Dysphonia — MCQs
What is the investigation of choice for dysphagia for solids?
A patient presents with hoarseness and laryngoscopy reveals a warty, cauliflower-like growth on the vocal cord. Identify the most likely lesion.
Reinke's layer is seen in:
A 50-year-old smoker presents with hoarseness, dysphagia, and weight loss. Flexible laryngoscopy shows a mass on the vocal cords. What is the next best step?
During thyroidectomy, which nerve, if damaged, can cause a hoarse voice?
A singer presents with difficulty singing at a high pitch. On examination, bowing of the vocal cord is observed on the right side. Which of the following muscles has likely been compromised?
A 16-year-old patient complains of difficulty in swallowing, difficulty in talking and sometimes difficulty in breathing. On physical examination the presentation is similar to that shown in the picture. What would be the probable diagnosis?
The following image shows:
Which of the following statements about laryngomalacia is true?
The image shows which of the following tests being performed? (Recent NEET Pattern 2016-17)
Dysphonia Indian Medical PG Practice Questions and MCQs
Question 1: What is the investigation of choice for dysphagia for solids?
- A. C.T. Scan
- B. Barium swallow
- C. X-ray chest
- D. Endoscopy (Correct Answer)
Explanation: ***Endoscopy*** - **Endoscopy** is the investigation of choice for dysphagia for solids because it allows direct visualization of the esophageal lumen and mucosa. - It enables the physician to identify and biopsy structural abnormalities such as strictures, tumors, or inflammation, which are common causes of dysphagia for solids. - Provides therapeutic options (dilation, stent placement) in the same sitting. *X-ray chest* - An **X-ray chest** can detect gross abnormalities like large masses or significant mediastinal widening but offers limited detail of the esophageal lumen. - It cannot reliably identify more subtle mucosal lesions or functional disorders leading to dysphagia. *C.T. Scan* - A **CT scan** provides cross-sectional images of the chest and mediastinum, useful for assessing extrinsic compression or advanced malignancies. - However, it is less sensitive for evaluating intrinsic esophageal mucosal abnormalities or differentiating between various causes of dysphagia compared to endoscopy. *Barium swallow* - A **barium swallow** is a radiological study that can demonstrate the contour and patency of the esophagus, especially useful for identifying strictures, webs, or diverticula. - While helpful as an initial investigation, it is a functional study and does not allow for direct visualization or tissue biopsy, which are often necessary for a definitive diagnosis of dysphagia for solids.
Question 2: A patient presents with hoarseness and laryngoscopy reveals a warty, cauliflower-like growth on the vocal cord. Identify the most likely lesion.
- A. Laryngeal papilloma (Correct Answer)
- B. Laryngeal malignancy
- C. Tracheomalacia
- D. Reinke’s edema
Explanation: ***Laryngeal papilloma*** - **Hoarseness** and a **warty, cauliflower-like growth** on the vocal cord are classic descriptions of a laryngeal papilloma, often caused by **HPV infection**. - These lesions can be solitary or multiple, and while benign, they can recur and cause voice changes and respiratory obstruction. *Laryngeal malignancy* - While hoarseness is a common symptom of laryngeal malignancy, the description of a **"warty, cauliflower-like growth"** is more characteristic of a papilloma than most typical carcinomas, which might appear more ulcerative or infiltrative. - Malignancies are more commonly associated with risk factors like **smoking and alcohol use**, and often present with other symptoms like dysphagia or weight loss. *Tracheomalacia* - **Tracheomalacia** refers to softening of the tracheal cartilage, leading to airway collapse, typically causing stridor or respiratory distress. - It does not present as a **discrete growth** on the vocal cords but rather as a diffuse structural weakness of the trachea. *Reinke’s edema* - **Reinke's edema** (polypoid corditis) is characterized by a **gelatinous or fluid-filled swelling** of the vocal cords, usually associated with chronic irritation like smoking. - It presents as a swollen, boggy appearance of the vocal cords, not a warty or cauliflower-like growth.
Question 3: Reinke's layer is seen in:
- A. Vocal cord (Correct Answer)
- B. Tympanic membrane
- C. Cochlea
- D. Reissner's membrane
Explanation: ***Vocal cord*** - **Reinke's space**, also known as Reinke's layer, is the superficial layer of the **lamina propria** of the vocal cord. - This layer is crucial for the **vibration of the vocal folds**, which is essential for sound production. *Tympanic membrane* - The **tympanic membrane**, or eardrum, is a thin membrane that separates the external ear from the middle ear [1]. [2]. - It vibrates in response to **sound waves** and transmits these vibrations to the ossicles, playing a role in hearing, not vocalization [1], [2]. *Cochlea* - The **cochlea** is a spiral-shaped cavity in the inner ear involved in the sense of hearing [2]. - It contains the **organ of Corti**, which converts sound vibrations into nerve impulses but has no connection to vocal cord anatomy [2]. *Reissner's membrane* - **Reissner's membrane** (vestibular membrane) is a thin membrane that separates the scala vestibuli from the scala media within the cochlea. - Its primary function is to maintain the **composition of the endolymph** in the scala media, and it is part of the auditory system, not the larynx.
Question 4: A 50-year-old smoker presents with hoarseness, dysphagia, and weight loss. Flexible laryngoscopy shows a mass on the vocal cords. What is the next best step?
- A. Direct laryngoscopy with biopsy (Correct Answer)
- B. MRI of neck
- C. CT scan of neck
- D. Radiotherapy
Explanation: ***Direct laryngoscopy with biopsy*** - A definitive diagnosis of a vocal cord mass requires **histological examination** to rule out malignancy, especially given the patient's risk factors (age, smoking) and symptoms (hoarseness, dysphagia, weight loss). - **Direct laryngoscopy** allows for a thorough, magnified view of the mass and precise biopsy collection, which is superior to flexible laryngoscopy alone for definitive diagnosis and staging. *MRI of neck* - While MRI can provide excellent soft tissue detail for **staging** a known malignancy, it cannot provide a **histological diagnosis**. - It would typically be performed after a biopsy confirms malignancy to assess the extent of the tumor and potential spread. *CT scan of neck* - A CT scan is useful for evaluating **bony involvement**, lymph node status, and tumor extension for **staging purposes**, but it is not a diagnostic tool for identifying the specific type of tissue or cell pathology. - Like MRI, a CT scan would generally follow a biopsy confirming malignancy. *Radiotherapy* - **Radiotherapy** is a treatment modality for laryngeal cancer, not a diagnostic step. - Initiating treatment without a definitive histological diagnosis of malignancy would be inappropriate and potentially harmful.
Question 5: During thyroidectomy, which nerve, if damaged, can cause a hoarse voice?
- A. Recurrent laryngeal; loops under aorta/subclavian (Correct Answer)
- B. Superior laryngeal; with superior thyroid artery
- C. Glossopharyngeal; along posterior thyroid
- D. Hypoglossal; inferior to thyroid
Explanation: ***Recurrent laryngeal; loops under aorta/subclavian*** - The **recurrent laryngeal nerve (RLN)** innervates most of the intrinsic muscles of the larynx, including the **posterior crico-arytenoid muscle**, which is responsible for abducting the vocal cords. - Damage to the RLN during thyroidectomy can lead to **vocal cord paralysis**, resulting in a hoarse voice, stridor, or aspiration. *Superior laryngeal; with superior thyroid artery* - The **superior laryngeal nerve (SLN)** branches into external and internal laryngeal nerves. The **external laryngeal nerve** runs with the **superior thyroid artery** and innervates the **cricothyroid muscle**, which is responsible for tensioning the vocal cords. - Damage to the SLN can cause subtle changes in voice pitch and reduced vocal range but typically does not cause hoarseness or vocal cord paralysis, which is more characteristic of RLN injury. *Glossopharyngeal; along posterior thyroid* - The **glossopharyngeal nerve (CN IX)** provides sensory innervation to the posterior third of the tongue, tonsils, pharynx, and middle ear, and motor innervation to the stylopharyngeus muscle. - It is not directly related to vocal cord function or hoarseness as a result of thyroid surgery. *Hypoglossal; inferior to thyroid* - The **hypoglossal nerve (CN XII)** innervates all extrinsic and intrinsic muscles of the tongue, controlling tongue movement. - Damage to the hypoglossal nerve would affect speech articulation and swallowing but not directly cause hoarseness or vocal cord paralysis.
Question 6: A singer presents with difficulty singing at a high pitch. On examination, bowing of the vocal cord is observed on the right side. Which of the following muscles has likely been compromised?
- A. Posterior cricoarytenoid
- B. Lateral cricoarytenoid
- C. Cricothyroid (Correct Answer)
- D. Thyroarytenoid
Explanation: ***Cricothyroid*** - The **cricothyroid muscle** is primarily responsible for **tensioning and elongating the vocal cords**, which is crucial for increasing vocal pitch. - Damage to this muscle or its innervation (superior laryngeal nerve) results in an inability to reach higher pitches and can cause **vocal cord bowing** due to reduced tension. *Posterior cricoarytenoid* - This muscle is the **primary abductor** of the vocal cords, meaning it opens the vocal cords for breathing. - Compromise would lead to difficulty breathing or a paralyzed vocal cord in the adducted position, not bowing with difficulty singing high notes. *Lateral cricoarytenoid* - The **lateral cricoarytenoid muscle** is a **vocal cord adductor** and rotator, bringing the vocal cords together to regulate voice intensity. - Dysfunction typically results in a weak and breathy voice, or difficulty bringing the cords together, not specifically difficulty with high pitch. *Thyroarytenoid* - The **thyroarytenoid muscle** (which includes the vocalis muscle) acts to **relax and shorten the vocal cords**, lowering pitch and modulating vocal cord tension. - Dysfunction would primarily lead to difficulty with lower pitches or a hoarse voice, as it prevents proper relaxation of the vocal cords.
Question 7: A 16-year-old patient complains of difficulty in swallowing, difficulty in talking and sometimes difficulty in breathing. On physical examination the presentation is similar to that shown in the picture. What would be the probable diagnosis?
- A. Ranula
- B. Lingual thyroid (Correct Answer)
- C. Enlarged adenoids
- D. Vallecular cyst
Explanation: ***Lingual thyroid*** - The image shows a **mass at the base of the tongue**, which is typical of a lingual thyroid, an ectopic thyroid tissue. - Symptoms like **difficulty swallowing (dysphagia)**, **difficulty talking (dysphonia)**, and **difficulty breathing (dyspnea)** are common with a lingual thyroid due to its obstructive nature. - Lingual thyroid results from **failure of thyroid descent** during embryological development and is the most common ectopic thyroid location. *Ranula* - A ranula is a **mucus extravasation cyst** found on the **floor of the mouth**, usually unilateral and bluish. - While it can cause speech or swallowing difficulties, its location is distinct from the mass seen at the tongue base. *Vallecular cyst* - A vallecular cyst is a **mucus retention cyst** located in the **vallecula** (between the base of tongue and epiglottis). - Can present with dysphagia and respiratory symptoms, but typically appears more **cystic and translucent** rather than solid tissue mass. - Less common in adolescents compared to lingual thyroid. *Enlarged adenoids* - Enlarged adenoids are located in the **nasopharynx** and typically cause nasal obstruction, mouth breathing, and recurrent ear infections. - They would not present as a visible mass at the base of the tongue nor cause dysphagia or dysphonia to this extent.
Question 8: The following image shows:
- A. Respiratory papillomatosis (Correct Answer)
- B. Vocal nodule
- C. Vocal polyp
- D. TB of vocal cords
Explanation: ***Respiratory papillomatosis*** - The image displays multiple **wart-like growths** on the vocal cords, characteristic of **respiratory papillomatosis**, which is caused by the **human papillomavirus (HPV)**. - These lesions often have an **irregular, cauliflower-like appearance** and can recur even after removal, making it a challenging condition to manage. *Vocal nodule* - Vocal nodules are typically **bilateral, symmetrical lesions** located at the junction of the anterior and middle thirds of the vocal cords. - They are usually **smooth, small, and whitish**, resulting from chronic vocal abuse, unlike the irregular and multiple growths seen in the image. *Vocal polyp* - Vocal polyps are typically **unilateral lesions** that can appear as sessile or pedunculated masses on a vocal cord. - They are often **larger than nodules** and may have a reddish or gelatinous appearance, but they usually occur singly, not as multiple diffuse growths like those pictured. *TB of vocal cords* - Tuberculosis of the vocal cords often presents with **ulcerative lesions**, granulomas, or diffuse inflammation, and may be accompanied by other signs of pulmonary TB. - The lesions caused by TB are generally **not papillomatous** or wart-like in nature, differentiating them from the appearance in the image.
Question 9: Which of the following statements about laryngomalacia is true?
- A. It is characterized by an omega-shaped epiglottis.
- B. It requires immediate surgical intervention.
- C. It always requires surgical intervention in newborns.
- D. It typically presents with inspiratory stridor. (Correct Answer)
Explanation: ***It typically presents with inspiratory stridor.*** - **Laryngomalacia** is the most common cause of **inspiratory stridor** in infants, usually presenting within the first few weeks of life due to collapse of supraglottic structures during inspiration. - The stridor is characteristically **worse when crying, feeding, or lying supine**, and often improves when the infant is prone. *It is characterized by an omega-shaped epiglottis.* - While an **omega-shaped epiglottis** can be a feature seen in laryngomalacia, it is not the sole or defining characteristic and is not universally present. - The primary characteristic is the **collapse of the supraglottic structures** (arytenoids, aryepiglottic folds, and epiglottis) into the laryngeal inlet upon inspiration. *It requires immediate surgical intervention.* - The vast majority of **laryngomalacia cases are mild to moderate** and resolve spontaneously by 12-18 months of age, requiring only conservative management. - **Surgical intervention** (supraglottoplasty) is reserved for severe cases with significant feeding difficulties, failure to thrive, severe airway obstruction, or apneic episodes. *It always requires surgical intervention in newborns.* - As mentioned, **most cases are self-limiting** and do not require surgery, especially in newborns. - Surgical intervention is only considered when there are **severe symptoms** impacting the infant's health and development.
Question 10: The image shows which of the following tests being performed? (Recent NEET Pattern 2016-17)
- A. A= Indirect laryngoscopy, B= Spatula test (Correct Answer)
- B. A= Posterior rhinoscopy, B= Spatula test
- C. A= Direct laryngoscopy, B= Spatula test
- D. A= Anterior rhinoscopy, B= Spatula test
Explanation: ***A= Indirect laryngoscopy, B= Spatula test*** - Image A depicts a mirror being used to visualize the larynx through the oral cavity, which is characteristic of **indirect laryngoscopy**. - Image B shows a spatula being used to apply pressure to the tongue or jaw while observing for a reflex action, which is consistent with the **spatula test** for tetanus. *A= Posterior rhinoscopy, B= Spatula test* - **Posterior rhinoscopy** involves visualizing the nasopharynx via a mirror placed behind the soft palate, which is not what is shown in Image A. - While Image B correctly shows a spatula test, Image A is clearly not a posterior rhinoscopy. *A= Direct laryngoscopy, B= Spatula test* - **Direct laryngoscopy** uses a laryngoscope to directly visualize the larynx without a mirror, often requiring sedation, which differs from the technique in Image A. - Image A shows the use of a mirror for visualization, thus ruling out direct laryngoscopy. *A= Anterior rhinoscopy, B= Spatula test* - **Anterior rhinoscopy** involves examining the anterior nasal cavity using a nasal speculum, which is not depicted in Image A. - Image A shows examination of the oral cavity and pharynx with a mirror, not the anterior nasal cavity.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free