Infections”, In the book, “Disease of EAR, NOSE AND THROAT”, 5th Edition, New Delhi, Page 278


Secondary Haemorrhage after tonsillectomy usually presents at:

A: 12 hoursB: 24 hours

C: 6 daysD: 12 daysCorrect Ans:CExplanation

Secondary haemorrhage usually seen between the 5th to 10th postoperative day.It is the result of sepsis & premature separation of the membrane. Usually, it is heralded by bloodstained sputum but may be profuse. Simple measures like removal of clot, topical application of dilute adrenaline or hydrogen peroxide with pressure usually suffice.For profuse bleeding, general anaesthesia is given & bleeding vessel is electrocoagulated or ligated. Sometimes, approximation of pillars with mattress sutures may be requered.Sometimes, external carotid ligation may also be required.Systemic antibiotics are given for control of infection.

Ref: Dhingra 4th edition, Page 384


A 5-year-old patient is scheduled for tonsillectomy. On the day of surgery he had running nose, temperature 37.5°C and dry cough. Which of the following should be the most appropriate decision for surgery?

A: Surgery should be cancelledB: Should get X-ray chest before proceeding for surgeryC: Cancel surgery for 3 weeks and patient to be on antibiotic

D:Can proceed for surgery if chest is clear and there is no history at asthma


Since the child in the question has developed upper respiratory tract infection on the day of his surgery, it is recommended to postpone the surgery and give antibiotics to treat his infection.

Several studies have shown that children undergoing an elective surgical procedure with an acute upper respiratory tract infection has an increased incidence of laryngospasm, bronchospasm or oxygen desaturation.

Ref: Medical Management of The Surgical Patient: A Textbook of Perioperative Medicine By Michael F. Lubin, Page 135; Ear, Nose and Throat Diseases By P L Dhingra, 4th Edition, Page 382.


A 6 year old child presented with recurrent URTI, mouth breathing and failure to grow. On examination he has high arched palate and impaired hearing. What is the management of choice in this child?

A: MyringotomyB: Myringotomy with grommet insertionC: Adenoidectomy with grommet insertionD: Tonsillectomy


Child in the question is showing features of adenoid hyperplasia as indicated by mouth breathing, nasal obstruction and recurrent URTI. He has impaired hearing as a result of serous otitis media which occur as a complication of adenoid hyperplasia. So the treatment of choice is adenoidectomy with grommet insertion which will take care of both the adenoid as well as serous otitis media.

Features of adenoid facies are:

? Elongated face with dull expression? Open mouth? Prominent and crowded upper teeth? Hitched up upper lip

? Pinched in appearance of nose? High arched palate


Which of the following condition is treated by laser-assisted uvulopalatoplasty?

A: SnoringB: PharyngotonsillitisC: Cleft palateD: StammeringCorrect Ans:AExplanation

Laser uvulopalatoplasty (LAUP) is the treatment for snoring. In LAUP, the redundant soft tissue is either excised or ablated. It helps to avoid most of the postoperative morbidity, as well as providing a good hemostatic benefit during surgery. The CO2 laser is the laser most commonly used by otolaryngologists for this operation.

Ref: Satar B., Shah A.R. (2012). Chapter 6. Lasers in Head & Neck Surgery. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.


Quincy tonsillectomy is done in:

A: TonsilolithB: Tonsillar malignancyC: TonsillitisD: None of the aboveCorrect Ans:CExplanation

Certain surgeons favor a "Quincy tonsillectomy," which is a tonsillectomy that is performed while the patient is acutely infected.



The Myer-Cotton grading system is used for:

A: Subglottic stenosisB: Tonsillitis

C: SinisitisD: None of the aboveCorrect Ans:AExplanation

The Myer-Cotton grading system describes the severity of stenosis according to the percentage of subglottic stenosis present. The percentage is calculated by measuring the largest sized endotracheal tube that can be passed through the subglottis and comparing this with the age-appropriate tube size for the child



Tonsillectomy is contraindicated in which of the following condition?

A: Small atrophic tonsilsB: QuinsyC: Poliomyelitis epidemicD: Tonsillolith


Performing tonsillectomy during poliomyelitis epidemic is an absolute contraindication. Unimmunised children may develop polio following tonsillectomy. A tonsillectomy may be performed long after the epidemic has passed and the child is immunised against polio.

Indications for Tonsillectomy:

Recurrent episodes of acute tonsillitis that is more than four attacks a year

Patients with recurrent sore throats and rheumatic fever and when tonsils cause repeated attacks of otitis media.

Presence or history of a peritonsillar abscess or of diphtheria carriers. Massive tonsillar hypertrophy causing respiratory obstruction in children Sleep apnea Glossopharyngeal neuralgia

Ref: Textbook Of The Ear, Nose And Throat By De Souza, C. Et Al. page 177-8.


Which among the following causes ‘thumb sign’ on an X-ray lateral view of the neck?

A: Acute epiglottitisB: Acute laryngo trachea bronchitisC: Acute tonsillitisD: Acute laryngitisCorrect Ans:AExplanation

Thumb sign is typically seen in acute epiglottitis due to swollen epiglottis. It is better appreciated in lateral view of neck. Normally, the epiglottis is quite thin in the anteroposterior (AP) dimension, resembling a little finger, whereas the abnormal, inflamed epiglottis appears shorter and has an increased AP dimension, resembling a thumb.

Acute epiglottitis is usually caused by infection with H influenzae type B.


Which structure forms the lateral wall of tonsillar fossa?

A: Facial nerveB: Glossopharyngeal arteryC: Superior constrictor muscleD: Palatopharyngeus muscle


The tonsils are situated one on each side of the lateral wall of oropharynx in the tonsillar fossa. The tonsillar bed is formed by pharyngobasilar fascia, palatoglossus muscle and superior constrictor muscle of the pharynx.

Tonsillar fossa is bounded anteriorly by the palatoglossal fold and posteriorly by the palatopharyngeal fold.

Capsule of the tonsil covers only the lateral surface of the tonsil, and is formed by pharyngobasilar fascia.

Medial surface is covered by mucous membrane of the oral cavity, with stratified squamous epithelium.


Which of the following statement about the nerve supply of palate is NOT TRUE?

A: Pharyngeal plexus supply muscles of soft palateB: Tensor veli palatini is supplied by mandibular nerveC: Anterior branch of pterygopalatine ganglion supplies soft palate

D:Middle and posterior lesser palatine nerves supply soft palate and tonsil


“Greater or anterior palatine branches of pterygopalatine ganglion supplies hard palate and lateral wall of the nose while the lesser or middle and posterior palatine nerve supply the soft palate and tonsils”.

All the muscles of the soft palate except tensor veli palatini are supplied by pharyngeal plexus (fibers of the plexus are derived from the cranial part of the accessory nerve through the vagus nerve)

Tensor veli palatini is supplied by mandibular nerve.

Ref: Snell’s Anatomy 8/e, Page 781-85 ; BDC 4/e, Vol.III, Page 210-13, 237


The tonsils are derived from which of the following branchial pouch?

A: 1st branchial pouchB: 2nd branchial pouchC: 3rd branchial pouchD: 4th branchial pouchCorrect Ans:BExplanation

Endoderm of the second pharyngeal pouch forms the stratified squamous, nonkeratinized epithelium lining the tonsillar crypts on pharyngeal surface of tonsil. The mesoderm forms lymphoid tissue, fibrous capsule, and connective tissue elements of tonsil.

Pharyngeal pouch derivatives:

First pouch: eustachian tube, tympanic cavity, endodermal lining of eardrum

Second pouch: palatine tonsils Third pouch: thymus and inferior parathyroid glands Fourth pouch: superior parathyroid, part of thymus Fifth pouch: parafollicular cells of thyroid

Ref: Textbook of Clinical Embroyology By Vishram Singh page 116. A Textbook of Neuroanatomy By Maria Patestas.


Health & Medicine

Previous year question on tonsils based on neet pg, usmle, plab and fmge or mci screening exams