Pharynx and tonsils: fish bone impaction: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Pharynx and tonsils: fish bone impaction

Sample item

A man feels a fish bone stuck in his throat after dinner and points to one side of the neck. He has no stridor or drooling. What is the most appropriate first step?

AObservation for two days without examinationBExamination of the oropharynx, followed by flexible nasopharyngolaryngoscopyCImmediate rigid oesophagoscopy under general anaesthesiaDBarium swallow

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Examination of the oropharynx, followed by flexible nasopharyngolaryngoscopy

Most impacted fish bones lie in the tonsil, base of the tongue or vallecula and are visible on oral examination or flexible laryngoscopy. Plain films often miss them, and barium swallow is avoided because it coats the bone and can aspirate. Rigid endoscopy is reserved for failed or complicated cases.

Option by option

A. Observation for two days without examination
Delay risks migration and abscess, and the examination is easy and quick.
B. Examination of the oropharynx, followed by flexible nasopharyngolaryngoscopy (correct)
Correct. Direct inspection and flexible laryngoscopy find most impacted bones in the pharynx.
C. Immediate rigid oesophagoscopy under general anaesthesia
Rigid oesophagoscopy is reserved for bones not found on simple examination or for suspected oesophageal impaction.
D. Barium swallow
Barium coats the bone, obscures the view and risks aspiration.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is B, Examination of the oropharynx, followed by flexible nasopharyngolaryngoscopy. Most impacted fish bones lie in the tonsil, base of the tongue or vallecula and are visible on oral examination or flexible laryngoscopy.

Why is "Observation for two days without examination" not the answer?

Delay risks migration and abscess, and the examination is easy and quick.

Why is "Immediate rigid oesophagoscopy under general anaesthesia" not the answer?

Rigid oesophagoscopy is reserved for bones not found on simple examination or for suspected oesophageal impaction.

Why is "Barium swallow" not the answer?

Barium coats the bone, obscures the view and risks aspiration.

What concept does this question test?

It tests Pharynx and tonsils: fish bone impaction in ENT. Plain films often miss them, and barium swallow is avoided because it coats the bone and can aspirate. Rigid endoscopy is reserved for failed or complicated cases.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pharynx and tonsils: fish bone impaction?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.