Category: Quiz

Retropharyngeal and Parapharyngeal Abscess

Retropharyngeal and Parapharyngeal Abscess/h3>

Q. 1

A 40-year-old woman had lower third molar extracted due to dental caries. Then she developed high fever and pain. On examination, tonsil deviated medially and there was swelling in upper one-third of sternocleidomastoid muscle, Most likely diagnosis is:

 A

Hematoma

 B

Retropharyngeal abscess

 C

Parapharyngeal abscess    

 D

Ludwig’s angina

Q. 1

A 40-year-old woman had lower third molar extracted due to dental caries. Then she developed high fever and pain. On examination, tonsil deviated medially and there was swelling in upper one-third of sternocleidomastoid muscle, Most likely diagnosis is:

 A

Hematoma

 B

Retropharyngeal abscess

 C

Parapharyngeal abscess    

 D

Ludwig’s angina

Ans. C

Explanation:

Abscess of pharyngomaxillary or lateral pharyngeal space is also known as parapharyngeal abscess.

Infection can come to this space from acute or chronic infections of tonsils and adenoids, bursting of peritonsillar abscess, dental infection of lower third molar teeth, Bezold’s abscess, petrositis, infections of parotid, retropharyngeal, and submaxillary spaces, injuries of neck etc.

Fever, odynophagia, sore throat, torticoilis and signs of toxemia may develop.


Q. 2

All of the following are true about retropharyngeal abscess except:

 A

Confined to one side of the midline

 B

Can be palpable per orally by pressing the finger on posterior pharyngeal wall

 C

Lies behind the prevertebral fascia

 D

Presents with dysphagia & difficulty in breathing

Q. 2

All of the following are true about retropharyngeal abscess except:

 A

Confined to one side of the midline

 B

Can be palpable per orally by pressing the finger on posterior pharyngeal wall

 C

Lies behind the prevertebral fascia

 D

Presents with dysphagia & difficulty in breathing

Ans. C

Explanation:

 

Retropharyngeal abscess lies anterior to the prevertebral fascia.

  • Retropharyngeal space lies anterior to prevertebral fascia. It is the space between the buccopharyngeal fascia covering pharyngeal constrictor muscles and the prevertebral fascia. The space is divided into two lateral compartments (space of Gillette) by a fibrous raphe. Thus abscess of this space causes paramedian swelling in posterior pharyngeal wall.
  • Each lateral space contains retropharyngeal nodes which disappear by 3-4 yrs of age. So abscess is commonly seen in chidren < 3 yrs of age.
  • It is the prevertebral space which lies behind the prevertebral fascia. Abscess of this space produces midline swelling.
  • The retropharyngeal abscess obstructs the aero digestive tract causing dysphagia, odynophagia, dyspnea, trismus etc.
  • Treatment is incision and drainage

Q. 3

Post-styloid space of parapharyngeal space contains all, EXCEPT:

 A

Cranial nerve IX

 B

Cranial nerve XII

 C

Parotid

 D

Lymph nodes

Q. 3

Post-styloid space of parapharyngeal space contains all, EXCEPT:

 A

Cranial nerve IX

 B

Cranial nerve XII

 C

Parotid

 D

Lymph nodes

Ans. C

Explanation:

The parapharyngeal space is a potential space, shaped like an inverted pyramid spanning the skull base to the hyoid.

The boundaries of the space are separated by the styloid process and its associated fascial attachments into the “prestyloid” and “poststyloid” compartments.

 The contents of the prestyloid space are the parotid, fat, and lymph nodes.

The poststyloid compartment is composed of CNs IX to XII, the carotid space contents, cervical sympathetic chain, fat, and lymph nodes. 
 
Ref: Schwartz’s principle of Surgery 9th edition, chapter 18.

Q. 4

A child presenting with high fever and hoarseness of voice is found to have retropharyngeal abscess. All of the following statements are true about acute retropharyngeal abscess, EXCEPT:

 A

It is usually restricted to one side of the midline

 B

Infection is posterior to the prevertebral fascia

 C

Causes difficulty in deglutition and respiration

 D

Can be easily palpated by placing a finger tip on the posterior pharyngeal wall

Q. 4

A child presenting with high fever and hoarseness of voice is found to have retropharyngeal abscess. All of the following statements are true about acute retropharyngeal abscess, EXCEPT:

 A

It is usually restricted to one side of the midline

 B

Infection is posterior to the prevertebral fascia

 C

Causes difficulty in deglutition and respiration

 D

Can be easily palpated by placing a finger tip on the posterior pharyngeal wall

Ans. B

Explanation:

Clinical features of retropharyngeal abscess:

  • Usually occurs in infants and young children, typically aged between 2 and 6 years.
  • Infection of the upper respiratory tract leads to pyogenic adenitis of the retropharyngeal lymph nodes. The resulting abscess is limited to one side of the midline by a median raphe and anterior to the prevertebral fascia.
  • A sore throat with dysphagia or odynophagia (including for saliva) will be present along with high pyrexia.
  • Palpation of the posterior pharyngeal wall may confirm the diagnosis of a retropharyngeal abscess.

Q. 5

A male aged 30 years presented with trismus, fe­ver, swelling pushing the tonsils medially and spreading laterally posterior to the middle sternocleido-mastoid. He gives H/0 excision of 3rd molar few days back for dental caries. The diagnosis is:

 A

Retropharyngeal abscess

 B

Ludwig’s angina

 C

Submental abscess

 D

Parapharyngeal abscess

Q. 5

A male aged 30 years presented with trismus, fe­ver, swelling pushing the tonsils medially and spreading laterally posterior to the middle sternocleido-mastoid. He gives H/0 excision of 3rd molar few days back for dental caries. The diagnosis is:

 A

Retropharyngeal abscess

 B

Ludwig’s angina

 C

Submental abscess

 D

Parapharyngeal abscess

Ans. D

Explanation:

Q. 6

A postdental extraction patient presents with swelling in posterior one third of the sternocleidomastoid, the tonsil is pushed medially. Most likely diagnosis is:

 A

Retopharyngeal abscess

 B

Parapharyngeal abscess

 C

Ludwig angina

 D

Vincent angina

Q. 6

A postdental extraction patient presents with swelling in posterior one third of the sternocleidomastoid, the tonsil is pushed medially. Most likely diagnosis is:

 A

Retopharyngeal abscess

 B

Parapharyngeal abscess

 C

Ludwig angina

 D

Vincent angina

Ans. B

Explanation:

Q. 7

Parapharyngeal space is also known as:

 A

Retropharyngeal space

 B

Pyriform sinus

 C

Lateral pharyngeal space

 D

All

Q. 7

Parapharyngeal space is also known as:

 A

Retropharyngeal space

 B

Pyriform sinus

 C

Lateral pharyngeal space

 D

All

Ans. C

Explanation:

Q. 8

The medial bulging of pharynx is seen in:

 A

Pharyngomaxillary abscess

 B

Retropharyngeal abscess

 C

Peritonsillar abscess

 D

Paratonsillar abscess

Q. 8

The medial bulging of pharynx is seen in:

 A

Pharyngomaxillary abscess

 B

Retropharyngeal abscess

 C

Peritonsillar abscess

 D

Paratonsillar abscess

Ans. A

Explanation:

 

Parapharyngeal space is also called lateral pharyngeal space and pharyngomaxillary space.


Q. 9

Trismus in parapharyngeal abscess is due to spasm of:

 A

Masseter muscle

 B

Medial pterygoid

 C

Lateral pterygoid

 D

Temporalis

Q. 9

Trismus in parapharyngeal abscess is due to spasm of:

 A

Masseter muscle

 B

Medial pterygoid

 C

Lateral pterygoid

 D

Temporalis

Ans. B

Explanation:

 

  • Styloid process divides the pharynx into anterior and posterior compartment.
  • Trismus occurs in infection of anterior compartment whereas torticollis (due to spasm of paravertebral muscles) occurs in the infection of posterior compartment.

Q. 10

Most common cause of chronic retropharyngeal abscess:

 A

Suppuration of retropharyngeal lymph node

 B

Caries of cervical spine

 C

Infective foreign body

 D

Caries teeth

Q. 10

Most common cause of chronic retropharyngeal abscess:

 A

Suppuration of retropharyngeal lymph node

 B

Caries of cervical spine

 C

Infective foreign body

 D

Caries teeth

Ans. B

Explanation:

Q. 11

True statement about chronic retropharyngeal abscess:

 A

Associated with tuberculosis of spine

 B

Causes psoas spasm

 C

Suppuration of Rouviere lymph node

 D

a and c

Q. 11

True statement about chronic retropharyngeal abscess:

 A

Associated with tuberculosis of spine

 B

Causes psoas spasm

 C

Suppuration of Rouviere lymph node

 D

a and c

Ans. D

Explanation:

 

  • Chronic retropharyngeal abscess is associated with caries of cervical spine or tuberculous infection of retropharyngeal lymph nodes secondary to tuberculosis of deep cervical nodes (i.e. suppuration of Rouviere nodes)
  • It leads to discomfort in throat, dysphagia, fluctuant swelling of postpharyngeal wall.
  • Retropharyngeal abscess does not lead to psoas spasm.

Treatment

  • Incison and drainage of abscess
  • Full course of ATT 

Q. 12

Which is  a false statement about Retropharyngeal abscess?

 A

It lies lateral to midline

 B

Causes difficulty in swallowing and speech

 C

Can always be palpated by finger at the post pharyngeal wall

 D

It is present beneath the vertebral fascia

Q. 12

Which is  a false statement about Retropharyngeal abscess?

 A

It lies lateral to midline

 B

Causes difficulty in swallowing and speech

 C

Can always be palpated by finger at the post pharyngeal wall

 D

It is present beneath the vertebral fascia

Ans. D

Explanation:

 

Retropharyngeal space lies behind the pharynx between the buccopharyngeal fascia covering pharyngeal constrictor muscles and the prevertebral facia (i.e. behind the pharynx and in front of prevertebral fascia)

 

On physical examination, may reveal bulging of the posterior pharyngeal wall.

Dysphagia and difficulty in breathing are prominent symptoms as the abscess obstructs the air and food passages


Q. 13

Middle age diabetic with tooth extraction with ipsilateral swelling over middle one-third of sternocleidomastoid and displacement of tonsils towards contralateral side:

 A

Parapharyngeal abscess

 B

Retropharyngeal abscess

 C

Ludwigs angina

 D

None

Q. 13

Middle age diabetic with tooth extraction with ipsilateral swelling over middle one-third of sternocleidomastoid and displacement of tonsils towards contralateral side:

 A

Parapharyngeal abscess

 B

Retropharyngeal abscess

 C

Ludwigs angina

 D

None

Ans. A

Explanation:

Q. 14

Which of the following is not true about acute retropharyngeal absess:

 A

Dysphagia

 B

Swelling on posterolateral wall

 C

Torticollis

 D

Caries of cervical spine is usually a common cause

Q. 14

Which of the following is not true about acute retropharyngeal absess:

 A

Dysphagia

 B

Swelling on posterolateral wall

 C

Torticollis

 D

Caries of cervical spine is usually a common cause

Ans. D

Explanation:

M/C cause acute retropharyngeal abscess in children is suppuration of retro pharyngeal lymphnodes secondary to infection of adenoids, nasopharynx and nasal cavity.

The M/C cause of acute retropharyngeal abscess in adutls is penetrating injury of posterior pharyngeal wall or cerivcal esophagus. 



Thyroglossal Cyst

Thyroglossal Cyst

Q. 1

Most common site of thyroglossal cyst is?

 A Subhyoid
 B

Suprahyoid

 C Tongue
 D

Subomohyoid

Q. 1

Most common site of thyroglossal cyst is?

 A Subhyoid
 B

Suprahyoid

 C Tongue
 D

Subomohyoid

Ans. A

Explanation:

Subhyoid REF: Schwartz’s Principles of Surgery 9th edition Chapter 39. Pediatric Surgery

“Usually the thyroglossal cyst is encountered in the midline at or below the level of the hyoid bone and moves up and down with swallowing or with protrusion of the tongue”


Q. 2

The following statements about thyroglossal cyst are true, EXCEPT:

 A

The cyst is located within 2 cm of the midline

 B

Incision and drainage is the treatment of choice

 C

The swelling moves upwards on protrusion of tongue

 D

It is the frequent cause of anterior midline neck masses in the first decade of life

Q. 2

The following statements about thyroglossal cyst are true, EXCEPT:

 A

The cyst is located within 2 cm of the midline

 B

Incision and drainage is the treatment of choice

 C

The swelling moves upwards on protrusion of tongue

 D

It is the frequent cause of anterior midline neck masses in the first decade of life

Ans. B

Explanation:

Thyroglossal cyst is a fluid filled sac resulting from a persistent thyroglossal duct.

Excision of the thyroglossal cyst along with the track and the body of the hyoid bone is the treatment of choice (Sistrunk’s operation).

Ref: Problem Based Approach in Pediatric Surgery By Rao, Page 108; Bailey and Love’s Short Practice of Surgery, 24th Edition, Pages 777-78.


Q. 3

A 16 year old girl presented with a painless swelling in the midline of the neck and moves up and down with swallowing and with protrusion of the tongue. Which is the most common site of thyroglossal cyst?

 A

Subhyoid

 B

Suprahyoid

 C

Tongue

 D

Subomohyoid

Q. 3

A 16 year old girl presented with a painless swelling in the midline of the neck and moves up and down with swallowing and with protrusion of the tongue. Which is the most common site of thyroglossal cyst?

 A

Subhyoid

 B

Suprahyoid

 C

Tongue

 D

Subomohyoid

Ans. A

Explanation:

Thyroglossal cyst arises from thyroglossal tract (extending from foramen caecum to isthmus of thyroid).

Most common site is subhyoid.

Other sites are thyroid and suprahyoid.

Typical presentation is painless, midline swelling in 15-30 years old female.

It is a soft, cystic, fluctuant, transillumination negative swelling.

It moves sideways, not vertically, with deglutition and protrusion of tongue (TUG due to attachment with hyoid).

Ref: Manual of Surgery: Essential Cases in Surgery By Sumit Chhikara, 2005, Page 58; Schwartz’s Principles of Surgery 9th edition, Chapter 39


Q. 4

A child presents with a midline swelling beneath the arch of the hyoid bone. What might this swelling be?

 A

Thyroglossal cyst

 B

Sternocleidomastoid tumour

 C

Both of the above

 D

None of the above

Q. 4

A child presents with a midline swelling beneath the arch of the hyoid bone. What might this swelling be?

 A

Thyroglossal cyst

 B

Sternocleidomastoid tumour

 C

Both of the above

 D

None of the above

Ans. A

Explanation:

The child most likely has a thyroglossal cyst that results from incomplete regression of the thyroglossal duct. These cysts may form anywhere along the line of descent of the thyroid gland as it migrates from the region of the foramen cecum of the tongue to its position in the neck. A cyst must be differentiated from ectopic glandular tissue, which may also remain along this pathway.

Q. 5

In thyroglossal cyst, carcinoma which arises is

 A

Follicular

 B

Medullary

 C

Papillary

 D

Anaplastic

Q. 5

In thyroglossal cyst, carcinoma which arises is

 A

Follicular

 B

Medullary

 C

Papillary

 D

Anaplastic

Ans. C

Explanation:

Ans :C.), Papillary.

  • Thyroglossal duct cysts are usually located in the midline of the neck. The coexistence of carcinomas in thyroglossal duct cysts is extremely rare, with most being papillary carcinomas.
  • The definitive surgery of Thyroglossal Cyst is Sistrunk’s operation.
  • There is still controversy regarding the need to remove the thyroid gland in the case of a papillary carcinoma of the Thyroglossal Duct Cyst.
  • Thyroidectomy is recommended in cases where (a) the thyroid gland is found to be nodular, with a cold nodule in a thyroid iodine uptake scan; (b) enlarged lymph nodes are present, or (c) a history of neck irradiation exists .

Q. 6

For thyroglossal cyst M.C. site is –

 A

Suprahyoid

 B

Subhyoid

 C

Foramen caecum

 D

Anterior border of sternomastoid

Q. 6

For thyroglossal cyst M.C. site is –

 A

Suprahyoid

 B

Subhyoid

 C

Foramen caecum

 D

Anterior border of sternomastoid

Ans. B

Explanation:

Ans is B ie Subhyoid 

  • Thyroglossal cyst
  • It is cystic swelling developed in the remnant of the thyroglossal duct or tract
  • Site – It may be present in any part of the thyroglossal tract (thyroglossal tract extends from foramen caecum to the isthmus of thyroid)
  • Common sites are:

subhyoid (most common)

in the region of the thyroid cartilages,

suprahyoid

in the floor of mouth

– beneath the foramen caecum

  • It is a midline swelling, except in the region of the thyroid cartilage, where the thyroglossal tract is pushed to one side, usually to the left.
  • Though its a congenital swelling most common age of presentation is between 2 to 4 yrs.
  • Mobility – Cyst can be moved sideways but not vertically
  • Peculiar characterstic which helps in distinguishing thyroglossal cyst from other neck swelling – it moves up with protrusion of tongue* as the thyroglossal tract is attached to the tongue.

– It also moves with degluttion so do all thyroid swellings, subhyoid bursitis, sublingual desmoid.

  • Cyst is lined by pseudostratified columnar epithelium and squamous epithelium with hetrotopic thyroid tissue present in 20% of cases..
  • Complications

– Recurrent infection,

– formation of thyroglossal fistula

carcinomatous change (usually Papillary carcinoma. *)

  • Treatment —> Treatment involves the “Sistrunk operation” which consists of enbloc cystectomy and excision of the central hyoid bone to minimize recurrence.
  • Note
  • Thyroglossal cyst is congenital but thyroglossal fistula is never congenital. It follows infection or inadequate removal of a thyroglossal cyst.



Q. 7

The following statements about thyroglossal cyst are true, except

 A

Frequent cause of anterior midline neck masses in the first decade of life

 B

The cyst is located within 2 cm of the midline

 C

Incision and drainage is the treatment of choice

 D

The swelling moves upwards on protrusion of tongue

Q. 7

The following statements about thyroglossal cyst are true, except

 A

Frequent cause of anterior midline neck masses in the first decade of life

 B

The cyst is located within 2 cm of the midline

 C

Incision and drainage is the treatment of choice

 D

The swelling moves upwards on protrusion of tongue

Ans. C

Explanation:

Ans. is ‘c’ i.e. Incision and drainage is the treatment of choice 

Treatment of thyroglossal cyst involves complete excision of cyst along with the thyroglossal tract. Incision and drainage can lead to fistula formation.


Q. 8

One of the following is an example of painless midline swelling –

 A

Branchial cyst

 B

Thyroglossal cyst

 C

Cystic hygroma

 D

Carotid body tumour

Q. 8

One of the following is an example of painless midline swelling –

 A

Branchial cyst

 B

Thyroglossal cyst

 C

Cystic hygroma

 D

Carotid body tumour

Ans. B

Explanation:

Ans is ‘b’ ie Thyroglossal cyst

Midline swelling of neck from above downwards

1. Ludwigs angina                                  7. Goitre

2. Enlarged submental lymph nodes

8. Lipoma & enlarged lymph nodes in the suprasternal space of

 

3. Sublingual dermoid

burns

 

4. Lipoma in submental region

9. Retrosternal goitre

 

5. Thyroglossal cyst

10. Thymic swelling

 

6. Subhyoid bursitis

11. (A dermoid cyst may occur anywhere in the midline)

 


Q. 9

Hyoid bone is closely associated with –

 A

Bronchiogenic cyst

 B

Cystic hygroma

 C

Thyroglossal cyst/fistula

 D

Branchial cyst

Q. 9

Hyoid bone is closely associated with –

 A

Bronchiogenic cyst

 B

Cystic hygroma

 C

Thyroglossal cyst/fistula

 D

Branchial cyst

Ans. C

Explanation:

Ans is ‘c’ i.e., Thyroglossal cyst 

Hyoid bone is closely associated with the thyroglossal tract from which thyroglossal cyst & fistula originate, thus during surgical excision of the thyroglossal cyst or fistula, the central part of the hyoid bone is excised (otherwise recurrence may occur).


Q. 10

In the management of thyroglossal cyst ‑

 A

Central portion of hyoid excised

 B

Sternothyroid muscle dissected

 C

Isthmusectomy with subtotal thyroidectomy

 D

Strap muscle of neck are dissected

Q. 10

In the management of thyroglossal cyst ‑

 A

Central portion of hyoid excised

 B

Sternothyroid muscle dissected

 C

Isthmusectomy with subtotal thyroidectomy

 D

Strap muscle of neck are dissected

Ans. A

Explanation:

Answer is ‘a’ i.e. Central portion of hyoid excised 

Thyroglossal cyst is managed by Sistrunk operation in which the cyst is completely excised along with the thyroglossal tract. Since the thyroglossal tract is intimately related to the hyoid bone, the central portion of the hyoid bone is also removed.


Q. 11

Most common site for thyroglossal cyst is ‑

 A

Suprahyoid

 B

Subhyoid

 C

Beneath the foramen ceacum

 D

Floor of mouth

Q. 11

Most common site for thyroglossal cyst is ‑

 A

Suprahyoid

 B

Subhyoid

 C

Beneath the foramen ceacum

 D

Floor of mouth

Ans. B

Explanation:

Ans. is ‘b’ i.e., Subhyoid 


Q. 12

Sistrunk’s operation is used in

 A

Parotid tumour

 B

Thyroglossal fistula

 C

Thyroglossal cyst

 D

b and c

Q. 12

Sistrunk’s operation is used in

 A

Parotid tumour

 B

Thyroglossal fistula

 C

Thyroglossal cyst

 D

b and c

Ans. D

Explanation:

Ans. Two options are correct i.e., ‘b’ i.e. Thyroglossal fistula & ‘c’ i.e. Thyroglossal cyst 


Q. 13

Excision of the hyoid bone is done in –

 A

Branchial cyst

 B

Branchial fistula

 C

Thyroglossal cyst

 D

Sublingual dermoids

Q. 13

Excision of the hyoid bone is done in –

 A

Branchial cyst

 B

Branchial fistula

 C

Thyroglossal cyst

 D

Sublingual dermoids

Ans. C

Explanation:

Ans. is ‘c’ i.e., Thyroglossal cyst 


Q. 14

Which of the following does not move on deglutition

 A

Subligual dermoid

 B

Thyroid nodule

 C

Pretracheallymphnode

 D

Thyroglossal cyst

Q. 14

Which of the following does not move on deglutition

 A

Subligual dermoid

 B

Thyroid nodule

 C

Pretracheallymphnode

 D

Thyroglossal cyst

Ans. A

Explanation:

Ans. is ‘a’ i.e., Subligual dermoid 

Not sure about option ‘c’ but answer ‘a’ is confirmed


Q. 15

Thyroglossal fistula develops due to –

 A

Developmental anomaly

 B

Injury

 C

Incomplete removal of thyroglossal cyst

 D

Inflammatory disorder

Q. 15

Thyroglossal fistula develops due to –

 A

Developmental anomaly

 B

Injury

 C

Incomplete removal of thyroglossal cyst

 D

Inflammatory disorder

Ans. C

Explanation:

Ans. is ‘c’ i.e., Incomplete removal of thyroglossal cyst 

Thyroglossal fistula is never congenital. It follows infection or inadequate removal of a thyroglossal cyst.


Q. 16

Which is never a cause of thyroglossal fistula ‑

 A

Infection of thyroglossal cyst

 B

Inadequate removal of thyroglossal cyst

 C

Congenital

 D

None of the above

Q. 16

Which is never a cause of thyroglossal fistula ‑

 A

Infection of thyroglossal cyst

 B

Inadequate removal of thyroglossal cyst

 C

Congenital

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Congenital 


Q. 17

Which of the following swelling moves on protrusion of tongue –

 A

Thyroglossal cyst

 B

Branchial cyst

 C

Ranula

 D

Cyst in hyoid bone

Q. 17

Which of the following swelling moves on protrusion of tongue –

 A

Thyroglossal cyst

 B

Branchial cyst

 C

Ranula

 D

Cyst in hyoid bone

Ans. A

Explanation:

Ans. is ‘a’ i.e., Thyroglossal cyst 


Q. 18

Hyoid bone is closely associated to:

September 2012

 A

Bronchogenic cyst

 B

Cystic hygroma

 C

Thyroglossal cyst

 D

Ranula

Q. 18

Hyoid bone is closely associated to:

September 2012

 A

Bronchogenic cyst

 B

Cystic hygroma

 C

Thyroglossal cyst

 D

Ranula

Ans. C

Explanation:

Ans. C i.e. Thyroglossal cyst

Thyroglossal cyst

MC site:

– Beneath the hyoid,

Occupies the midline usually (except in the region of thyroid cartilage),

  • Swelling moves upwards on protrusion of the tongue as well as on swallowing (attachment with foramen caecum),
  • Painless

Q. 19

MC site for thyroglossal cyst is:

March 2013 (a, d, g, h)

 A

Beneath the foramen caecum

 B

Floor of mouth

 C

Above hyoid

 D

Subhyoid

Q. 19

MC site for thyroglossal cyst is:

March 2013 (a, d, g, h)

 A

Beneath the foramen caecum

 B

Floor of mouth

 C

Above hyoid

 D

Subhyoid

Ans. D

Explanation:

Ans. D i.e. Subhyoid


Q. 20

Anterior m i d line swelling of neck is:

March 2013 (g)

 A

Branchial cyst

 B

Thyroglossal cyst

 C

Cystic hygroma

 D

Carotid body tumour

Q. 20

Anterior m i d line swelling of neck is:

March 2013 (g)

 A

Branchial cyst

 B

Thyroglossal cyst

 C

Cystic hygroma

 D

Carotid body tumour

Ans. B

Explanation:

Ans. B i.e. Thyroglossal cyst


Q. 21

Most common malignancy arising in thyroglossal cyst is 

 A

Follicular

 B

Papillary

 C

Medullary

 D

Anaplastic

Q. 21

Most common malignancy arising in thyroglossal cyst is 

 A

Follicular

 B

Papillary

 C

Medullary

 D

Anaplastic

Ans. B

Explanation:

 

Thvroglossal Cyst

  • Contains clear to cloudy fluid with sparse cellularity.
  • Cystic background contains few if any epithelial cells.
  • Some inflammatory cells and crystals might be present.
  • Rarely malignant transformation occurs in about 1% of the cases.
  • Most common malignancy arising is papillary carcinoma followed by squamous cell carcinoma.

Q. 22

In the management of the condition “marked by a red arrow” in the reconstructed CT scan of the neck as shown in the picture below ? 

 A

Central portion of hyoid excised.


 B

Sternothyroid muscle dissected.


 C

Isthmusectomy with subtotal thyroidectomy.

 D

Strap muscle of neck are dissected.

Q. 22

In the management of the condition “marked by a red arrow” in the reconstructed CT scan of the neck as shown in the picture below ? 

 A

Central portion of hyoid excised.


 B

Sternothyroid muscle dissected.


 C

Isthmusectomy with subtotal thyroidectomy.

 D

Strap muscle of neck are dissected.

Ans. A

Explanation:

 Reconstructed CT scan of the neck as shown in the picture above demonstrates a midline cystic lesion i.e Thyroglossal duct cyst with a slightly enhancing wall.

In the management of thyroglossal cyst, the central portion of hyoid is excised.

Thyroglossal cyst is managed by Sistrunk operation in which the cyst is completely excised along with the thyroglossal tract. Since the thyroglossal tract is intimately related to the hyoid bone, the central portion of the hyoid bone is also removed.



Obturator nerve

OBTURATOR NERVE

Q. 1

Which muscles are supplied by obturator nerve‑

 A

Abductor muscle

 B

Adductor compartment

 C

Extensor compartment

 D

Flexor compartment

Q. 1

Which muscles are supplied by obturator nerve‑

 A

Abductor muscle

 B

Adductor compartment

 C

Extensor compartment

 D

Flexor compartment

Ans. B

Explanation:

B. i.e. Adductor compartment

Adductor compartment of thigh is supplied by obturator nerveQ; and anterior flexor compartmentof thigh by femoral nerve. Gluteus medius, minimus & tensor fascia lata are supplied by superior gluteal nerve, (Mn- “Middle & Minimum class Tension is superior”). Where as gluteus maximus is supplied by inferior gluteal nerve.


Q. 2

Nerve supply of adductor magnus is through:

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Q. 2

Nerve supply of adductor magnus is through:

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Ans. C

Explanation:

Innervation of adductor magnus

  • Posterior division of obturator nerve innervates most of the adductor magnus
  • Vertical or hamstring portion innervated by tibial nerve (L2, L3, L4)

Q. 3

Nerve Supply of the Muscle marked as Muscle A in the diagram is 

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Q. 3

Nerve Supply of the Muscle marked as Muscle A in the diagram is 

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Ans. C

Explanation:

Innervation of adductor magnus

  • Posterior division of obturator nerve innervates most of the adductor magnus
  • Vertical or hamstring portion innervated by tibial nerve (L2, L3, L4)

Q. 4

All nerves pass thorugh greater sciatic notch except ‑

 A

Superior gluteal nerve

 B

Inferior gluteal nerve

 C

Sciatic nerve

 D

Obturator nerve

Q. 4

All nerves pass thorugh greater sciatic notch except ‑

 A

Superior gluteal nerve

 B

Inferior gluteal nerve

 C

Sciatic nerve

 D

Obturator nerve

Ans. D

Explanation:

Ans. is ‘d’ i.e., Obturator nerve


Q. 5

Structures crossing dorsal surface of the given structure marked by a “red arrow” are ? 

 A

Internal pudendal vessel.

 B

Pudendal nerve.


 C

Obturator nerve.

 D

Nerve to obturator internus.

Q. 5

Structures crossing dorsal surface of the given structure marked by a “red arrow” are ? 

 A

Internal pudendal vessel.

 B

Pudendal nerve.


 C

Obturator nerve.

 D

Nerve to obturator internus.

Ans. C

Explanation:

Ans;C).Obturator nerve

The structure marked by a red arrow represents the ischial spine.

ISCHIAL SPINEa thin pointed triangular eminence that projects from the dorsal border of the ischium and gives attachment to the gemellus superior on its external surface and to the coccygeus, levator ani, and pelvic fascia on its internal surface

  • The structure crossing dorsal surface of ischial spine is the Obturator nerve.
  • Psoas major, iliacus & pectineus muscles, femoral vessels and nerve, femoral branch of genitofemoral nerve, lateral cutaneous nerve of thigh and lymphatics pass below inguinal ligament.
  • ‘PIN’ structures i.e. Pudendal nerve, Internal Pudendal vessels, Nerve to obturator internus come out of greater sciatic foramen, cross the dorsal surface of ischial spine & enter into lesser sciatic foramen.
  • From the posterior border of the body of the Ischium there extends backward a thin and pointed triangular eminence, the ischial spine, more or less elongated in different subjects.

Surfaces

external surface gives attachment to the Gemellus superior
internal surface gives attachment to the CoccygeusLevator ani, and the pelvic fascia
pointed extremity the sacrospinous ligament is attached.

Clinical significance

It can serve as a landmark in pudendal anesthesia.




Femoral sheath

FEMORAL SHEATH

Q. 1

Which of the following does not form boundary of femoral ring:

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

a & c

Q. 1

Which of the following does not form boundary of femoral ring:

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

a & c

Ans. D

Explanation:

A i.e. Femoral Artey; C i.e. Femoral nerve


Q. 2

On an average, the distance between femoral ring and saphenous opening (length of femoral canal) is ‑

 A

1.25 cm

 B

2.50 cm

 C

3.75 cm

 D

5.00 cm

Q. 2

On an average, the distance between femoral ring and saphenous opening (length of femoral canal) is ‑

 A

1.25 cm

 B

2.50 cm

 C

3.75 cm

 D

5.00 cm

Ans. A

Explanation:

Ans. is ‘a’ i.e., 1.25 cm 


Q. 3

Structure forming medial boundary of femoral ring is:      

 A

Inguinal ligament

 B

Pecten pubis

 C

Lacunar ligament

 D

Conjoint tendon

Q. 3

Structure forming medial boundary of femoral ring is:      

 A

Inguinal ligament

 B

Pecten pubis

 C

Lacunar ligament

 D

Conjoint tendon

Ans. C

Explanation:

Ans. C i.e. Lacunar ligament


Q. 4

Structure which lies outside the femoral sheath 

 A

Femoral artery

 B

Femoral nerve

 C

Femoral vein

 D

Genitofemoral nerve

Q. 4

Structure which lies outside the femoral sheath 

 A

Femoral artery

 B

Femoral nerve

 C

Femoral vein

 D

Genitofemoral nerve

Ans. B

Explanation:

 Femoral nerve

Femoral sheath

Femoral sheath is a funnel shaped fascial prolongation around proximal part of femoral vessels, situated in the femoral triangle, below the inguinal ligament. It is 3-4 cm long. It is formed by fascia iliaca.

Femoral sheath is divided into 3 separate fascial compartements by septa :‑

i) Lateral compartment :- It contains femoral artery and femoral branch of genitofemoral nerve.

ii) Intermediate compartment :- Femoral vein.

iii) Medial compartment (femoral canal) :- It is conical in shape, wider above adn narrow below. The wider upper opening is known as femoral ring, which is potentially a weak point in lower abdomen and is the site for femoral hernia. Femoral ring is bounded : Anteriorly by inguinal ligament, medially by lacunar ligament, posteriorly by pectineus with its covering fascia, and laterally by septum separating it from femoral vein. Femoral canal contains lymph node of cloquet or Rosenmuller and lymphatics.



Hip joint movements

HIP JOINT MOVEMENTS

Q. 1

Muscles that can cause external rotation of the hip include all of the following except:

 A

Sartorius

 B

Obturator internus

 C

Obturator externus

 D

Gluteus minimus

Q. 1

Muscles that can cause external rotation of the hip include all of the following except:

 A

Sartorius

 B

Obturator internus

 C

Obturator externus

 D

Gluteus minimus

Ans. D

Explanation:

Ans:D.)Gluteus Minimus.

Many of the muscles of the gluteal region are external rotators of the hip. These muscles include the gluteus maximus, piriformis, obturator internus, obturator externus, quadratus femoris, superior gemellus, and inferior gemellus. The sartorius is a flexor and external rotator of the hip. The gluteus minimus is an abductor and internal rotator of the hip.


Q. 2

Which of the following is the action of tensor fasciae latae?

 A

Abduction of hip

 B

Flexion of hip

 C

Extension of knee

 D

All the above

Q. 2

Which of the following is the action of tensor fasciae latae?

 A

Abduction of hip

 B

Flexion of hip

 C

Extension of knee

 D

All the above

Ans. D

Explanation:

Tensor fasciae latae extends from iliac crest to iliotibial track. It is also involved in medial rotation of hip. Tensor fascia latae is innervated by the superior gluteal nerve, L4, L5 and S1. The basic functional movement of tensor fascia latae is walking. The tensor fascia lata is heavily utilized in horse riding, hurdling and water skiing. 


Q. 3

Which of the following muscle helps in the flexion of hip joint?

 A

Psoas

 B

Piriformis

 C

Pectoralis major

 D

External oblique abdominis

Q. 3

Which of the following muscle helps in the flexion of hip joint?

 A

Psoas

 B

Piriformis

 C

Pectoralis major

 D

External oblique abdominis

Ans. A

Explanation:

Flexors of hip: Psoas major and illiacus are the chief flexors of hip joint. Pectineus, rectus femoris, adductors and sartorius are the accessory muscles. Adductors mainly the adductor longus participate in the early stages of flexion.


Q. 4

All are abductors of thigh, EXCEPT?

 A

Sartorius

 B

Piriformis

 C

Gluteus minimus

 D

Gluteus medius

Q. 4

All are abductors of thigh, EXCEPT?

 A

Sartorius

 B

Piriformis

 C

Gluteus minimus

 D

Gluteus medius

Ans. B

Explanation:

Piriformis helps in lateral rotation of hip and is not a abductor. Gluteus medius, gluteus minimus and sartorius are abductors of hip.

 

The hip joint is a ball and socket joint. It has the following normal ranges of movement: Flexion, Extension, Adduction, Abduction, Medial Rotation and Lateral Rotation. There are various muscles which bring about these movements.
 

Hip joint Movement

Chief muscles

Accessory muscles

Abductors of hip

Gluteus medius

Gluteus minimus

Sartorius

Tensor fascia lata

Adductors of hip

Adductor longus, brevis and magnus

Pectineus

Gracilis

Lateral rotators of hip

Externus obturator

Internus obturator

superior and inferior gemelli

Quadratus femoris

Pyriormis

Sartorius

Gluteus maximus

Medial rotators of hip

Tensor fascia lata

Gluteus medius

Gluteus minimus

 

Extensors

Gluteus maximus

Hamstrings

 

Flexors

Psoas major

Iliacus

Pectinius

Rectus femoris

Sartorius

Adductor longus


Q. 5

All are abductors of thigh, EXCEPT?

 A

Gluteus maximus

 B

Gracilis muscle

 C

Sartorius

 D

Piriformis

Q. 5

All are abductors of thigh, EXCEPT?

 A

Gluteus maximus

 B

Gracilis muscle

 C

Sartorius

 D

Piriformis

Ans. B

Explanation:

  • The muscles of the gluteal region primarily act on the hip joint, producing extension, medial rotation, lateral rotation, and abduction. 
  • The piriformis acts as an abductor, lateral rotator, and weak extensor of the thigh. The action of the sartorius muscle is to flex, abduct, and laterally rotate the thigh at the hip joint and flex the leg at the knee joint. 
  • The gracilis muscle adducts the thigh at the hip joint and flexes the leg at the knee joint.

Q. 6

Which of the ligaments limits extension at the hip joint?

 A

Iliofemoral

 B

Ligamentum capitis femoris

 C

Pubofemoral

 D

Zona orbicularis

Q. 6

Which of the ligaments limits extension at the hip joint?

 A

Iliofemoral

 B

Ligamentum capitis femoris

 C

Pubofemoral

 D

Zona orbicularis

Ans. A

Explanation:

The iliofemoral ligament is a Y-shaped ligament extending from the anterior inferior iliac spine to the anterior surface of the intertrochanteric line of the femur. It prevents hyperextension of the hip joint during standing by screwing the femoral head into the acetabulum. (The ischiofemoral ligament also helps to prevent hyperextension of the hip joint by screwing the femoral head into the acetabulum).

Ligamentum capitis femoris attaches the head of the femur to the acetabular fossa. The pubofemoral ligament connects the pubic portion of the rim of the bony acetabulum to the medial surface of the femoral neck. It prevents over abduction of the hip joint.

Zona orbicularis is a band of circularly oriented ligamentous fibers that reinforce the capsule of the hip joint. it helps keep the head of the femur in its socket.


Q. 7

True regarding the hip joint is :

 A

Medial rotation and Abduction is caused by Gluteus medius and Gluteus minimus

 B

Medial rotation and Adduction is caused by Gluteus medius and Gluteus minimus

 C

Lateral rotaters of thigh are supplied by femoral nerve

 D

Hyperextension of Hip is prevented by capsular thickening

Q. 7

True regarding the hip joint is :

 A

Medial rotation and Abduction is caused by Gluteus medius and Gluteus minimus

 B

Medial rotation and Adduction is caused by Gluteus medius and Gluteus minimus

 C

Lateral rotaters of thigh are supplied by femoral nerve

 D

Hyperextension of Hip is prevented by capsular thickening

Ans. A

Explanation:

A i.e. Medial rotation & abduction is caused by gluteus medius & minimus

Gluteus medius & minimus are powerful abductors of hip & also cause medial rotation (not lateral rotation). Gluteus maximus is extensor & lateral rotator of hip.

Sartorius is flexor, abductor & lateral rotator of hip & flexes knee joint. (i.e. palthi posture/ sitting crossed leg / position in which tailors sit).

Tensor fascia lata is flexor, abductor & medial rotator of hip; helps in knee extension.

Hyper extension is prevented by iliofemoral ligament (Ligament of Bigelow)  not by capsular thickening

Femoral nerve (L2L3L4) supplies flexor muscles of hip (anterior compartment of thigh) i.e. – Sartorius, Quadriceps femoris (rectus femoris + vastus laterlis, medialis & intermedius), articularis genu  not lateral rotators of thigh (eg. Gluteus maximus)


Q. 8

Abduction of the thigh is limited by :

September 2009

 A

Ischiofemoral ligaments

 B

Pubofemoral ligaments

 C

Iliofemoral ligaments

 D

Sacroiliac ligament

Q. 8

Abduction of the thigh is limited by :

September 2009

 A

Ischiofemoral ligaments

 B

Pubofemoral ligaments

 C

Iliofemoral ligaments

 D

Sacroiliac ligament

Ans. B

Explanation:

Ans. B: Pubofemoral ligaments



Muscular compartment of leg

MUSCULAR COMPARTMENT OF LEG

Q. 1 Which of the following muscle is not a hybrid muscle
 A Pectoralis major
 B Extensor digitorum
 C Flexor digitorum profundus
 D Brachialis
Q. 1 Which of the following muscle is not a hybrid muscle
 A Pectoralis major
 B Extensor digitorum
 C Flexor digitorum profundus
 D Brachialis
Ans. B

Explanation:

Extensor digitorum

Hybrid muscles are the muscles having more than one nerve supply

Pctoralis major: lateral & medial pectoral nerves

 

Brachialis: additional proprioceptive fibres from radial nerve, in addition to its muscular nerve, musculocutaneous nerve.

 

 Extensor digitorum is supplied by the posterior interosseous nerve only.


Q. 2

Which is an unlocker of knee?

 A

Popliteus 

 B

biceps femoris 

 C

Sartorius

 D

Gastrocnemius

Q. 2

Which is an unlocker of knee?

 A

Popliteus 

 B

biceps femoris 

 C

Sartorius

 D

Gastrocnemius

Ans. A

Explanation:

Popliteus

  • Locking or screw home mechanism: Conjuct medial rotation of femur on tibia in later stages of extension due to quadriceps femoris locks the knee joint.
  • Unlocking of knee joint: At beginning of flexion from full extension with foot flexed, lateral rotation by Popliteus muscle unlocks the joint.

Q. 3

Tibialis posterior is inserted in all the tarsal bones, except?

 A

Calcaneus

 B

Intermediate cuneiform

 C

Cuboid

 D

Talus

Q. 3

Tibialis posterior is inserted in all the tarsal bones, except?

 A

Calcaneus

 B

Intermediate cuneiform

 C

Cuboid

 D

Talus

Ans. D

Explanation:

Talus


Q. 4

The muscle that acts primarily as an evertor of ankle inserted into the medial cuneiform is which of the following?

 A

Peroneus longus

 B

Peroneus brevis

 C

Tibialis anterior

 D

Tibialis posterior

Q. 4

The muscle that acts primarily as an evertor of ankle inserted into the medial cuneiform is which of the following?

 A

Peroneus longus

 B

Peroneus brevis

 C

Tibialis anterior

 D

Tibialis posterior

Ans. A

Explanation:

The peroneus longus and brevis act primarily as evertors, with the peroneus brevis being the stronger of the two. In the question, the evertor inserted to the medial cuneiform, which is peroneus longus.

The peroneus brevis inserts on the base of the fifth metatarsal and the peroneus longus courses under the cuboid to insert on the base of the first metatarsal and medial cuneiform. 

The tibialis anterior is the dorsiflexor of foot at the ankle joint. It is the invertor of the foot at the midtarsal and subtalar joints.

Tibialis posterior is the principal invertor of the foot.


Q. 5

Which of the following muscle is used in normal walk during stance and swing?

 A

Popliteus

 B

Gastrocnemius

 C

Tibialis anterior

 D

Iliopsoas

Q. 5

Which of the following muscle is used in normal walk during stance and swing?

 A

Popliteus

 B

Gastrocnemius

 C

Tibialis anterior

 D

Iliopsoas

Ans. B

Explanation:

Normal walking constitute of stance phase (when at least one leg is in contact with the ground) and swing phase (when the leg is in air). 

 Together, the soleus, gastrocnemius, and plantaris act as powerful plantar flexors of the ankle joint. They provide the main forward propulsive force in walking and running by using the foot as a lever and raising the heel off the ground.

Q. 6

Among the following, the structure that passes deep to the flexor retinaculum is?

 A

Tibialis anterior

 B

Tibialis posterior

 C

Peroneus brevis

 D

Peroneus longus

Q. 6

Among the following, the structure that passes deep to the flexor retinaculum is?

 A

Tibialis anterior

 B

Tibialis posterior

 C

Peroneus brevis

 D

Peroneus longus

Ans. B

Explanation:

Tibialis posterior is the deepest and most centrally located muscle in the deep posterior compartment of the leg. It arises from the upper posterior aspect of tibia, fibula and interosseous membrane and passes medially deep to the flexor retinaculum. Its tendons flares and inserts into the navicular, tarsal bones, and bases of the second, to fourth metatarsals.

Flexor retinaculum is a thick band of deep fascia on the medial aspect of the ankle 
Medial calcaneal nerve and medial calcaneal artery pierce the retinaculum.
Structures passing below it from above down are:
  • Tibialis posterior tendon
  • Flexor digitorum longus tendon
  • Flexor hallucis longus tendon
  • Posterior tibial artery
  • Tibial nerve.

Q. 7

Boundaries of Popliteal fossa

 A

Biceps femoris

 B

Both heads of Gastrocnemius

 C

Adductor magnus

 D

All

Q. 7

Boundaries of Popliteal fossa

 A

Biceps femoris

 B

Both heads of Gastrocnemius

 C

Adductor magnus

 D

All

Ans. D

Explanation:

A. i.e. Biceps femoris; B. i.e. Both heads of gastrocnemius; C. i.e. Adductor magnus


Q. 8

Violent inversion of the foot will lead to avulsion of tendon of which the following muscle attached to the tuberosity of the 5th metatarsal?

 A

Peroneus brevis

 B

Peroneus longus

 C

Peroneus tertius

 D

Extensor digitorum brev

Q. 8

Violent inversion of the foot will lead to avulsion of tendon of which the following muscle attached to the tuberosity of the 5th metatarsal?

 A

Peroneus brevis

 B

Peroneus longus

 C

Peroneus tertius

 D

Extensor digitorum brev

Ans. A

Explanation:

A i.e. Peroneus brevis 

Violent inversion of foot may cause avulsion of tuberosity of 5n1, metatarsal base, the insertion of peroneus (fibularis) brevis muscleQ.


Q. 9

Muscle acting both at knee and ankle joint is/are:

 A

Gastrocnemius

 B

Soleus

 C

Plantaris

 D

A and c both

Q. 9

Muscle acting both at knee and ankle joint is/are:

 A

Gastrocnemius

 B

Soleus

 C

Plantaris

 D

A and c both

Ans. D

Explanation:

A i.e. Gastrocnemius C i.e. Plantaris 


Q. 10

Muscle(s) causing dorsiflexion of foot is/are:

 A

Extensor digitorum longus

 B

Extensor hallucis longus

 C

Tibialis anterior

 D

All

Q. 10

Muscle(s) causing dorsiflexion of foot is/are:

 A

Extensor digitorum longus

 B

Extensor hallucis longus

 C

Tibialis anterior

 D

All

Ans. D

Explanation:

A i.e. Extensor digitorum longus; B i.e. Extensor hallucis longus; C i.e. Tibialis anterior


Q. 11

Planter flaxion is brought about by which of these muscles:

 A

Plantaris

 B

FHL

 C

Soleus

 D

All

Q. 11

Planter flaxion is brought about by which of these muscles:

 A

Plantaris

 B

FHL

 C

Soleus

 D

All

Ans. D

Explanation:

A. i.e. Plantans; B. i.e. FHL; C. i.e. Soleus


Q. 12

Anterior compartment of leg contains all muscle except :

 A

Peroneus brevis

 B

Peroneus tertius

 C

Extensor hallucis longus

 D

Tibialis anterior

Q. 12

Anterior compartment of leg contains all muscle except :

 A

Peroneus brevis

 B

Peroneus tertius

 C

Extensor hallucis longus

 D

Tibialis anterior

Ans. A

Explanation:

A. i.e. Peroneus brevis


Q. 13

Identify the Muscle Marked as A in the Image 

 A

Sartorius

 B

Gastrocnemius

 C

Soleus

 D

Tibialis Posterior

Q. 13

Identify the Muscle Marked as A in the Image 

 A

Sartorius

 B

Gastrocnemius

 C

Soleus

 D

Tibialis Posterior

Ans. A

Explanation:


Q. 14

Identify the Muscle Marked as A in the Image 

 A

Sartorius

 B

Gastrocnemius

 C

Soleus

 D

Tibialis Posterior

Q. 14

Identify the Muscle Marked as A in the Image 

 A

Sartorius

 B

Gastrocnemius

 C

Soleus

 D

Tibialis Posterior

Ans. A

Explanation:


Q. 15

True about popliteus are all except‑

 A

Flexor of knee

 B

Intracapsular origin

 C

Supplied by tibial nerve

 D

Causes locking of knee

Q. 15

True about popliteus are all except‑

 A

Flexor of knee

 B

Intracapsular origin

 C

Supplied by tibial nerve

 D

Causes locking of knee

Ans. D

Explanation:

Popliteus

Popliteus is a deep muscle of posterior compartment of leg.

Features of popletius are –

Origin

  • Lateral surface of lateral condyle of femur, origin is intracapsular.
  • Outer margin of lateral meniscus of knee.

Insertion

  • Posterior surface of shaft of tibia above soleal line.

Nerve supply

  • Tibial nerve

Action

  • Ulocks knee joint by lateral rotation of femur on tibia prior flexion.
  • Accessory flexor of knee.

Q. 16

Which of the following dorsiflexes the foot –

 A

Tibialis posterior

 B

Tibialis anterior

 C

Peroneus brevis

 D

Extensor digitorum brevis

Q. 16

Which of the following dorsiflexes the foot –

 A

Tibialis posterior

 B

Tibialis anterior

 C

Peroneus brevis

 D

Extensor digitorum brevis

Ans. B

Explanation:

 Tibialis anterior


Q. 17

Action of tibialis anterior ‑

 A

Plantar flexion of foot

 B

Adduction of foot

 C

Inversion of foot

 D

None of the above

Q. 17

Action of tibialis anterior ‑

 A

Plantar flexion of foot

 B

Adduction of foot

 C

Inversion of foot

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Inversion of foot


Q. 18

Action of popliteus muscle ‑

 A

Medial rotation of femur

 B

Lateral rotation of femur

 C

Locking of knee

 D

Extension of knee

Q. 18

Action of popliteus muscle ‑

 A

Medial rotation of femur

 B

Lateral rotation of femur

 C

Locking of knee

 D

Extension of knee

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lateral rotation of femur

Ponliteus

  • Popliteus is a deep muscle of posterior compartment of leg.
  • Features of popletius are ‑

Origin

  • Lateral surface of lateral condyle of femur, origin is intracapsular.
  • Outer margin of lateral meniscus of knee.

Insertion

  • Posterior surface of shaft of tibia above soleal line.

Nerve supply

  • Tibial nerve

Action

  • Ulocks knee joint by lateral rotation of femur on tibia prior flexion.
  • Accessory flexor of knee

Q. 19

Which is called as peripheral heart ‑

 A

Popliteus

 B

Soleus

 C

Plantaris

 D

None

Q. 19

Which is called as peripheral heart ‑

 A

Popliteus

 B

Soleus

 C

Plantaris

 D

None

Ans. B

Explanation:

Ans. is ‘b’ i.e., Soleus

Soleus is known as ‘peripheral heart’ as it helps in venous return from lower limb.


Q. 20

 Action (Arrow) shown in photograph is due to action of 

 A

 Tibialis anterior

 B

 Tibialis posterior 

 C

 Soleus 

 D

 Peroneus lomgus

Q. 20

 Action (Arrow) shown in photograph is due to action of 

 A

 Tibialis anterior

 B

 Tibialis posterior 

 C

 Soleus 

 D

 Peroneus lomgus

Ans. A

Explanation:

 Ans:A.)Tibialis Anterior.

Inversion of foot is shown in the image.



Venous drainage of lower limb

VENOUS DRAINAGE OF LOWER LIMB

Q. 1

Short saphenous vein in a tributary of:

 A

Medial marginal vein

 B

Lateral marginal vein

 C

Posterior tibial vein

 D

Dorsal venous arch

Q. 1

Short saphenous vein in a tributary of:

 A

Medial marginal vein

 B

Lateral marginal vein

 C

Posterior tibial vein

 D

Dorsal venous arch

Ans. B

Explanation:

Lateral marginal vein


Q. 2

The femoral ring is bounded by the following structures except?

 A

Femoral vein

 B

Inguinal ligament

 C

Femoral artery

 D

Lacunar ligament

Q. 2

The femoral ring is bounded by the following structures except?

 A

Femoral vein

 B

Inguinal ligament

 C

Femoral artery

 D

Lacunar ligament

Ans. C

Explanation:

The femoral ring is not bounded by Femoral artery.


Q. 3

An obese patient is brought into the casualty in shock and in need of intravenous fluids. No superficial veins can be seen or palpated. The emergency room physician decides to make an incision to locate the great saphenous vein for the insertion of a cannula (“saphenous cutdown”). In which of the following locations should the incision be made?

 A

Anterior to the lateral malleolus

 B

Anterior to the medial malleolus

 C

On the dorsum of the foot, lateral to the extensor hallucis longus tendon

 D

Posterior to the lateral malleolus

Q. 3

An obese patient is brought into the casualty in shock and in need of intravenous fluids. No superficial veins can be seen or palpated. The emergency room physician decides to make an incision to locate the great saphenous vein for the insertion of a cannula (“saphenous cutdown”). In which of the following locations should the incision be made?

 A

Anterior to the lateral malleolus

 B

Anterior to the medial malleolus

 C

On the dorsum of the foot, lateral to the extensor hallucis longus tendon

 D

Posterior to the lateral malleolus

Ans. B

Explanation:

The great saphenous vein is one of the two major superficial veins of the lower limb. It is found in the superficial fascia, where it is accessible for procedures such as saphenous cutdown and saphenous venous graft. As the vein ascends along the lower limb, it passes anterior to the medial malleolus at the ankle and posterior to the medial side of the knee. The vein then passes through the saphenous hiatus of the fascia lata to empty into the femoral vein slightly below the inguinal ligament.

  • No major vein is found anterior to the lateral malleolus.
  • Veins on the dorsum of the foot are small tributaries of the great and small saphenous veins.
  • The small saphenous vein passes posterior to the lateral malleolus.

Q. 4

Which of the following structures passes behind the inguinal ligament?

1. Femoral branch of genitofemoral nerve
2. Superficial epigastric artery
3. Psoas major
4. Femoral vein
5. Saphenous vein

 

 A

1,2 & 3

 B

3 & 4

 C

1,3,4 & 5

 D

All

Q. 4

Which of the following structures passes behind the inguinal ligament?

1. Femoral branch of genitofemoral nerve
2. Superficial epigastric artery
3. Psoas major
4. Femoral vein
5. Saphenous vein

 

 A

1,2 & 3

 B

3 & 4

 C

1,3,4 & 5

 D

All

Ans. B

Explanation:

Three small cutaneous arteries (superficial external pudendal, superficial epigastric and superficial circumflex iliac arteries) arising from the femoral artery can be seen a little below the inguinal ligaments.

Femoral branch of the genitofemoral nerve pierces the femoral sheath and overlying deep fascia 2 cm below the mid inguinal point.

The great saphenous vein pierces the saphenous opening in the deep fascia (fascia lata) of the thigh and joins the femoral vein 4 cm below and lateral to the pubic tubercle.

So from the above discussion it is clear that femoral branch of the genitofemoral nerve, superficial epigastric artery and saphenous vein passes below (not behind) the inguinal ligament.

Psoas major insertion: The muscle passes behind the inguinal ligament and in front of the hip joint to enter the thigh.
Femoral vein leaves the thigh by passing behind the inguinal ligament.


Q. 5

Short saphenous vein is a tributary of which of the following vein?

 A

Medial marginal vein

 B

Lateral marginal vein

 C

Posterior tibial vein

 D

Dorsal venous arch

Q. 5

Short saphenous vein is a tributary of which of the following vein?

 A

Medial marginal vein

 B

Lateral marginal vein

 C

Posterior tibial vein

 D

Dorsal venous arch

Ans. B

Explanation:

The veins in the leg consist of a superficial and a deep venous system. The superficial system consists of the great saphenous vein, located medially, and the small saphenous vein, located posterolaterally.
  • The great saphenous vein originates from the medial side of the dorsal venous arch in the foot and drains in the femoral vein.
  • The small saphenous vein originates from the lateral side of the dorsal venous arch in the foot and drains in the popliteal vein.

Q. 6

True about the anatomy of great saphenous vein:

 A

Starts as a continuation of medial marginal vein

 B

Ends of femoral vein 2.5 cm below the inguinal ligament

 C

There are 2 – 5 valves below the knee.

 D

Ascends 2.5 – 3 cm behind tibial malleolus

Q. 6

True about the anatomy of great saphenous vein:

 A

Starts as a continuation of medial marginal vein

 B

Ends of femoral vein 2.5 cm below the inguinal ligament

 C

There are 2 – 5 valves below the knee.

 D

Ascends 2.5 – 3 cm behind tibial malleolus

Ans. A

Explanation:

A i.e. Starts as continuation- of medial marginal vein


Q. 7

The most important perforator of the Lower limb is between –

 A

Long saphenous and posterior tibial vein

 B

Short saphenous and posterior tibial vein

 C

Short saphenous and popliteal vein

 D

Long saphenous and femoral vein

Q. 7

The most important perforator of the Lower limb is between –

 A

Long saphenous and posterior tibial vein

 B

Short saphenous and posterior tibial vein

 C

Short saphenous and popliteal vein

 D

Long saphenous and femoral vein

Ans. D

Explanation:

Ans. is `d’ i.e., Long saphenous and femoral vein


Q. 8

All of the following veins lack valves except

 A

Femoral vein

 B

Portal vein

 C

IVC

 D

Dural venous sinuses

Q. 8

All of the following veins lack valves except

 A

Femoral vein

 B

Portal vein

 C

IVC

 D

Dural venous sinuses

Ans. A

Explanation:

Veins which do not have valves are:

  • IVC
  • SVC
  • Hepatic, ovarian, uterine, renal, emissary, cerebral, pulmonary, and umbilical veins
  • Portal venous system is a valveless system

Q. 9

The Diagram Shows the Venous Drainage of Lower Limb. Identify Vein Marked as Vein B in the Diagram ?

 A

Femoral Vein

 B

Great Saphenous Vein

 C

Popliteal Vein

 D

Small Saphenous Vein

Q. 9

The Diagram Shows the Venous Drainage of Lower Limb. Identify Vein Marked as Vein B in the Diagram ?

 A

Femoral Vein

 B

Great Saphenous Vein

 C

Popliteal Vein

 D

Small Saphenous Vein

Ans. B

Explanation:


Q. 10

All are true about short saphenous vein except‑

 A

Runs behind lateral malleolus

 B

Runs on lateral side of leg

 C

Accompanied by sural nerve

 D

Achillis tendon is medial to vein

Q. 10

All are true about short saphenous vein except‑

 A

Runs behind lateral malleolus

 B

Runs on lateral side of leg

 C

Accompanied by sural nerve

 D

Achillis tendon is medial to vein

Ans. B

Explanation:

Ans. is ‘b’ i.e., Runs on lateral side of leg

Short saphanous vein runs in the back (posteriorly) of leg (not laterally).

Short saphanous vein

  • It is formed by union of the lateral end of the dorsal venous arch with the lateral marginal vein.
  • It enters the back of leg by passing behind the lateral malleolus and is accompanied by sural nerve. 
  • In leg it ascends lateral to tendocalcaneous (tendoachillis). Thus tendoachillis is medial to vein.
  • It usually has 7-13 valves. It terminates into the popliteal vein.
  • It is connected with peroneal vein through the lateral ankle perforators.

Q. 11

Structure which lies outside the femoral sheath 

 A

Femoral artery

 B

Femoral nerve

 C

Femoral vein

 D

Genitofemoral nerve

Q. 11

Structure which lies outside the femoral sheath 

 A

Femoral artery

 B

Femoral nerve

 C

Femoral vein

 D

Genitofemoral nerve

Ans. B

Explanation:

 Femoral nerve

Femoral sheath

Femoral sheath is a funnel shaped fascial prolongation around proximal part of femoral vessels, situated in the femoral triangle, below the inguinal ligament. It is 3-4 cm long. It is formed by fascia iliaca.

Femoral sheath is divided into 3 separate fascial compartements by septa :‑

i) Lateral compartment :- It contains femoral artery and femoral branch of genitofemoral nerve.

ii) Intermediate compartment :- Femoral vein.

iii) Medial compartment (femoral canal) :- It is conical in shape, wider above adn narrow below. The wider upper opening is known as femoral ring, which is potentially a weak point in lower abdomen and is the site for femoral hernia. Femoral ring is bounded : Anteriorly by inguinal ligament, medially by lacunar ligament, posteriorly by pectineus with its covering fascia, and laterally by septum separating it from femoral vein. Femoral canal contains lymph node of cloquet or Rosenmuller and lymphatics.


Q. 12

Not a content of Hunter’s canal ‑

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

Sphenous nerve

Q. 12

Not a content of Hunter’s canal ‑

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

Sphenous nerve

Ans. C

Explanation:

Ans. is ‘c’ i.e., Femoral nerve

Contents of adductor canal are femoral artery, femoral vein, Saphenous nerve, nerve to vastus medialis, descending genicular artery, deep lymph vessels, and two terminal divisions of obturator nerve.


Q. 13

True about the anatomy of this vein (presented by arrow) in this image

 A

Starts as a continuation of medial marginal vein

 B

Ends of femoral vein 2.5 cm below the inguinal ligament

 C

There are 2 – 5 valves below the knee.

 D

Ascends 2.5 – 3 cm behind tibial malleolus

Q. 13

True about the anatomy of this vein (presented by arrow) in this image

 A

Starts as a continuation of medial marginal vein

 B

Ends of femoral vein 2.5 cm below the inguinal ligament

 C

There are 2 – 5 valves below the knee.

 D

Ascends 2.5 – 3 cm behind tibial malleolus

Ans. A

Explanation:

Ans;A).Starts as a continuation of medial marginal vein

Vein is Great Saphenous vein

  •  Starts as continuation- of medial marginal vein
  • The great saphenous vein (GSV, alternately “long saphenous vein“) is a large, subcutaneous, superficial vein of the leg.
  • It is the longest vein in the body, running along the length of the lower limb.


Tibial nerve

TIBIAL NERVE

Q. 1

Nerve supply of adductor magnus is through:

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Q. 1

Nerve supply of adductor magnus is through:

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Ans. C

Explanation:

Innervation of adductor magnus

  • Posterior division of obturator nerve innervates most of the adductor magnus
  • Vertical or hamstring portion innervated by tibial nerve (L2, L3, L4)

Q. 2

Nerve Supply of the Muscle marked as Muscle A in the diagram is 

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Q. 2

Nerve Supply of the Muscle marked as Muscle A in the diagram is 

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Ans. C

Explanation:

Innervation of adductor magnus

  • Posterior division of obturator nerve innervates most of the adductor magnus
  • Vertical or hamstring portion innervated by tibial nerve (L2, L3, L4)

Q. 3

True about popliteus are all except‑

 A

Flexor of knee

 B

Intracapsular origin

 C

Supplied by tibial nerve

 D

Causes locking of knee

Q. 3

True about popliteus are all except‑

 A

Flexor of knee

 B

Intracapsular origin

 C

Supplied by tibial nerve

 D

Causes locking of knee

Ans. D

Explanation:

Popliteus

Popliteus is a deep muscle of posterior compartment of leg.

Features of popletius are –

Origin

  • Lateral surface of lateral condyle of femur, origin is intracapsular.
  • Outer margin of lateral meniscus of knee.

Insertion

  • Posterior surface of shaft of tibia above soleal line.

Nerve supply

  • Tibial nerve

Action

  • Ulocks knee joint by lateral rotation of femur on tibia prior flexion.
  • Accessory flexor of knee.


Common perioneal nerve / fibular nerve

COMMON PERIONEAL NERVE / FIBULAR NERVE

Q. 1 Muscles of the anterior compartment of the  leg are innervated primarily by
 A Deep peroneal nerve
 B Superficial peroneal nerve
 C Sural nerve
 D Saphenous
Q. 1 Muscles of the anterior compartment of the  leg are innervated primarily by
 A Deep peroneal nerve
 B Superficial peroneal nerve
 C Sural nerve
 D Saphenous
Ans. A

Explanation:

In the leg, the deep peroneal nerve supplies muscular branches to the Tibialis anterior, Extensor digitorum longus, Fibularis (Peroneus) tertius, and Extensor hallucis longus, and an articular branch to the ankle-joint.


Q. 2

Common peroneal nerve is related to which of the following structures?

 A

Shaft of tibia

 B

Neck of fibula

 C

Lower tibio-fibular joint

 D

Shaft of fibula

Q. 2

Common peroneal nerve is related to which of the following structures?

 A

Shaft of tibia

 B

Neck of fibula

 C

Lower tibio-fibular joint

 D

Shaft of fibula

Ans. B

Explanation:

The common fibular nerve arises from the posterior division of the sacral plexus (L4–S2) and descends in an inferolateral direction, across the popliteal fossa to the fibular head. Just distal to the fibular head, the common fibular nerve bifurcates into the deep fibular and superficial fibular nerves.It is easily palpated against ihe neck of fibula because of its subcutaneous position.It is commonly injured in fractues of neck of the fibula.It gets thickened in leprosy which may also cause foot drop.


Q. 3

Deep peroneal nerve provides sensory innervation to the following?

 A

Anterolateral dorsum of foot

 B

Lateral part of leg

 C

1st web space

 D

5th web space

Q. 3

Deep peroneal nerve provides sensory innervation to the following?

 A

Anterolateral dorsum of foot

 B

Lateral part of leg

 C

1st web space

 D

5th web space

Ans. C

Explanation:

Cutaneous branch of deep peroneal nerve provides sensory innervation to the web space between the first and second toe and a small area just proximal to the first and second toe on the plantar aspect of the foot.

Muscular branch supplies the tibialis anterior, extensor digitorum longus, peroneus tertius, and extensor hallucis longus.
 
Articular branch supplies the ankle and tarsal joints.

Q. 4

Common peroneal nerve is related to which of the  following structures

 A

Shaft of tibia

 B

Neck of fibula

 C

Lower tibio-fibular joint

 D

Shaft of fibula

Q. 4

Common peroneal nerve is related to which of the  following structures

 A

Shaft of tibia

 B

Neck of fibula

 C

Lower tibio-fibular joint

 D

Shaft of fibula

Ans. B

Explanation:

B i.e., Neck of fibula

Common peroneal nerve winds around neck of fibula to enter peroneus longus muscle. Because of its subcutaneous position it can be easily palpated here & is very prone to injury. So fracture neck of fibula may cause foot drop.


Q. 5

False about tibia-fibula is ‑

 A

Nutrient artery of tibia is from posterior tibial artery

 B

Nutrient artery of fibula is from peroneal artery

 C

Proximal end of tibia is related to common peroneal nerve

 D

Tibia is the most common site of osteomyelitis

Q. 5

False about tibia-fibula is ‑

 A

Nutrient artery of tibia is from posterior tibial artery

 B

Nutrient artery of fibula is from peroneal artery

 C

Proximal end of tibia is related to common peroneal nerve

 D

Tibia is the most common site of osteomyelitis

Ans. C

Explanation:

  • Common peroneal nerve is related to neck of fibula (not tibia).
  • Nutrient artery of tibia is a branch of posterior tibial artery.
  • Nutrient artery of fibula is a branch of peroneal artery.
  • Tibia is the commonest site of osteomyelitis.

Q. 6

Nerve that winds around neck of fibula ‑

 A

Tibial nerve

 B

Deep peroneal nerve

 C

Superficial peroneal nerve

 D

Common peroneal nerve

Q. 6

Nerve that winds around neck of fibula ‑

 A

Tibial nerve

 B

Deep peroneal nerve

 C

Superficial peroneal nerve

 D

Common peroneal nerve

Ans. D

Explanation:

Common peroneal nerve winds around neck offibula to enter peroneus longus muscle. Because of its subcutaneous position it can be easily palpated here and is very prone to injury. So fracture neck of fibula may cause foot drop.



Nasopharyngeal Carcinoma

Nasopharyngeal Carcinoma

Q. 1

Treatment of choice of Nasopharyngeal Carcinoma is? 

 A

Surgery

 B

Chemotherapy

 C

Radiotherapy

 D

Chemoradiation

Q. 1

Treatment of choice of Nasopharyngeal Carcinoma is? 

 A

Surgery

 B

Chemotherapy

 C

Radiotherapy

 D

Chemoradiation

Ans. C

Explanation:

Q. 2

Radiotherapy is treatment of choice for:

 A

Nasopharyngeal Ca T3 N1

 B

Supraglottic Ca T3NO

 C

Glottic CaT3N 1

 D

Subglottic Ca T3NO

Q. 2

Radiotherapy is treatment of choice for:

 A

Nasopharyngeal Ca T3 N1

 B

Supraglottic Ca T3NO

 C

Glottic CaT3N 1

 D

Subglottic Ca T3NO

Ans. A

Explanation:

Q. 3 Radiotherapy is the “Treatment” of Choice for:
 A Nasopharyngeal carcinoma T3N I
 B Supraglottic CA T3NO
 C Glottic CA T3NI
 D Subglottic CA T3NO
Q. 3 Radiotherapy is the “Treatment” of Choice for:
 A Nasopharyngeal carcinoma T3N I
 B Supraglottic CA T3NO
 C Glottic CA T3NI
 D Subglottic CA T3NO
Ans. A

Explanation:

Nasopharyngeal carcinoma T3N I


Q. 4

Nasopharyngeal carcinoma is mostly:

 A

Basal cell carcinoma

 B

Squamous cell carcinoma

 C

Adenocarcinoma

 D

Epidermoid carcinoma

Q. 4

Nasopharyngeal carcinoma is mostly:

 A

Basal cell carcinoma

 B

Squamous cell carcinoma

 C

Adenocarcinoma

 D

Epidermoid carcinoma

Ans. B

Explanation:

Q. 5

Trootter’s triad is seen in:

 A

Nassopharyngeal fibroma

 B

Maxillary sinusitis

 C

Nasopharyngeal carcinoma

 D

Maxillary carcinoma

Q. 5

Trootter’s triad is seen in:

 A

Nassopharyngeal fibroma

 B

Maxillary sinusitis

 C

Nasopharyngeal carcinoma

 D

Maxillary carcinoma

Ans. C

Explanation:

Q. 6

Commonest site of Nasopharyngeal carcinoma is:

 A

Roof

 B

Posterior

 C

Lateral wall

 D

Anterior wall

Q. 6

Commonest site of Nasopharyngeal carcinoma is:

 A

Roof

 B

Posterior

 C

Lateral wall

 D

Anterior wall

Ans. C

Explanation:

Q. 7

The following diseases are associated with Epstein-Barr virus infection, EXCEPT:

 A

Infectious mononucleosis

 B

Epidermodysplasia

 C

Nasopharyngeal carcinoma

 D

Oral hairy leukoplakia

Q. 7

The following diseases are associated with Epstein-Barr virus infection, EXCEPT:

 A

Infectious mononucleosis

 B

Epidermodysplasia

 C

Nasopharyngeal carcinoma

 D

Oral hairy leukoplakia

Ans. B

Explanation:

Epstein Barr Virus may lead to the following:

  • Infectious mononucleosis
  •  EBV associated tumors

Ref: Harrison’s Principles of Internal Medicine, 16th Edition, Pages 1046, 47


Q. 8

The Epstein Barr virus is implicated in all of the following conditions, EXCEPT :

 A

Nasopharyngeal Ca

 B

Burkitt’s lymphoma

 C

Infectious mononucleosis

 D

Leukemia

Q. 8

The Epstein Barr virus is implicated in all of the following conditions, EXCEPT :

 A

Nasopharyngeal Ca

 B

Burkitt’s lymphoma

 C

Infectious mononucleosis

 D

Leukemia

Ans. D

Explanation:

EBV is known to cause infectious mononucleosis, lymphoproliferative syndrome(fever, lymphadenopathy and hepatosplenomegaly), burkitt lymphoma, nasopharyngeal carcinoma, and in AIDS patients its known to cause hairy leukoplakia of tongue, interstitial lymphocytic pneumonia and lymphoma. 
 
In Sub saharan africa Burkitt lymphoma is the most common malignancy in young children. It  is thought to result from an early EBV infection that produces a large pool of infected B lymphocytes. It can be diagnosed by presence of increased  IgA antibody levels to both VCA and early EBV antigens.
 
Nasopharyngeal carcinoma is endemic in Southern China, where it is responsible for 25% of mortality from cancer. 
 
Ref: Ray C.G., Ryan K.J. (2010). Chapter 14. Herpesviruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.

Q. 9

Smoking increase the risk of all of the following cancer’s, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

Ca Esophagus

Q. 9

Smoking increase the risk of all of the following cancer’s, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

Ca Esophagus

Ans. B

Explanation:

Role of smoking and development of nasopharyngeal carcinoma is still not clear.

 
Ref: Diet, Nutrition and Cancer: Proceedings of The 16th International Symposium on Mycotoxins By Takamatsu No Miya, Page 51; Carcinomas of The Head and Neck: Evaluation and Management By Charlotte Jacobs, Page 275; Cancer Prevention: The Causes and Prevention of Cancer By Graham A. Colditz, David John Hunter, Page 327

Q. 10

Concomitant chemoradiotherapy is indicated in all of the following malignancies except:

 A

Stage III B Ca Cervix

 B

T2 N0 M0 Anal Cancer

 C

T2 N0 M0 Glottic Cancer

 D

T1 N2 M0 Nasopharyngeal Cancer

Q. 10

Concomitant chemoradiotherapy is indicated in all of the following malignancies except:

 A

Stage III B Ca Cervix

 B

T2 N0 M0 Anal Cancer

 C

T2 N0 M0 Glottic Cancer

 D

T1 N2 M0 Nasopharyngeal Cancer

Ans. C

Explanation:

T2 N0 M0 Glottic Cancer is an early stage glottis tumor extending to supraglottis and /or subglottis and /or with impaired vocal cord mobility, with no lymph node involvement or distant metastasis.

Radiotherapy alone is the standard treatment for early glottis cancer.

Concurrent chemoradiotherapy is indicated in locally advanced disease.

 
Ref: Cervical Cancer: Current and Emerging Trends in Detection and Treatment By Heather Hasan, Page 39; Oxford Desk Reference Oncology By Thankamma, Page321; Gastrointestinal and Liver Tumors By Wolfgang Scheppach, Page 173

Q. 11

A 55 year old man presented with epistaxis. On investigation, nasopharyngeal cancer was diagnosed. Regarding nasopharyngeal carcinoma,

Assertion: This patient may have ulcerative form of nasopharyngeal cancer

Reason: Because epistaxis is the common symptom of ulcerative type
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 11

A 55 year old man presented with epistaxis. On investigation, nasopharyngeal cancer was diagnosed. Regarding nasopharyngeal carcinoma,

Assertion: This patient may have ulcerative form of nasopharyngeal cancer

Reason: Because epistaxis is the common symptom of ulcerative type
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. A

Explanation:

In ulcerative form of nasopharyngeal carcinoma, epistaxis is the common symptom. Proliferative type causes obstructive nasal symptoms. Growth infiltrates submucosally in infiltrative type of carcinoma.

Ref: Diseases of Ear, Nose and Throat By PL Dhingra, 4th Edition, Page 232, 233.


Q. 12

A male patient was diagnosed of having nasopharyngeal carcinoma. He had cranial nerve involvements and conductive deafness at the time of presentation. Consider the following:

Assertion: He may have Trotter’s triad which is associated with nasopharyngeal carcinoma

Reason: He could be presenting with conductive deafness, contralateral temporoparietal neuralgia, and palatal paralysis to acquire the diagnosis.
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 12

A male patient was diagnosed of having nasopharyngeal carcinoma. He had cranial nerve involvements and conductive deafness at the time of presentation. Consider the following:

Assertion: He may have Trotter’s triad which is associated with nasopharyngeal carcinoma

Reason: He could be presenting with conductive deafness, contralateral temporoparietal neuralgia, and palatal paralysis to acquire the diagnosis.
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. C

Explanation:

Nasopharyngeal cancer can cause conductive deafness (Eustachian tube blockage), ipsilateral (not contralateral) temporoparietal neuralgia (involvement of cranial nerve V) and palatal paralysis (CN X)- collectively called Trotter’s triad.

 

 


Q. 13

Commonest site of nasopharyngeal carcinoma is:

 A

Roof

 B

Posterior

 C

Lateral wall

 D

Anterior wall

Q. 13

Commonest site of nasopharyngeal carcinoma is:

 A

Roof

 B

Posterior

 C

Lateral wall

 D

Anterior wall

Ans. C

Explanation:

The lateral walls include the eustachian tube, the torus tubarius, and the fossa of Rosenmüller. The most common site of origin for nasopharyngeal carcinoma is the fossa of Rosenmüller.

Q. 14

Which among the following carcinoma is treated by radiotherapy?

 A

Supraglottic Ca T3 N0

 B

Nasopharyngeal Ca T3 N1

 C

Glottic CaT3 N1

 D

Subglottic Ca T3 N0

Q. 14

Which among the following carcinoma is treated by radiotherapy?

 A

Supraglottic Ca T3 N0

 B

Nasopharyngeal Ca T3 N1

 C

Glottic CaT3 N1

 D

Subglottic Ca T3 N0

Ans. B

Explanation:

Over 95% of endemic nasopharyngeal carcinomas (NPC) are classified as WHO type 3 and associated with EBV.

NPC tends to occur in younger persons and is not associated with tobacco usage.

NPC is an aggressive neoplasm with cervical lymph node metastases present in 60 to 90% of patients at diagnosis.

Because of unique anatomic, biological, and clinical characteristics, therapy for NPC is distinctive.

Radiotherapy is the mainstay of local therapy. NPCs are highly chemoradiosensitive.

Intensity-modulated radiation therapy (IMRT) allows for greater conformality of the high-dose regions with relative sparing of adjacent normal tissues compared to traditional radiation techniques.


Q. 15

All of the following are true about Nasopharyngeal carcinoma, EXCEPT:

 A

Bimodal age distribution

 B

Nasopharyngectomy with Radical Neck dissection is the treatment of choice

 C

IgA antibody to EBV is observed

 D

Squammous cell carcinoma is the most common histological subtype

Q. 15

All of the following are true about Nasopharyngeal carcinoma, EXCEPT:

 A

Bimodal age distribution

 B

Nasopharyngectomy with Radical Neck dissection is the treatment of choice

 C

IgA antibody to EBV is observed

 D

Squammous cell carcinoma is the most common histological subtype

Ans. B

Explanation:

Radiotherapy is the treatment of choice for nasopharyngeal carcinoma and not Nasopharyngectomy.
Nasopharyngeal carcinoma has a bimodal age distribution with peak distribution in the second and sixth decades in life.
 

Q. 16

In which country is Nasopharyngeal carcinoma most commonly found?

 A

India

 B

China

 C

Pakistan

 D

Japan

Q. 16

In which country is Nasopharyngeal carcinoma most commonly found?

 A

India

 B

China

 C

Pakistan

 D

Japan

Ans. B

Explanation:

Nasopharyngeal carcinoma is most common in China particularly in southern states and Taiwan.

Factors operative in China are burning of incense or wood(polycyclic hydrocarbon), use of preserved salted fish (nitrosamines) along with vitamin C deficient diet. Infection with Epstein Barr Virus also act as predisposing factor. 
 

Q. 17

All are associated with EBV except ‑

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Oral hairy leukoplakia

 D

Epidermodysplasia

Q. 17

All are associated with EBV except ‑

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Oral hairy leukoplakia

 D

Epidermodysplasia

Ans. D

Explanation:

Ans. is ‘d’ i.e., Epidermodysplasia 

Epstein – Barr Virus (EBV)

.    Belongs to Herpes viruses family.

.   Infection is most common in early childhood, with a second peak during late adolescence.

.   Infectious mononucleosis (IM) is usually a disease of young adults.

.   EBV is transmitted by saliva (oral secretions) of infected person.

.   Intimate oral contact, as in kissing is the predominant mode of transmission         causes kissing disease.

.   The virus enter the pharyngeal epithelial cells and B cells through (CR 2 / or CD21) receptors.

.     Memory B Cells are the reservoir of EBV:

Clinical Manifestations  :Most primary infections are asymptomatic

.     Causes an acute self limited illness          —>          Infectious mononucleosis (Glandular fever)

.     Incubation period                                                         4-8 weeks

.    Age groups                                                                     young adults

.    Most common symptom of IMN is sore throat

.   Most common sign is lymphadenopathy

.   Most common complication —> meningitis/encephalitis



Q. 18

E. B. virus causes all except –

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Burkitt’s Lymphoma

 D

Carcinoma cervix

Q. 18

E. B. virus causes all except –

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Burkitt’s Lymphoma

 D

Carcinoma cervix

Ans. D

Explanation:

Ans. is ‘d’ i.e., Carcinoma Cervix


Q. 19

Estein Barr (EB) virus has been implicated in the following malignancies except –

 A

Hodgkin’s disease

 B

Non Hodgkin’s lymphoma

 C

Nasopharyngeal carcinoma

 D

Multiple myeloma

Q. 19

Estein Barr (EB) virus has been implicated in the following malignancies except –

 A

Hodgkin’s disease

 B

Non Hodgkin’s lymphoma

 C

Nasopharyngeal carcinoma

 D

Multiple myeloma

Ans. D

Explanation:

Ans. is ‘d’ i.e., Multiple myeloma


Q. 20

Ebstein Barr virus is associated with-

 A

Carcinoma larynx

 B

Carcinoma bladder

 C

Carcinoma nasopharynx

 D

Carcinoma maxilla

Q. 20

Ebstein Barr virus is associated with-

 A

Carcinoma larynx

 B

Carcinoma bladder

 C

Carcinoma nasopharynx

 D

Carcinoma maxilla

Ans. C

Explanation:

Ans. is ‘c’ i.e., Carcinoma nasopharynx


Q. 21

The following are true about EBV except – 

 A

A member of herpes virus family

 B

Infects epithelial cells of oropharynx

 C

The main target of virus is the T- cell lymphocytes

 D

It is implicated in nasopharyngeal carcinoma

Q. 21

The following are true about EBV except – 

 A

A member of herpes virus family

 B

Infects epithelial cells of oropharynx

 C

The main target of virus is the T- cell lymphocytes

 D

It is implicated in nasopharyngeal carcinoma

Ans. B

Explanation:

Ans is ‘b’ i.e., Infects epithelial cells of oropharynx 

.   Main target for EBV is B- cell.


Q. 22

Radiotherapy is Rx of choice for:

 A

Nasopharyngeal Carcinoma T3N1

 B

Supraglottic Carcinoma T3NO

 C

Glottic Carcinoma T3N1

 D

Subglottic Carcinoma T3NO

Q. 22

Radiotherapy is Rx of choice for:

 A

Nasopharyngeal Carcinoma T3N1

 B

Supraglottic Carcinoma T3NO

 C

Glottic Carcinoma T3N1

 D

Subglottic Carcinoma T3NO

Ans. A

Explanation:

A i.e. Nasopharyngeal Carcinoma T3N1

Radiotherapy is the standard treatment of nasopharyngeal carcinomaQ, as surgery is not fesibleQ. Patient with advanced disease also receive concurrent chemotherapy.

Radical Radiotherapy is preferred treatment for early supraglottic carcinomas (i.e. small (< 6m1) tumor mass and absence of cartilage invasion). In unfavourable conditions voice preserving supraglottic laryngectomy (surgery) is preferred. Tumors involving the true vocal cords or cartilage are treated with supracricoid laryngectomy & for advanced tumors total laryngectomy is required. Cord fixation is an indirect evidence of cricoarytenoid joint involvement. It upstages the tumor to T3 and precludes voice preserving surgery in all laryngeal cancers. Radiotherapy is preferred modality for definitive treatment of early glottic carcinoma (T2 NO) as it allows voice preservation. Hemilaryngectomy is the usual surgical procedure in early glottic cancers and supracricoid laryngectomy is performed if there is imaging evidence of invasion of anterior or posterior commissure, contra lateral true vocal cord, false vocal cord or parglottic fat invasion.


Q. 23

Secondaries in the neck with no obvious primary malignancy is most often due to –

 A

Ca. Stomach

 B

Ca. Larynx

 C

Ca. Nasopharynx

 D

Ca. Thyroid

Q. 23

Secondaries in the neck with no obvious primary malignancy is most often due to –

 A

Ca. Stomach

 B

Ca. Larynx

 C

Ca. Nasopharynx

 D

Ca. Thyroid

Ans. C

Explanation:

Ans. is ‘c’ i.e., Ca. Nasopharynx 


Q. 24

Trotters triad is seen in –

 A

Angiofibroma

 B

Nasopharyngeal carcinoma

 C

Laryngeal carcinoma

 D

Growth in fossa of Rosenmuller

Q. 24

Trotters triad is seen in –

 A

Angiofibroma

 B

Nasopharyngeal carcinoma

 C

Laryngeal carcinoma

 D

Growth in fossa of Rosenmuller

Ans. B

Explanation:

Ans. is ‘b’ i.e., Nasopharyngeal carcinoma 


Q. 25

Most common tumor to produce metastasis to cervical lymph nodes –

 A

Glottic Ca

 B

Nasopharyngeal carcinoma

 C

Ca Base of tongue

 D

Ca lip

Q. 25

Most common tumor to produce metastasis to cervical lymph nodes –

 A

Glottic Ca

 B

Nasopharyngeal carcinoma

 C

Ca Base of tongue

 D

Ca lip

Ans. B

Explanation:

Ans is “b” i.e. Nasopharyngeal carcinoma 

Note: Glottic carcinoma never metastasizes to lymph nodes and carcinoma lip metastasizes rarely and very late


Q. 26

Concomitant chemoradiotherapy is indicated in all of the following except

 A

Stage III B Ca Cervix

 B

T2 No Mo Glottic Cancer

 C

T1 N2 Mo Nasopharyngeal Cancer

 D

a and b

Q. 26

Concomitant chemoradiotherapy is indicated in all of the following except

 A

Stage III B Ca Cervix

 B

T2 No Mo Glottic Cancer

 C

T1 N2 Mo Nasopharyngeal Cancer

 D

a and b

Ans. B

Explanation:

Ans is B i.e. T2 NO MO Glottic Cancer 

Concomitant chemoradiation means- chemotherapy and radiation therapy are given simultaneously rather than vii sequentially.

“Principles of Combining Anticancer Agents with Radiation Therapy‑

Combining chemotherapy with radiation therapy has produced important improvements in treatment outcome. Randomized clinical trials clinical trials show improved local control and survival through the use of concurrent chemotherapy and radiation therapy for patients with high-grade gliomas and locally advanced cancers of the head and neck, lung, esophagus, stomach, rectum, and anus. There are least two proposed reasons why chemoradiotherapy might be successful. The first is radiosensitization. The underlying concept is that the observed effect of using chemotherapy and radiation concurrently is greater than simply adding the two together. A second proposed reason to combine radiation and chemotherapy is to realize the benefit of improved local control radiation along with the systemic effect of chemotherapy; a concept called spatial additivity.” [Devita, Hellman & Rosenberg’s Cancer: Principles & Practice of Oncology, 8th EditionChapter 211

Now coming to the given options:

  • Anal cancer: Concomitant chemoradiotherapy is the treatment of choice. Chemoradiotherapy achieves survival rates similar to those of radical surgical excision without loss of continence.
  • Cervical cancer: Treatment of cervical cancer is based on stage of disease. In general, early stage disease (I—IIa) can be treated with either radical surgery or radiation therapy. Advanced stage disease (III —IV)is best treated with chemoradiation. [Novaks gynaecology 14/e p1403]
  • Head and Neck Cancer: [Harrison I7/e p550]
  • Patients with head and neck cancer can be categorized into three clinical groups: those with localized disease, those with locally or regionally advanced disease, and those with recurrent and/or metastatic disease.
  • Localized Disease- that is, TI or T2 (stage I or stage II) lesions without detectable lymph node involvement or distant metastases. These lesions are treated with curative intent by surgery or radiation therapy. The choice of modality differs according to anatomic location and institutional expertise. Radiation therapy is often preferred for laryngeal cancer to preserve voice function, and surgery is preferred for small lesions in the oral cavity to avoid the long-term complications of radiation, such as xerostomia and dental decay. Overall 5-year survival is 60-90%.
  • Locally or Regionally Advanced Disease- i.e.disease with a large primary tumor and/or lymph node metastases. Such patients can also be treated with curative intent, but not with surgery or radiation therapy alone. Combined modality therapy including surgery, radiation therapy, and chemotherapy is most successful. Concomitant chemotherapy and radiation therapy appears to be the most effective approach. It can be administered either as a primary treatment for patients with unresectable disease, to pursue an organ preserving approach, or in the postoperative setting for intermediate-stage resectable tumors.
  • Recurrent and/or Metastatic Disease- Patients with recurrent and/or metastatic disease are, with few exceptions, treated with palliative intent. Some patients may require local or regional radiation therapy for pain control, but most are given chemotherapy.
  • Option D – T1 N2 MO Nasopharyngeal cancer is stage III ds. (Locoregional advanced ds.) and hence would need concurrent chemoradiation.
  • Option C – T2 NO MO Glottic cancer is stage II ds. (Localized ds.) and therefore would not need chemoradiation. 

Q. 27

Smoking may be associated with all of the following cancers, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

None

Q. 27

Smoking may be associated with all of the following cancers, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

None

Ans. D

Explanation:

Ans is None > Ca Nasopharynx

All the given options are mentioned by Harrison:

  • Harrison 17/e p2737 writes- “Tobacco smoking causes cancer of the lung, oral cavity, naso-, oro-, and hypopharynx, nasal cavity and paranasal sinuses, larynx, esophagus, stomach, pancreas, liver, kidney (body and pelvis), ureter, urinary bladder, and uterine cervix and also causes myeloid leukemia. There is evidence suggesting that cigarette smoking may play a role in increasing the risk of colorectal and possibly premenopausal breast cancer, but there is no association with postmenopausal breast cancer. There does not appear to be a causal link between cigarette smoking and cancer of the endometrium, and there is a lower risk of uterine cancer among postmenopausal women who smoke.”
  • Thus the answer should be none, however Nasopharyngeal carcinoma is found to be least associated with smoking. Head & Neck Cancers by Enslow Jacobs 2003e p492 writes-“Association between smoking and nasopharyngeal carcinoma has been shown only by a few studies. If the association of tobacco and NPC is real, the possible mechanism of tumor induction would be the nitrosamines and its precursors in tobacco.”

Q. 28

Which one of the following is the most common tumor to produce metastasis to cervical lymph nodes?

 A

Glottic carcinoma

 B

Nasopharyngeal carcinoma

 C

Carcinoma base of tongue

 D

Carcinoma lip

Q. 28

Which one of the following is the most common tumor to produce metastasis to cervical lymph nodes?

 A

Glottic carcinoma

 B

Nasopharyngeal carcinoma

 C

Carcinoma base of tongue

 D

Carcinoma lip

Ans. B

Explanation:

Ans. is ‘b’ i.e. Nasopharyngeal carcinoma 


Q. 29

Cause of U/L secretory otitis media in an adult is:

 A

CSOM

 B

Nasopharyngeal carcinoma

 C

Mastoiditis

 D

Foreign body of external ear

Q. 29

Cause of U/L secretory otitis media in an adult is:

 A

CSOM

 B

Nasopharyngeal carcinoma

 C

Mastoiditis

 D

Foreign body of external ear

Ans. B

Explanation:

 


 


Q. 30

Most common site for nasopharyngeal carcinoma: 

 A

Nasal septum

 B

Fossa of rosenmuller

 C

Vault of nasopharynx

 D

Anterosuperior wall

Q. 30

Most common site for nasopharyngeal carcinoma: 

 A

Nasal septum

 B

Fossa of rosenmuller

 C

Vault of nasopharynx

 D

Anterosuperior wall

Ans. B

Explanation:

Nasopharyngeal carcinoma most commonly arises from fossa of rosenmuller in lateral wall of nasopharynx.


Q. 31

Nasopharyngeal Ca involve:

 A

Nasal cavity

 B

Orophaynx

 C

Oral cavity

 D

All

Q. 31

Nasopharyngeal Ca involve:

 A

Nasal cavity

 B

Orophaynx

 C

Oral cavity

 D

All

Ans. A

Explanation:

 

Nasopharyngeal cancer arises from fossa of Rosenmuller in the lateral wall of nasopharynx and can spread to various sites.


Q. 32

Nasopharyngeal Ca is caused by:

 A

EBV

 B

Papilloma virus

 C

Parvo virus

 D

Adeno virus

Q. 32

Nasopharyngeal Ca is caused by:

 A

EBV

 B

Papilloma virus

 C

Parvo virus

 D

Adeno virus

Ans. A

Explanation:

Etiology of Nasopharyngeal Carcinoma

  • Genetic: It is most common in China.
  • Viral: Epstein-Barr virus is closely associated with nasopharyngeal cancer. Epstein-Barr virus has identified in tumor epithelial cells (not lymphocytes) of most undifferentiated and nonkeratinizing squamous cell carcinoma.
  • Environmental: Burning of incense or wood (polycyclic hydrocarbon); smoking of tobacco and opium; air pollution; nitrosamines from dry salted fish along with vitamin C deficient diet have been linked to the etiology of nasopharyngeal cancer.



Q. 33

Most common presentation in nasopharyngeal carcinoma is with:

 A

Epistaxis

 B

Hoarseness of voice

 C

Nasal stuffiness

 D

Cervical lymphadenopathy

Q. 33

Most common presentation in nasopharyngeal carcinoma is with:

 A

Epistaxis

 B

Hoarseness of voice

 C

Nasal stuffiness

 D

Cervical lymphadenopathy

Ans. D

Explanation:

 

The most common complain at presentation is the presence of an upper neck swelling. Unilateral neck swelling is much more common although bilateral metastasis also occur.


Q. 34

A 70-year-old male presents with Neck nodes. Examination reveals a Dull Tympanic Membrance, deaf­ness and tinnitus and on evaluation Audiometry gives Curve B. The most probable diagnosis is:

 A

Nasopharyngeal carcinoma

 B

Fluid in middle ear

 C

Tumor in interior ear

 D

Sensorineuronal hearing loss

Q. 34

A 70-year-old male presents with Neck nodes. Examination reveals a Dull Tympanic Membrance, deaf­ness and tinnitus and on evaluation Audiometry gives Curve B. The most probable diagnosis is:

 A

Nasopharyngeal carcinoma

 B

Fluid in middle ear

 C

Tumor in interior ear

 D

Sensorineuronal hearing loss

Ans. A

Explanation:

 

 

 



Q. 35

Nasopharyngeal Ca causes deafness by:

 A

Temporal bone metastasis

 B

Middle ear infiltration

 C

Serous effusion

 D

Radiation therapy

Q. 35

Nasopharyngeal Ca causes deafness by:

 A

Temporal bone metastasis

 B

Middle ear infiltration

 C

Serous effusion

 D

Radiation therapy

Ans. C

Explanation:

 

Nasopharyngeal carcinoma spreads to Eustachian tube, blocks it and causes Serous Otitis Media which in turn causes Conductive hearing loss.


Q. 36

Horner’s syndrome is caused by:

 A

Nasopharyngeal carcinoma metastasis

 B

Facial bone injury

 C

Maxillary sinusitis

 D

Ethmoidal polyp

Q. 36

Horner’s syndrome is caused by:

 A

Nasopharyngeal carcinoma metastasis

 B

Facial bone injury

 C

Maxillary sinusitis

 D

Ethmoidal polyp

Ans. A

Explanation:

 

 Nasopharyngeal carcinoma can cause Horner’s syndrome due to involvement of cervical sympathetic chain. –Mohan Bonsai


Q. 37

Trotter’s triad is seen in carcinoma of:

 A

Maxilla

 B

Larynx

 C

Nasopharynx

 D

Ethmoid sinus

Q. 37

Trotter’s triad is seen in carcinoma of:

 A

Maxilla

 B

Larynx

 C

Nasopharynx

 D

Ethmoid sinus

Ans. C

Explanation:

Q. 38

Nasopharyngeal Ca:

 A

M/c nerve involved is vagus

 B

Unilateral serous otitis media is seen

 C

Treatment of choice – radiotherapy

 D

b and c

Q. 38

Nasopharyngeal Ca:

 A

M/c nerve involved is vagus

 B

Unilateral serous otitis media is seen

 C

Treatment of choice – radiotherapy

 D

b and c

Ans. D

Explanation:

Q. 39

Which of thefollowing is NOT true about nasopharyngeal carcinoma?

 A

Bimodal age distribution

 B

EBV is implicated as etiological agent

 C

Squamous cell carcinoma is common

 D

Nasopharyngectomy and lymph node dissection is main­stay of treatment

Q. 39

Which of thefollowing is NOT true about nasopharyngeal carcinoma?

 A

Bimodal age distribution

 B

EBV is implicated as etiological agent

 C

Squamous cell carcinoma is common

 D

Nasopharyngectomy and lymph node dissection is main­stay of treatment

Ans. D

Explanation:

 

In nasopharyngeal carcinoma, radiotherapy is the mainstay of treatment.

Radical neck dissection is required for persistent nodes when primary has been controlled.



Q. 40

Treatment of choice in nasopharyngeal carcinoma:

 A

Radiotherapy

 B

Chemotherapy

 C

Surgery

 D

Surgery and radiotherapy

Q. 40

Treatment of choice in nasopharyngeal carcinoma:

 A

Radiotherapy

 B

Chemotherapy

 C

Surgery

 D

Surgery and radiotherapy

Ans. A

Explanation:

 

TOC for persistent nasopharyngeal fibroma – Radiation + Surgery

TOC for advanced carcinoma – Chemotherapy + Radiation



Q. 41

Most common presentation in nasopharyngeal carcinoma:

 A

Epistaxis

 B

Hoarseness of voice

 C

Nasal stuffiness

 D

Cervical lymphadenopathy

Q. 41

Most common presentation in nasopharyngeal carcinoma:

 A

Epistaxis

 B

Hoarseness of voice

 C

Nasal stuffiness

 D

Cervical lymphadenopathy

Ans. D

Explanation:

 

Cervical lymphadenopathy is the M/C presentation of nasopharyngeal carcinoma. It may be the only manifestation in some cases.


Q. 42

70-years-old man presents with cervical lymphadenopathy. What can be the cause?

 A

Nasopharyngeal carcinoma

 B

Angiofibroma

 C

Acoustic neuroma

 D

Otosclerosis

Q. 42

70-years-old man presents with cervical lymphadenopathy. What can be the cause?

 A

Nasopharyngeal carcinoma

 B

Angiofibroma

 C

Acoustic neuroma

 D

Otosclerosis

Ans. A

Explanation:

Q. 43

Nasopharyngeal cancer occurs most commonly in:

 A

India

 B

Bangladesh

 C

Pakistan

 D

China

Q. 43

Nasopharyngeal cancer occurs most commonly in:

 A

India

 B

Bangladesh

 C

Pakistan

 D

China

Ans. D

Explanation:

Q. 44

All are associated with Epstein Barr virus EXCEPT:

March 2013

 A

Burkitts lymphoma

 B

Nasopharyngeal carcinoma

 C

Infectious mononucleosis

 D

Kaposi sarcoma

Q. 44

All are associated with Epstein Barr virus EXCEPT:

March 2013

 A

Burkitts lymphoma

 B

Nasopharyngeal carcinoma

 C

Infectious mononucleosis

 D

Kaposi sarcoma

Ans. D

Explanation:

Ans. D i.e. Kaposi sarcoma

Human Herpes Virus type 8 is associated with 3 conditions, i.e. Kaposi’s disease, B-cell lymphoma and Castleman’s disease


Q. 45

EBV causes:      

March 2013

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Glandular fever

 D

All of the above

Q. 45

EBV causes:      

March 2013

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Glandular fever

 D

All of the above

Ans. D

Explanation:

Ans. D i.e. All of the above

Epstein-Barr virus (EBV)/ Human herpesvirus 4 (HHV-4)

  • It is a virus of the herpes family, and is one of the most common viruses in humans.
  • It is best known as the cause of infectious mononucleosis (glandular fever).
  • It is also associated with particular forms of cancer, such as Hodgkin’s lymphoma, Burkitt’s lymphoma, nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV) such as hairy leukoplakia and central nervous system lymphomas.
  • There is evidence that infection with the virus is associated with a higher risk of certain autoimmune diseases, especially dermatomyositis, systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s syndrome, and multiple sclerosis.
  • Infection with EBV occurs by the oral transfer of saliva and genital secretions.

Q. 46

EBV (epstein barr virus) causes all except:

September 2005 & March 2013

 A

Glandular fever

 B

Burkitt’s lymphoma

 C

Pancreatic carcinoma

 D

Nasopharyngeal carcinoma

Q. 46

EBV (epstein barr virus) causes all except:

September 2005 & March 2013

 A

Glandular fever

 B

Burkitt’s lymphoma

 C

Pancreatic carcinoma

 D

Nasopharyngeal carcinoma

Ans. C

Explanation:

Ans. C: Pancreatic carcinoma

Epstein-Barr virus (EBV) causes infectious mononucleosis as a primary disease.

The virus infects more than 90% of the average population and persists lifelong in peripheral B-lymphocytes. The virus is produced in the parotid gland and spread via the oral route.

Serology suggests that the Epstein-Barr virus might be involved in the causation of two neoplastic diseases of humans: African Burkitt’s lymphoma and nasopharyngeal carcinoma. Whereas the development of the lymphoma has an even better linkage with chromosomal rearrangements, nasopharyngeal carcinoma shows a unique association with Epstein-Barr virus

It is also associated with causation of glandular fever and lymphoma


Q. 47

All of the following statements about Nasopharyngeal carcinoma are true EXCEPT:         

 A

Bimodal age distribution

 B

Nasopharyngectomy with radical neck dissection is the treatment of choice

 C

IgA antibody to EBV is observed

 D

Squamous cell carcinoma is the most common histological subtype

Q. 47

All of the following statements about Nasopharyngeal carcinoma are true EXCEPT:         

 A

Bimodal age distribution

 B

Nasopharyngectomy with radical neck dissection is the treatment of choice

 C

IgA antibody to EBV is observed

 D

Squamous cell carcinoma is the most common histological subtype

Ans. B

Explanation:

 

Irradiation is the treatment of choice for nasopharyngeal carcinoma


Q. 48

Treatment of choice for nasopharyngeal carcinoma:

 A

Chemotherapy

 B

Radiotherapy

 C

Surgical

 D

Wait & watch

Q. 48

Treatment of choice for nasopharyngeal carcinoma:

 A

Chemotherapy

 B

Radiotherapy

 C

Surgical

 D

Wait & watch

Ans. B

Explanation:

 

Treatment of nasopharyngeal carcinoma

  • Radiation therapy is the mainstay of treatment, with chemotherapy used in advanced cases.
  • Concurrent cisplatin, 5-fluorouracil, and radiotherapy have been shown to improve survival.
  • Sequential chemoradiotherapy with gemcitabine and cisplatin has been shown to improve survival in locoregionally advanced nasopharyngeal carcinoma.
  • Many pediatric studies have used neoadjuvant chemotherapy followed by radiation therapy with improvement in local control or progression-free survival rates over radiotherapy alone.

Q. 49

Horner’s syndrome is caused by:           

March 2009

 A

Facial injury

 B

Nasopharyngeal carcinoma with metastasis

 C

Meniere’s disease

 D

All of the above

Q. 49

Horner’s syndrome is caused by:           

March 2009

 A

Facial injury

 B

Nasopharyngeal carcinoma with metastasis

 C

Meniere’s disease

 D

All of the above

Ans. B

Explanation:

Ans. B: Nasopharyngeal carcinoma with metastasis

Causes of Homer’s syndrome:

First-order neuron lesions

– Arnold-Chiari malformation

– Basal meningitis (e.g., syphilis)

– Basal skull tumors

– Cerebral vascular accident (CVA)/ Wallenberg syndrome (lateral medullary syndrome) disease (e.g., multiple sclerosis)

– Intrapontine hemorrhage

Neck trauma (e.g., traumatic dislocation of cervical vertebrae, traumatic dissection of the vertebral artery)

– Pituitary tumor

– Syringomyelia

Second-order neuron lesions

– Pancoast tumor (tumor in the apex of the lung – most commonly squamous cell carcinoma)

– Birth trauma with injury to lower brachial plexus

– Cervical rib Aneurysm/dissection of aorta

– Nasopharyngeal carcinoma (involvement of cervical sympathetic chain)

– Central venous catheterization

Trauma/surgical injury (e.g., radical neck dissection, thyroidectomy, carotid angiography, coronary artery bypass graft)

– Lymphadenopathy (e.g., Hodgkin disease, leukemia, tuberculosis, mediastinal tumors)

– Neuroblastoma

Third-order neuron lesions

– Internal carotid artery dissection (associated with sudden ipsilateral face and/or neck pain)

– Raeder syndrome (paratrigeminal syndrome) – Oculosympathetic paresis and ipsilateral facial pain with variable involvement of the trigeminal and oculomotor nerves

– Carotid cavernous fistula

Cluster/ migraine headaches

– Herpes zoster

  • Drugs (may cause symptoms similar to Horner syndrome and may affect any region)

– Acetophenazine

– Bupivacaine

– Chloroprocaine

– Chlorpromazine


Q. 50

Nasopharyngeal carcinoma caused by ‑

 A

EBV

 B

HPV

 C

HSV

 D

VZV

Q. 50

Nasopharyngeal carcinoma caused by ‑

 A

EBV

 B

HPV

 C

HSV

 D

VZV

Ans. A

Explanation:

Ans. is ‘a’ i.e., EBV

Nasopharyngeal Carcinoma

  • Nasopharyngeal carcinoma is a rare tumor arising from epithelium of the nasopharynx. Nasopharyngeal cancer is uncommon in India except in North East region where people are predominantly of Mongoloid origin. People in Southern china, Taiwan and Indonesia are more prone to this cancer. The maximum age incidence is in the fifth decade and the male : female ratio is 2 : 1. Squamous cell carcinoma in various grades of its differentiation or its variants as transitional cell carcinoma and lymphoepithelioma, is the most common (85%).

Etiology

Nasopharyngeal carcinoma is multifactorial in origin, the three risk factors are :‑

  1. Genetic : Chinese have a higher genetic susceptibility to nasopharyngeal cancer. Even after migration to other countries they continue to have higher incidence.
  2. Viral : Epstein- Bar virus is closely associated with nasopharyngeal cancer. Specific viral markers are being developed to screen people in high incidence areas.
  3. Environmental: Air pollution, smoking of tobacco and opium, nitrosamines from dry salted fish, smoke from burning of incense and wood have all been incriminated.

Origin and spread

The commonest site of origin of nasopharyngeal carcinoma is fossa of Rosenmuller in the lateral wall of nasopharynx.


Q. 51

Patient with nasopharyngeal carcinoma can present with the following except ‑

 A

Homer’s syndrome

 B

Epistaxis and proptosis

 C

Trismus

 D

Sensineuronal hearing loss

Q. 51

Patient with nasopharyngeal carcinoma can present with the following except ‑

 A

Homer’s syndrome

 B

Epistaxis and proptosis

 C

Trismus

 D

Sensineuronal hearing loss

Ans. D

Explanation:

Ans. is ‘d’ i.e., Sensineuronal hearing loss


Q. 52

Which of the following is a wrong association ‑

 A

HPV – CaCx

 B

EBV – Burkitt’s lymphoma

 C

HHV 8 – Kaposi sarcoma

 D

CMV – Nasopharyngeal carcinoma

Q. 52

Which of the following is a wrong association ‑

 A

HPV – CaCx

 B

EBV – Burkitt’s lymphoma

 C

HHV 8 – Kaposi sarcoma

 D

CMV – Nasopharyngeal carcinoma

Ans. D

Explanation:

Ans. is ‘d’ i.e., CMV-Nasopharyngeal carcinoma


Q. 53

Keratinizing squamous cell carcinoma of nasopharynx is ‑

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Q. 53

Keratinizing squamous cell carcinoma of nasopharynx is ‑

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Ans. A

Explanation:

Ans. is ‘a’ i.e., Type I



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