Pharynx

PHARYNX

Q. 1

Which of the following statement regarding the sensory nerve supply of pharyngeal mucous membrane is TRUE?

 A

Nasopharynx is supplied by the maxillary nerve

 B

Glossopharyngeal nerve innervates the oral pharynx

 C

Laryngeal pharynx is supplied by the internal laryngeal branch of vagus nerve

 D

All of the above

Q. 1

Which of the following statement regarding the sensory nerve supply of pharyngeal mucous membrane is TRUE?

 A

Nasopharynx is supplied by the maxillary nerve

 B

Glossopharyngeal nerve innervates the oral pharynx

 C

Laryngeal pharynx is supplied by the internal laryngeal branch of vagus nerve

 D

All of the above

Ans. D

Explanation:

Nerves providing sensory innervation of the nasopharynx are :
Maxillary nerve innervates nasopharynx, glossopharyngeal nerve innervates the oral pharynx and laryngeal pharynx is supplied by the internal laryngeal branch of vagus nerve.
 

Q. 2

Airway noise originating in the nose, nasopharynx and oropharynx is known as:

 A

Stridor

 B

Stertor

 C

Both of the above

 D

None of the above

Q. 2

Airway noise originating in the nose, nasopharynx and oropharynx is known as:

 A

Stridor

 B

Stertor

 C

Both of the above

 D

None of the above

Ans. B

Explanation:

Stridor is a harsh noise produced by turbulent airflow through a partially obstructed airway. It may be inspiratory, expiratory, or both (biphasic).

The term stertor is used to describe airway noise originating in the nose, nasopharynx, and oropharynx; therefore, stridor is generally of laryngeal or tracheal origin.


Q. 3

When a large bolus of food is swallowed, the hyoid bone moves anteriorly to open the pharynx. The muscle responsible for this action is innervated by which of the following nerves?

 A

C1 (ansa cervicalis)

 B

CN IX

 C

Pharyngeal plexus

 D

CN V3

Q. 3

When a large bolus of food is swallowed, the hyoid bone moves anteriorly to open the pharynx. The muscle responsible for this action is innervated by which of the following nerves?

 A

C1 (ansa cervicalis)

 B

CN IX

 C

Pharyngeal plexus

 D

CN V3

Ans. A

Explanation:

The muscle that moves the hyoid anteriorly to open the pharynx is the geniohyoid. This muscle is innervated by the ansa cervicalis branch of C1. The ansa cervicalis also innervates the thyrohyoid and the intra hyoids.

Note:

  • Cranial nerve IX innervates the stylopharyngeus.
  • The pharyngeal plexus innervates the palatoglossus, palatopharyngeus, and cricopharyngeus.
  • Cranial nerve V-3 innervates most of the muscles of mastication.

Q. 4

Referred otalgia from base of tongue or oropharynx is carried by nerve?

 A

Cranial nerve V

 B

Cranial nerve VII

 C

Cranial nerve IX

 D

Cranial nerve X

Q. 4

Referred otalgia from base of tongue or oropharynx is carried by nerve?

 A

Cranial nerve V

 B

Cranial nerve VII

 C

Cranial nerve IX

 D

Cranial nerve X

Ans. C

Explanation:

The Jacobson nerve, tympanic branch of glossopharyngeal nerve (cranial nerve IX) directly innervates the ear but also has pharyngeal, lingual, and tonsillar branches to supply the posterior one-third portion of the tongue, tonsillar fossa, pharynx, eustachian tube, and parapharyngeal and retropharyngeal spaces. So any pathology involving those areas can lead to referred otalgia.

Must know:
Referred Otalgia: the source of the pain does not reside within the ear but, rather it originates from a source distant from the ear hence it is called as “referred otalgia”. Any pathology residing within the sensory net of cranial nerves V, VII, IX, and X and upper cervical nerves C2 and C3 can potentially cause referred otalgia.


Q. 5

All muscles of the pharynx are supplied by pharyngeal plexus, EXCEPT?

 A

Inferior constrictors

 B

Salpingopharyngeus

 C

Stylopharyngeus

 D

None of the above

Q. 5

All muscles of the pharynx are supplied by pharyngeal plexus, EXCEPT?

 A

Inferior constrictors

 B

Salpingopharyngeus

 C

Stylopharyngeus

 D

None of the above

Ans. C

Explanation:

With the exception of stylopharyngeus, which is supplied by the glossopharyngeal nerve, the muscles are supplied by the cranial part of the accessory nerve via the pharyngeal plexus.

 


Q. 6

The pharyngeal diverticulum is a protustion of mucosa between-

 A

The two parts of inferior constrictor muslce of the pharynx

 B

The two parts of middle constrictor muslce of the pharynx

 C

The two parts of the superior constrictor muscle of the pharynx

 D

Cricopharyngeal and posterior part o suprahyoid membrane

Q. 6

The pharyngeal diverticulum is a protustion of mucosa between-

 A

The two parts of inferior constrictor muslce of the pharynx

 B

The two parts of middle constrictor muslce of the pharynx

 C

The two parts of the superior constrictor muscle of the pharynx

 D

Cricopharyngeal and posterior part o suprahyoid membrane

Ans. A

Explanation:

Ans. is ‘a’ i.e., The two parts of inferior constrictor muscle of the pharynx 


Q. 7

Killian’s dehiscence is seen in:

 A

Oropharynx

 B

Nasophrynx

 C

Cricopharynx

 D

Vocal cords

Q. 7

Killian’s dehiscence is seen in:

 A

Oropharynx

 B

Nasophrynx

 C

Cricopharynx

 D

Vocal cords

Ans. C

Explanation:

 

Killian’s Dehiscence 

  • It is an area of weakness between the two parts of inferior constrictor muscle—sub thyropharyngeus and cricopharyngeus
  • A pulsion diverticulum of pharyngeal mucosa can emerge posteriorly through the Killian’s dehiscence called as Zenker’s diverticulum or pharyngeal pouch. This pouch is posterior.
  • Since it is an area of weakness it is one of the sites of esophageal perforation during instrumentation and scopy—hence also called ‘Gateway of Tears’.
  • A true diverticulum has all the layers of a tubular structure but zenker’s diverticulum is a false diverticulum as h. does not have any muscular layer.

 

  • Killian-Janieson’s space – It lies between cricopharyngeus and circular fibres of the esophagus.
  • Lamier Hackemann’s space – It lies between circular and longitudinal fibers of esophagus.

Q. 8

True regarding nasopharynx are all except:

 A

Fossa of rosenmuller corresponds to the internal carotid artery

 B

Lateral wall has pharyngeal opening of Eustachian

 C

Passavant’s muscle is formed by Stylopharyngeus

 D

Also called as epipharynx

Q. 8

True regarding nasopharynx are all except:

 A

Fossa of rosenmuller corresponds to the internal carotid artery

 B

Lateral wall has pharyngeal opening of Eustachian

 C

Passavant’s muscle is formed by Stylopharyngeus

 D

Also called as epipharynx

Ans. C

Explanation:

Q. 9

True regarding opening of auditory tube in nasopharynx is:     

 A

Posterior to inferior nasal concha

 B

Posterior to middle nasal concha

 C

Superior to inferior nasal concha

 D

Inferior to inferior nasal concha

Q. 9

True regarding opening of auditory tube in nasopharynx is:     

 A

Posterior to inferior nasal concha

 B

Posterior to middle nasal concha

 C

Superior to inferior nasal concha

 D

Inferior to inferior nasal concha

Ans. A

Explanation:

The lateral wall of nasopharynx has pharyngeal opening of the auditory tube, at the level of the inferior nasal concha and 1.2 cm behind it


Q. 10

True about pharyngeal diverticula are all excep

 A

Results due to neuromuscular incoordination

 B

Lies in the anterior wall of pharynx

 C

They are normal in pig

 D

Food may get accumulated

Q. 10

True about pharyngeal diverticula are all excep

 A

Results due to neuromuscular incoordination

 B

Lies in the anterior wall of pharynx

 C

They are normal in pig

 D

Food may get accumulated

Ans. B

Explanation:

  • Killians dehiscence is a weak part in the posterior wall of the pharynx which lies at the level of vocal folds or upper border of the cricoid lamina and is limited inferiorly by the thick cricopharyngeal sphincter.
  • Pharyngeal diverticula results due to outpouching of the dehiscence
  • Two parts of the inferior constrictor has different nerve supplies, propulsive thyropharyngeus by the pharyngeal plexus and the sphincter cricopharyngeus by the recurrent laryngeal nerve so there is possibility of neuromuscular incoordination. If cricopharyngeus fails to relax and the thyropharyngeus contracts bolus of food may be pushed backwards and tends to produce a diverticulum

Q. 11

False regarding the foreign body of oropharynx is ‑

 A

Impacted foreign bodies most often lodge in the soft tissue at the base of tongue

 B

Food particles are the most common oropharyngeal foreign bodies in children

 C

Clinical hypopharyngeal foreign bodies are amenable to clinical examination

 D

Endoscopy and MDCT are used in the diagnosis

Q. 11

False regarding the foreign body of oropharynx is ‑

 A

Impacted foreign bodies most often lodge in the soft tissue at the base of tongue

 B

Food particles are the most common oropharyngeal foreign bodies in children

 C

Clinical hypopharyngeal foreign bodies are amenable to clinical examination

 D

Endoscopy and MDCT are used in the diagnosis

Ans. B

Explanation:

Ans. is ‘b’ i.e., Food particles are the most common oropharyngeal foreign bodies in children

Oropharyngeal foreign bodies

  • Most ingested foreign bodies do not impact in the oropharynx
  • Sharp foreign bodies like fish and chicken bones most commonly impact in the soft tissues at the base of the tongue.
  • Hypopharyngeal foreign bodies can be detected by good physical examination.
  • Endoscopy and MDCT are used in the diagnosis of foreign bodies of cervical esophagus.
  • Coins are the most common impacted oropharyngeal foreign bodies encountered in children followed by food particles.

Q. 12

Pyriform fossa is situated in ‑

 A

Oropharynx

 B

Hypopharynx

 C

Nasopharynx

 D

None of the above

Q. 12

Pyriform fossa is situated in ‑

 A

Oropharynx

 B

Hypopharynx

 C

Nasopharynx

 D

None of the above

Ans. B

Explanation:

Ans. is ‘b’ i.e., Hypopharynx

Pyriform fossa is a part of laryngopharynx (hypopharynx)


Q. 13

All muscles of pharynx are supplied by pharyngeal plexus except –

 A

Palatopharyngngeus

 B

Stylopharyngeus

 C

Salpingopharyngeus

 D

Superior constrictor

Q. 13

All muscles of pharynx are supplied by pharyngeal plexus except –

 A

Palatopharyngngeus

 B

Stylopharyngeus

 C

Salpingopharyngeus

 D

Superior constrictor

Ans. B

Explanation:

All muscles of pharynx are supplied by cranial accessory through branches of vagus via pharyngeal plexus except stylopharyngeus which is supplied by glossopharyngeal.

The inferior constrictor receives an additional supply from the external and recurrent laryngeal nerves.


Q. 14

Lower border of pharynx is at the level of (Extent of pharynx is upto) ‑

 A

C2

 B

C3

 C

C4

 D

C6

Q. 14

Lower border of pharynx is at the level of (Extent of pharynx is upto) ‑

 A

C2

 B

C3

 C

C4

 D

C6

Ans. D

Explanation:

Ans. is ‘d’ i.e., C6

Pharynx is a musculomembranous tube that extands from the base of skull to the level of the sixth cervical vertebra, where it is continuous with esophagus. Pharynx is subdivided into :‑

I) Nasopharynx :- Part of the pharynx above the soft palate, i.e. from the base of skull to the soft palate‑

2) Oropharynx :- Extends from the soft palate superiorly to the level of hyoid inferiorly.

3)  Hypopharynx :- The hypopharynx includes that portion of the pharynx below the level of the hyoid.


Q. 15

Keratinizing squamous cell carcinoma of nasopharynx is ‑

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Q. 15

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


Q. 16

In which part of the pharynx the procedure shown in the picture below is being performed ? 

 A

Nasopharynx.

 B

Oropharynx.

 C

Pharynx.

 D

None of the above.

Q. 16

In which part of the pharynx the procedure shown in the picture below is being performed ? 

 A

Nasopharynx.

 B

Oropharynx.

 C

Pharynx.

 D

None of the above.

Ans. A

Explanation:

Ans:A.)Nasopharynx.

The procedure shown in the picture above represents Posterior Rhinoscopy test.

Different methods of examining the Nasopharynx 

i. Posterior Rhinoscopy

ii. Nasopharyngoscopy.

iii. Examination under anaesthesia after palatal retraction.

iv. Digital palpation.

v. Radiological examination.

Posterior Rhinoscopy:

It is method of examination of the Nasopharynx.

Structures seen on posterior rhinoscopy:
– Both choanae

– Posterior end of nasal septum

– Opening of Eustachian

– Posterior end of superior/tube middle and inferior turbinates

– Fossa of Rosenmuller

– Torus Tubarius

– Adenoids

– Roof and posterior wall and nasopharynx.


Q. 17

Nasopharynx is lined by which epithelium ‑

 A

Stratified squamous nonkerationized

 B

Stratified squamous keratinized

 C

Ciliated columnar

 D

Cuboidal

Q. 17

Nasopharynx is lined by which epithelium ‑

 A

Stratified squamous nonkerationized

 B

Stratified squamous keratinized

 C

Ciliated columnar

 D

Cuboidal

Ans. C

Explanation:

Ans. is ‘c’ i.e., Ciliated columnar


Q. 18

Lymphatic drainage of orpharynx is mainly through‑

 A

Superficial cervical lymph nodes

 B

Submandibular nodes

 C

Jugulodigastric node

 D

Jugulo-omohyoid nodes

Q. 18

Lymphatic drainage of orpharynx is mainly through‑

 A

Superficial cervical lymph nodes

 B

Submandibular nodes

 C

Jugulodigastric node

 D

Jugulo-omohyoid nodes

Ans. C

Explanation:

Ans. is ‘c’ i.e., Jugulodigastric nodes

  • Deep cervical lymph nodes are divided into two groups :- (i) jugulodigastric, and (ii) jugulo-omohyoid.
  • Lymphatics from oropharynx drain into jugulodigastric nodes.

Lymphatic drainage of pharynx

  • Lymphatic drainage of pharynx may be :‑

1. Nasopharynx

  • Nasopharynx drains into upper deep cervical nodes either directly or indirectly through retropharyngeal or parapharyngeal nodes.
  • Nasopharynx also drains into spinal accessory chain of nodes in the posterior triangle of the neck.

2. Oropharynx

  • Lymphatics from the oropharynx drain into upper jugular particularly the jugulodigastric (tonsillar) nodes.
  • The soft palate, lateral and posterior pharyngeal walls and the base of tongue also drain into retropharyngeal and parapharyngeal nodes and from there to the jugulodigastric and posterior cervical group.

3. Hyphopharynx

  • Pyriform sinus drains into upper jugular chain & then to deep cervical group of lymph nodes.
  • Postcricoid region drains into parapharyngeal and paratracheal group of lymph nodes.
  • Posterior pharyngeal wall drains into parapharyngeal lymph nodes and finally to deep cervical lymph nodes.


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