Revision with a Master Quiz of 28 questions based on NEET PG Sample Questions on Tonsil from Previous Year NEET PG Online Exams.

1. A child presents with a white patch over the tonsils; diagnosis is best made by
culture in:
A: Loeffler medium
B:
LJ
medium
C: Blood agar
D: Tellurite medium
Correct Ans:A
Explanation
In the child presenting with a white patch over the tonsil, we suspect a diagnosis
of 'diphtheria'. Usual media used for cultivation of Diphtheria are Loeffler’s
serum slope & tellurite blood agar.
Ref: Text Book of Microbilogy By Ananthanarayan, 6th Edition, Page 215 and
8th Edition, Page 233
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A febrile 23-year-old college student presents with fatigue and difficulty
swallowing. Physical exam reveals exudative tonsillitis, palatal petechiae, cervical
lymphadenopathy, and tender hepatosplenomegaly. A complete blood count
reveals mild anemia, lymphocytosis with about 30% of the lymphocytes
exhibiting atypical features, and a mild thrombocytopenia. Coombs' test is
positive. Which of the following is the most likely complication of this syndrome?
A: Acute cholecystitis
B: Ascending cholangitis
C: Diarrhea
D: Splenic rupture
Correct Ans:D
Explanation

2. The syndrome represented by the clinical vignette is infectious
mononucleosis. Epstein-Barr virus (EBV) is the usual cause of heterophile-
positive infectious mononucleosis;cytomegalovirus is responsible for a minority
of cases. Rarely, splenic rupture requiring splenectomy can result from
splenomegaly and capsular swelling, usually occurring during the 2nd and 3rd
weeks of the illness.
Acute cholecystitis is not associated with infectious mononucleosis.The most
frequently isolated pathogens are E. coli, Klebsiella spp., group D Streptococcus,
Staphylococcus spp., and Clostridium spp.
Ascending cholangitis is not associated with infectious mononucleosis.
Cholangitis usually presents with biliary colic, jaundice, and spiking fever with
chills (Charcot's triad). Blood cultures are usually positive (E. coli is a common
isolate), with an accompanying leukocytosis.
AIDS-related cholangitis has been reported, presenting with abdominal pain and
obstructive liver symptoms. Potential etiologic agents include Cytomegalovirus,
Cryptosporidium parvum, and Microsporidia, including Enterocytozoon
cuniculi.
Diarrhea is not usually produced by infectious mononucleosis.
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Bilateral tonsillectomy is performed on an otherwise healthy 11-year-old female
with recurrent upper respiratory tract infections. On pathologcal examination of
the tonsils, numerous small, yellow granules are noted. A granule crushed
between two slides have a dense, gram-positive center and numerous branching
filaments at the periphery. The granules are most likely composed of which of
the following organisms?
A: Actinomyces israelii
B: Aspergillus fumigatus
C: Blastomyces dermatitidis
D: Candida albicans
Correct Ans:A

3. Explanation
Actinomyces are normal inhabitants of the gastrointestinal tract that grow under
anaerobic and microaerophilic conditions. Although they are gram-positive rods,
they grow as branching filaments and have been confused with fungi. The yellow
colonies (sulfur granules) are found in low-oxygen niches like the tonsils and in
actinomycotic abscesses.
Aspergillus fumigatus may be present in the respiratory tract as an opportunistic
pathogen; however, fungus balls are generally seen only in pre-existing cavities
(e.g., bronchiectasis, TB), not in the tonsils.
Blastomyces dermatitidis is a respiratory pathogen that is seen as thick-walled
yeasts within granulomas.
Candida albicans, also a normal inhabitant of the oral cavity, would present as
whitish plaques and would appear microscopically as budding yeasts.
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An unimmunized child is brought to you with a history of URTI. On examination you find
signs suggestive of diphtheria. Which type of diphtheria would suggest the worst
prognosis?
A: Tonsillopharyngeal
B:
Laryngea
l
C: Nasal
D: Cutaneous
Correct Ans:B
Explanation
Tonsillopharyngeal type of diphtheria is the commonest type of diphtheria infection. Here
there is a small chance for bullneck and toxemia. In case of laryngeal diphtheria there is a
real danger of asphyxia and urgent tracheostomy may be required to save the patient.
Hence it is the most severe form of the disease and has got the worst prognosis. Nasal
diphtheria is the mildest form of respiratory diphtheria. Cutaneous diphtheria is caused by
non toxigenic strains.

4. Ref: Textbook of Microbiology by Ananthanarayan, Edition 6, Page 217; Harrison, Edition
17, Page 891, 892
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Tonsillar carcinoma is associated with infection of:
A:
HI
V
B: HPV
C: HSV
D: None of the above
Correct Ans:B
Explanation
HPV is an epitheliotropic virus that has been detected to varying degrees within samples of
oral cavity squamous cell carcinoma. Infection alone is not considered sufficient for
malignant conversion; however, results of multiple studies suggest a role of HPV in a subset
of head and neck squamous cell carcinoma. Approximately 40% of tonsillar carcinomas
demonstrate evidence of HPV types 16 and 18.
Ref: Schwartz’s principle of surgery 9th edition, chapter 18.
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Tonsillectomy is recommended if number of acute infections in a year exceed:
A: 3
B: 4
C: 5
D: 6
Correct Ans:A
Explanation
Tonsillectomy and adenoidectomy are indicated for chronic or recurrent acute infection and
for obstructive hypertrophy. The American Academy of Otolaryngology–Head and Neck
Surgery Clinical Indicators Compendium suggests tonsillectomy after three or more
infections per year despite adequate medical therapy. Some feel that tonsillectomy is

5. indicated in children who miss 2 or more weeks of school annually secondary to tonsil
infections.
Ref: Schwartz’s principle of surgery 9th edition, chapter 18.
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Ramavati a 40 years old female presented with a progressively increasing lump in the
parotid region. On oral examination, the tonsil was pushed medially.Biopsy showed it to be
pleomorphic adenoma. The appropriate treatment is:
A: Superficial parotidectomy
B:
Lumpectom
y
C: Conservative total parotidectomy
D: Enucleation
Correct Ans:C
Explanation
Pleomorphic adenomas, or benign mixed tumors, are the most common neoplasms of the
salivary glands. Complete surgical excision of the tumor with uninvolved margins is the
recommended treatment. A superficial parotidectomy with clear margins is the treatment of
a pleomorphic adenoma located in the superficial lobe of the parotid gland. The prognosis
for pleomorphic adenomas is excellent, with a 95% rate of non-recurrence.
Although radiation is not indicated in the treatment of benign
salivary tumors, it has been used occasionally to control
recurrent pleomorphic adenomas.
Ref: Butt F.Y. (2012). Chapter 18. Benign Diseases of the
Salivary Glands. In A.K. Lalwani (Ed), CURRENT Diagnosis &
Treatment in Otolaryngology—Head & Neck Surgery, 3e.
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The commonest cause of death in diphtheritic child after few weeks of infection is:

6. A: IIIrd nerve palsy
B:
Myocarditi
s
C: Tonsillitis
D: Septicemia
Correct Ans:B
Explanation
Myocarditis and neuropathy are the most common and most serious complications. Deaths
from diphtheria occur either from tracheobronchial obstruction by the pseudomembrane
acutely or cardiac complications several weeks after the primary infection.
Diphtheritic myocarditis is characterized by a rapid, thready pulse; indistinct heart sounds,
ST-T wave changes, conduction abnormalities, dysrhythmias, or cardiac failure;
hepatomegaly; and fluid retention. Myocardial dysfunction may occur from 2 to 40 days
after the onset of pharyngitis. Myocarditis is typically associated with dysrhythmia of the
conduction tract and dilated cardiomyopathy.
Ref: Jauch E.C., Barbabella S.P., Fernandez F.J., Knoop K.J. (2010). Chapter 5. Ear, Nose,
and Throat Conditions. In K.J. Knoop, L.B. Stack, A.B. Storrow, R.J. Thurman (Eds), The
Atlas of Emergency Medicine, 3e.
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What is the COMMONEST cause of death in diphtheritic child?
A: IIIrd cranial nerve palsy
B:
Myocarditi
s
C: Tonsillitis
D: Septicemia
Correct Ans:B
Explanation
Diphtheria is an acute infection of the upper respiratory tract or skin caused by toxin-
producing Corynebacterium diphtheriae. Important complications of diphtheria are
diphtheritic myocarditis, polyneuritis and bronchopneumonia. Myocarditis is the most
common cause of death in these children with mortality varying between 3-25% when
associated with early myocarditis.

7. Myocardial dysfunction occur 2-40 days after the onset of pharyngitis. Diphtheritic
myocarditis is characterized by rapid thready pulse, thready pulse, indistinct heart sounds,
dysrhythmias, cardiac failure and ECG showing ST-T wave changes.
Ref: Ogle J.W., Anderson M.S. (2012). Chapter 42. Infections: Bacterial & Spirochetal. In
W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT
Diagnosis & Treatment: Pediatrics, 21e.
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An 8 year old child is referred to you with history of Mononeuritis multiplex. On
examination you find that there is hepatosplenomegaly. Examination of the oral cavity and
pharynx revealed enlarged orange coloured tonsils. Which of the following statement
regarding the above condition is false?
A: It is a case of Tangier diaese
B: The plasma LDL - c levels will be low
C: It is an autosomal recessive condition
D: It is caused by ABCA1 deficiency
Correct Ans:C
Explanation
Tangier disease is an autosomal co dominant condition caused by mutation in the gene
coding for ABCA 1. These patients have low levels of HDL-C, ApoA - I and LDL-C. There may
be a slightly elevated triglyceride levels. The accumulation of cholesterol in the reticulo
endothelial system is responsible for the findings described in the question.
Ref: Harrison, Edition 17, Page - 2423 ; Essential revision notes for MRCP by Philip A Kalra,
Edition 3, Page - 333

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Pathognomonic enlarged, grayish yellow or orange tonsils are seen in:
A: Familial hypercholesterolemia
B:
LCAT
deficiency
C: Tangier disease
D: Abetalipoproteinemia
Correct Ans:C
Explanation
Patients with Tangier disease have extremely low circulating plasma levels of HDL-C (<5
mg/dL). Cholesterol accumulates in the reticuloendothelial system of these patients,
resulting in hepatosplenomegaly and pathognomonic enlarged, grayish yellow or orange
tonsils.
Reference:
Harrisons Principles of Internal Medicine, 18th Edition, Page 3154
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What is the treatment of choice in a 6 year old child with recurrent URTI with mouth
breathing having high arched palate, impaired hearing and growth failure?
A: Tonsillectomy
B: Grommet insertion
C: Myringotomy with grommet insertion
D: Adenoidectomy with grommet insertion
Correct Ans:D
Explanation
Hypertrophic adenoid tissue causes nasal obstruction, mouth-breathing, and similarly,
obstruction of the Eustachian tube orifices. Removing large adenoids enhances the patency
of the nasopharyngeal airway, relieving the overall pressure in the nasopharynx, in turn
allowing improved aeration of the middle ear cleft.

9. The goal of placement of tympanostomy tubes is to aerate the middle ear space and prevent
accumulation of middle ear inflammation and effusion. In effect, ventilation of the middle
ear enhances hearing thresholds.
Ref: Pai S., Parikh S.R. (2012). Chapter 49. Otitis Media. In A.K. Lalwani (Ed), CURRENT
Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.
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Commonest causative organism for acute tonsillitis is which of the following?
A: B streptococci
B: Parainfluenza virus
C: H influenza
D: Corynebacterium
Correct Ans:A
Explanation
Parainfluenza virus causes tracheobronchitis and H influenza cause acute epiglottitis.
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All of the following are absolute indications for tonsillectomy, except
A: Recurrent attacks
B: Peritonsillar abscess
C: Suspected malignancy
D: Acute tonsillitis
Correct Ans:D
Explanation
Recurrent throat infections, peritonsillar abcess, tonsillitis causing febrile seizures, hypertrophy of
tonsils causing sleep apnoea or speech interference and any suspicion of malignancy are absolute
indications for tonsillectomy.

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A child with high fever, severe sore throat presented with painful swallowing. Her voice
was abnormal. Quinsy was diagnosed. What is referred to as Quinsy?
A: Peritonsillar abscess
B: Retropharyngeal abscess
C: Parapharyngeal abscess
D: Any of the above
Correct Ans:A
Explanation
 When infection penetrates the tonsillar capsule and involves the
surrounding tissues, peritonsillar cellulitis results.
 Peritonsillar abscess otherwise known as ‘quinsy’ and cellulitis present
with severe sore throat, odynophagia, trismus, medial deviation of the soft
palate and peritonsillar fold, and an abnormal muffled ("hot
potato") voice.
Ref: Lustig L.R., Schindler J.S. (2013). Chapter 8. Ear, Nose, & Throat Disorders. In M.A.
Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013.
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Tonsiloliths are best treated with:
A: Antibiotic
B: Hydrogen peroxide
C: Steroids
D: None of the above
Correct Ans:B
Explanation
The treatment for these tonsillar concretions or chronic tonsillitis is aggressive mouth care,
which includes irrigation of the tonsils or cleaning them with a cotton swab soaked in 3%
hydrogen peroxide. With time, the cellular debris is often retained in the branching crypts
and with recurrent formation of focal bacterial abscesses in the tonsillar parenchyma,
which later undergoes fibrosis and scarring; local care may not control these symptoms.

11. Tonsillar surgery and elimination of these cryptic structures may be needed to control these
infections.
Ref: Current diagnosis and treatment in otolaryngology, 2nd ed, Chapter 20.
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Pus collection in “quinsy” usually gets collected in which location?
A: Peritonsillar space
B:
Within the
tonsil
C: Parapharyngeal space
D: Retropharyngeal space
Correct Ans:A
Explanation
Quinsy usually follows an episode of acute tonsillitis. Parapharyngeal abscess is a
complication of quinsy.
Ref: PL Dingra, (2010), Chapter 51, “Head and Neck Space Infections”, In the book,
“Disease of EAR, NOSE AND THROAT”, 5th Edition, New Delhi, Page 278
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Secondary Haemorrhage after tonsillectomy usually presents at:
A: 12 hours
B:
24
hours
C: 6 days
D: 12 days
Correct Ans:C
Explanation

12. Secondary haemorrhage usually seen between the 5th to 10th postoperative day.
It is the result of sepsis & premature separation of the membrane. Usually, it is heralded by
bloodstained sputum but may be profuse. Simple measures like removal of clot, topical
application of dilute adrenaline or hydrogen peroxide with pressure usually suffice.
For profuse bleeding, general anaesthesia is given & bleeding vessel is electrocoagulated or
ligated. Sometimes, approximation of pillars with mattress sutures may be requered.
Sometimes, external carotid ligation may also be required.
Systemic antibiotics are given for control of infection.
Ref: Dhingra 4th edition, Page 384
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A 5-year-old patient is scheduled for tonsillectomy. On the day of surgery he had running
nose, temperature 37.5°C and dry cough. Which of the following should be the most
appropriate decision for surgery?
A: Surgery should be cancelled
B: Should get X-ray chest before proceeding for surgery
C: Cancel surgery for 3 weeks and patient to be on antibiotic
D:
Can proceed for surgery if chest is clear and there is no history at
asthma
Correct Ans:C
Explanation
Since the child in the question has developed upper respiratory tract infection on the day of
his surgery, it is recommended to postpone the surgery and give antibiotics to treat his
infection.
Several studies have shown that children undergoing an elective surgical procedure with an
acute upper respiratory tract infection has an increased incidence of laryngospasm,
bronchospasm or oxygen desaturation.
Ref: Medical Management of The Surgical Patient: A Textbook of Perioperative Medicine By
Michael F. Lubin, Page 135; Ear, Nose and Throat Diseases By P L Dhingra, 4th Edition, Page
382.
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13. A 6 year old child presented with recurrent URTI, mouth breathing and failure to grow. On
examination he has high arched palate and impaired hearing. What is the management of
choice in this child?
A: Myringotomy
B: Myringotomy with grommet insertion
C: Adenoidectomy with grommet insertion
D: Tonsillectomy
Correct Ans:C
Explanation
Child in the question is showing features of adenoid hyperplasia as indicated by mouth
breathing, nasal obstruction and recurrent URTI. He has impaired hearing as a result of
serous otitis media which occur as a complication of adenoid hyperplasia. So the treatment
of choice is adenoidectomy with grommet insertion which will take care of both the adenoid
as well as serous otitis media.
Features of adenoid facies are:
? Elongated face with dull expression
? Open mouth
? Prominent and crowded upper teeth
? Hitched up upper lip
? Pinched in appearance of nose
? High arched palate
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Which of the following condition is treated by laser-assisted uvulopalatoplasty?
A: Snoring
B: Pharyngotonsillitis
C: Cleft palate
D: Stammering
Correct Ans:A
Explanation
Laser uvulopalatoplasty (LAUP) is the treatment for snoring. In LAUP, the redundant soft
tissue is either excised or ablated. It helps to avoid most of the postoperative morbidity, as
well as providing a good hemostatic benefit during surgery. The CO2 laser is the laser most
commonly used by otolaryngologists for this operation.

14. Ref: Satar B., Shah A.R. (2012). Chapter 6. Lasers in Head & Neck Surgery. In A.K. Lalwani
(Ed), CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e.
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Quincy tonsillectomy is done in:
A: Tonsilolith
B: Tonsillar malignancy
C: Tonsillitis
D: None of the above
Correct Ans:C
Explanation
Certain surgeons favor a "Quincy tonsillectomy," which is a tonsillectomy that is performed
while the patient is acutely infected.
Ref: Current diagnosis and treatment in otolaryngology, 2nd ed, Chapter 20.
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The Myer-Cotton grading system is used for:
A: Subglottic stenosis
B:
Tonsilliti
s
C: Sinisitis
D: None of the above
Correct Ans:A
Explanation
The Myer-Cotton grading system describes the severity of stenosis according to the
percentage of subglottic stenosis present. The percentage is calculated by measuring the
largest sized endotracheal tube that can be passed through the subglottis and comparing
this with the age-appropriate tube size for the child
Ref: Current diagnosis and treatment in otolaryngology, 2nd ed, Chapter 32.

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Tonsillectomy is contraindicated in which of the following condition?
A: Small atrophic tonsils
B: Quinsy
C: Poliomyelitis epidemic
D: Tonsillolith
Correct Ans:C
Explanation
Performing tonsillectomy during poliomyelitis epidemic is an absolute contraindication.
Unimmunised children may develop polio following tonsillectomy. A tonsillectomy may be
performed long after the epidemic has passed and the child is immunised against polio.
Indications for Tonsillectomy:
 Recurrent episodes of acute tonsillitis that is more than four attacks a
year
 Patients with recurrent sore throats and rheumatic fever and when tonsils
cause repeated attacks of otitis media.
 Presence or history of a peritonsillar abscess or of diphtheria carriers.
 Massive tonsillar hypertrophy causing respiratory obstruction in children
 Sleep apnea
 Glossopharyngeal neuralgia
Ref: Textbook Of The Ear, Nose And Throat By De Souza, C. Et Al. page 177-8.
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Which among the following causes ‘thumb sign’ on an X-ray lateral view of the neck?
A: Acute epiglottitis
B: Acute laryngo trachea bronchitis
C: Acute tonsillitis

16. D: Acute laryngitis
Correct Ans:A
Explanation
Thumb sign is typically seen in acute epiglottitis due to swollen epiglottis. It is better
appreciated in lateral view of neck. Normally, the epiglottis is quite thin in the
anteroposterior (AP) dimension, resembling a little finger, whereas the abnormal, inflamed
epiglottis appears shorter and has an increased AP dimension, resembling a thumb.
Acute epiglottitis is usually caused by infection with H influenzae type B.
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Which structure forms the lateral wall of tonsillar fossa?
A: Facial nerve
B: Glossopharyngeal artery
C: Superior constrictor muscle
D: Palatopharyngeus muscle
Correct Ans:C
Explanation
The tonsils are situated one on each side of the lateral wall of oropharynx in the tonsillar
fossa. The tonsillar bed is formed by pharyngobasilar fascia, palatoglossus muscle and
superior constrictor muscle of the pharynx.
Tonsillar fossa is bounded anteriorly by the palatoglossal fold and posteriorly by the
palatopharyngeal fold.
Capsule of the tonsil covers only the lateral surface of the tonsil, and is formed by
pharyngobasilar fascia.
Medial surface is covered by mucous membrane of the oral cavity, with stratified squamous
epithelium.
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17. Which of the following statement about the nerve supply of palate is NOT TRUE?
A: Pharyngeal plexus supply muscles of soft palate
B: Tensor veli palatini is supplied by mandibular nerve
C: Anterior branch of pterygopalatine ganglion supplies soft palate
D:
Middle and posterior lesser palatine nerves supply soft palate
and tonsil
Correct Ans:C
Explanation
“Greater or anterior palatine branches of pterygopalatine ganglion supplies hard palate and
lateral wall of the nose while the lesser or middle and posterior palatine nerve supply the
soft palate and tonsils”.
All the muscles of the soft palate except tensor veli palatini are supplied by pharyngeal
plexus (fibers of the plexus are derived from the cranial part of the accessory nerve through
the vagus nerve)
Tensor veli palatini is supplied by mandibular nerve.
Ref: Snell’s Anatomy 8/e, Page 781-85 ; BDC 4/e, Vol.III, Page 210-13, 237
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The tonsils are derived from which of the following branchial pouch?
A: 1st branchial pouch
B: 2nd branchial pouch
C: 3rd branchial pouch
D: 4th branchial pouch
Correct Ans:B
Explanation
Endoderm of the second pharyngeal pouch forms the stratified squamous, nonkeratinized
epithelium lining the tonsillar crypts on pharyngeal surface of tonsil. The mesoderm forms
lymphoid tissue, fibrous capsule, and connective tissue elements of tonsil.
Pharyngeal pouch derivatives:
 First pouch: eustachian tube, tympanic cavity, endodermal lining of
eardrum

18.  Second pouch: palatine tonsils
 Third pouch: thymus and inferior parathyroid glands
 Fourth pouch: superior parathyroid, part of thymus
 Fifth pouch: parafollicular cells of thyroid
Ref: Textbook of Clinical Embroyology By Vishram Singh page 116. A Textbook of
Neuroanatomy By Maria Patestas.
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