Pharynx (Tonsils, Adenoids, Abscesses, NPC, JNA) MCQs

ENT · 54 free questions with answers & explanations.

1. A 5-year-old child presents with snoring, apnoeic episodes, and failure to thrive. Examination reveals large obstructing adenoids. Overnight polysomnography confirms OSA with an AHI of 10 events/hour. The definitive treatment is:
2. A child presents with 'hot potato voice,' pooling of saliva, stridor, and a bulge in the posterior pharyngeal wall visualised below the level of C2. CT neck shows a retropharyngeal collection. The most feared immediate complication of an untreated retropharyngeal abscess in this child is:
3. Regarding NPC staging, which criterion places a patient in Stage IVA (AJCC 8th edition)?
4. Juvenile nasopharyngeal angiofibroma (JNA) staging by Andrews-Fisch classification: a tumor extending into the pterygopalatine fossa and orbit without intracranial extension is classified as:
5. Nasopharyngeal carcinoma (NPC) is strongly associated with EBV. Which histological subtype of NPC (WHO classification) is MOST common globally and has the BEST prognosis?
6. A 30-year-old presents with severe right-sided sore throat, trismus, muffled ('hot potato') voice, uvular deviation to the LEFT, and bulging of the RIGHT peritonsillar area. Where is the abscess pointing, and what is the preferred drainage site?
7. OSA severity classification by AHI (apnea-hypopnea index): which AHI range defines MODERATE OSA in adults, and what is the current first-line treatment?
8. Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular tumour. On angiography, it derives its primary blood supply from:
9. In nasopharyngeal carcinoma (NPC), the EBV-associated subtype with the best response to chemoradiotherapy and most favourable prognosis is:
10. Parapharyngeal abscess can involve both the pre- and post-styloid compartments. Involvement of the post-styloid (retrostyloid) compartment is particularly dangerous because it contains:
11. Grisel's syndrome is a non-traumatic atlantoaxial subluxation that may complicate upper respiratory tract infections and adenotonsillectomy. The pathophysiology involves:
12. A 16-year-old male presents with progressive nasal obstruction, unilateral epistaxis, conductive hearing loss, and a smooth, pulsatile nasopharyngeal mass. CT shows a hypervascular mass in the nasopharynx extending into the pterygopalatine fossa with anterior bowing of the posterior maxillary sinus wall (Holman-Miller sign). The diagnosis is juvenile nasopharyngeal angiofibroma (JNA). Which is the MOST COMMON arterial supply to this tumor?
13. Nasopharyngeal carcinoma (NPC) has a strong association with EBV. Which EBV latency protein is detectable in serum and is used for NPC screening and monitoring response to treatment?
14. A 25-year-old presents with severe throat pain, trismus, uvular deviation to the left, and a bulging right peritonsillar area. Peritonsillar abscess (quinsy) is diagnosed. After aspiration/drainage, the patient recovers. What is the MOST COMMON bacteriological agent in peritonsillar abscess and the best long-term preventive strategy?
15. A 45-year-old Chinese man presents with unilateral serosanguineous nasal discharge, unilateral conductive hearing loss, and a neck mass. MRI shows a mass in the fossa of Rosenmüller with skull base invasion. Biopsy shows WHO Type III histology. The EBV serological marker most specific for nasopharyngeal carcinoma in this undifferentiated type is:
16. Peritonsillar abscess (quinsy) is most commonly caused by Fusobacterium necrophorum and streptococcal species. The abscess forms between the tonsillar capsule and the superior constrictor muscle. Which nerve, if affected by deep extension, explains the trismus seen in peritonsillar abscess?
17. A newborn has difficulty feeding with regurgitation through the nose. Inserting a nasogastric tube fails bilaterally. The diagnosis is bilateral choanal atresia. The most common bony or membranous composition of choanal atresia and the congenital association using the CHARGE mnemonic are:
18. A 14-year-old boy presents with progressively worsening nasal obstruction, epistaxis, and right cheek fullness. Examination shows a vascular mass in the nasopharynx that bleeds on probing. Contrast CT shows intense homogeneous enhancement with 'salt and pepper' pattern. What is the imaging finding called, and what does it represent?
19. Nasopharyngeal carcinoma (NPC) is strongly associated with EBV. The undifferentiated (WHO Type III) NPC shows the highest EBV association. Which EBV gene product serves as a surrogate marker for EBV latency type II (the type in NPC) and can be detected immunohistochemically?
20. A 35-year-old presents with severe throat pain, trismus, uvular deviation to the left, and left peritonsillar bulging. What is the landmark for needle aspiration to avoid the carotid artery?
21. A child presents with neck stiffness, fever, and an inability to extend the neck following a sore throat. CT shows a posterior pharyngeal collection. What is the MOST significant danger of retropharyngeal abscess?
22. A 30-year-old Chinese man presents with cervical lymphadenopathy, bloody nasal discharge, and conductive hearing loss. Nasopharyngoscopy reveals a submucosal mass in the fossa of Rosenmüller. EBV IgA-VCA serology is elevated. Biopsy shows undifferentiated carcinoma with prominent lymphocyte infiltrate. Per WHO 2022 classification, this tumour type is:
23. A 25-year-old presents with right-sided peritonsillar abscess (quinsy): uvular deviation to the LEFT, trismus, 'hot potato' voice, and fluctuant bulging of the right anterior pillar. The most appropriate first-line drainage procedure in a cooperative adult under local anaesthesia is:
24. Retropharyngeal abscess occurs predominantly in children under 4 years because:
25. A 16-year-old male presents with progressive nasal obstruction, epistaxis, and a pulsatile nasopharyngeal mass. Biopsy is inadvertently performed and causes profuse uncontrollable bleeding. On contrast MRI, the mass shows intense enhancement and characteristic 'salt and pepper' appearance. The MOST appropriate preoperative intervention before surgical excision is:
26. Nasopharyngeal carcinoma (NPC) is strongly associated with EBV infection. Which histological type has the STRONGEST association with EBV and the BEST prognosis with radiotherapy?
27. During drainage of a peritonsillar abscess, what is the MOST common site for the abscess to be located, and which important structure must the surgeon avoid by limiting needle insertion depth to 1 cm?
28. A 16-year-old male presents with progressive unilateral nasal obstruction, recurrent epistaxis, and a mass in the nasopharynx that is highly vascular on endoscopy. CT shows a mass centered at the sphenopalatine foramen extending into the pterygopalatine fossa with bone erosion. Which of the following angiographic and surgical statements about this tumor is CORRECT?
29. A patient with peritonsillar abscess (PTA) presents with unilateral throat pain, dysphagia, trismus, and deviation of the uvula toward the OPPOSITE side. Which of the following explains why the uvula deviates away from the abscess side?
30. A 15-year-old boy presents with progressive nasal obstruction, unilateral nasal bleeding, and a pinkish-gray mass visible in the nasopharynx. Contrast CT shows a highly vascular mass centered at the sphenopalatine foramen with anterior bowing of the posterior maxillary sinus wall (Holman-Miller sign). The diagnosis is:
31. A 50-year-old Chinese man presents with a painless cervical lymphadenopathy (Level II, right side), epistaxis, and right-sided nasal obstruction. Nasal endoscopy shows a mass in the fossa of Rosenmuller. The virus most strongly associated with this tumor is:
32. Parapharyngeal abscess can be differentiated from peritonsillar abscess (PTA) on clinical examination by the direction of tonsillar displacement:
33. A 16-year-old male presents with progressive unilateral nasal obstruction, intermittent epistaxis, and a biopsy-proven juvenile nasopharyngeal angiofibroma (JNA). Pre-operative angiography and embolization is performed. The primary feeding vessel in most JNA cases is:
34. EBV-associated nasopharyngeal carcinoma (NPC) is most commonly of which WHO histological type and where does it most frequently drain lymphatically first?
35. Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign but locally aggressive vascular tumour. Its characteristic presentation, hormonal predisposition, and the primary feeding vessel are:
36. A patient presents with a peritonsillar abscess (Quinsy). On examination, there is uvular deviation to the right (away from the affected side). Which is the preferred drainage technique in an adult, and what is the anatomical danger during incision?
37. Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign but locally aggressive vascular tumor. The most critical preoperative preparation to reduce intraoperative haemorrhage is:
38. A peritonsillar abscess (quinsy) is drained. The space in which pus collects is between the:
39. A 35-year-old male presents with progressive nasal obstruction, unilateral blood-tinged nasal discharge, and a mass in the nasopharynx. CT shows a lobulated hypervascular mass in the nasopharynx with widening of the sphenopalatine foramen and erosion of the pterygoid plates. The diagnosis is juvenile nasopharyngeal angiofibroma (JNA). Regarding preoperative management, which intervention is most important to reduce intraoperative blood loss?
40. A 50-year-old male Chinese patient presents with a neck mass at level II and epistaxis. Flexible nasopharyngoscopy reveals a mass in the fossa of Rosenmuller. Biopsy shows non-keratinizing undifferentiated carcinoma. The etiological virus and most commonly used radiological staging investigation are respectively:
41. A 50-year-old Chinese male presents with a neck mass, unilateral serous otitis media, and nasal obstruction. Nasopharyngoscopy shows a suspicious submucosal mass in the fossa of Rosenmuller. Biopsy shows undifferentiated carcinoma. Which virus is associated with this tumor, and what serological marker supports the diagnosis?
42. A 45-year-old develops a retropharyngeal abscess following a fish bone injury. He presents with odynophagia, neck stiffness, and drooling. Lateral neck X-ray shows widening of the retropharyngeal space (>7 mm at C2). What is the critical danger of this condition?
43. A 16-year-old boy presents with progressive nasal obstruction, recurrent epistaxis, and a mass in the nasopharynx visible on nasopharyngoscopy. CT shows a lobulated soft-tissue mass centered at the sphenopalatine foramen with bony erosion and avid enhancement. Angiography shows feeding from internal maxillary artery. The most appropriate preoperative step before surgical excision is:
44. A 50-year-old Chinese man presents with a painless neck mass. Examination reveals a mass in the posterolateral neck. Nasopharyngoscopy shows a subtle submucosal bulge in the lateral wall of the nasopharynx (fossa of Rosenmüller). The most specific serological marker used in diagnosis and monitoring of this tumor is:
45. A 16-year-old male presents with progressive unilateral nasal obstruction, recurrent epistaxis and a pinkish vascular mass visible in the right posterior nasal space that bleeds profusely on attempted biopsy. The most appropriate investigation before surgical planning is:
46. A patient with nasopharyngeal carcinoma (NPC) is classified as WHO Type III. This histological subtype is associated with which aetiological agent and has the best response to radiotherapy?
47. In a patient with peritonsillar abscess (quinsy), the most common site of pus accumulation is:
48. Juvenile nasopharyngeal angiofibroma (JNA) is characterised by all of the following EXCEPT:
49. The EBV-associated nasopharyngeal carcinoma (NPC) most commonly arises in which anatomical subsite?
50. A 20-year-old presents with sore throat, trismus, uvular deviation to the left, and a bulge in the right peritonsillar area. The most likely diagnosis and the most appropriate immediate management are:
51. Nasopharyngeal carcinoma is characteristically associated with which virus, and what is its most common histological subtype in Southeast Asia?
52. A 25-year-old presents with fever, sore throat, 'hot potato voice,' drooling, and uvular deviation to the left. He has trismus. The most likely diagnosis is:
53. A 45-year-old Chinese male presents with a painless unilateral cervical lymphadenopathy at level II for 6 weeks. He also has unilateral nasal obstruction and bloody nasal discharge. Nasopharyngoscopy reveals a mass in the right fossa of Rosenmuller. Biopsy confirms undifferentiated nasopharyngeal carcinoma. EBV LMP-1 is positive. According to AJCC 8th edition, a T2 NPC involves:
54. A child with retropharyngeal abscess on CT scan shows a rim-enhancing fluid collection between the posterior pharyngeal wall and the prevertebral fascia at C2–C4. The most common organism causing this condition in children under 5 years is: