Chronic Laryngitis — MCQs
Patient following peanut consumption presented with laryngeal edema, stridor, hoarseness of voice and swelling of tongue. Most likely diagnosis is:
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?
Mouse-nibbled vocal cords are seen in which condition?
A child presents with high grade fever, inspiratory stridor and develops swallowing difficulty with drooling of saliva since last 4-6 hours. Which of the following treatment is recommended apart from general airway management?
Which of the following is a precancerous lesion?
Laryngitis sicca is associated with ?
The following image shows:
Which part of the larynx is most commonly involved in tuberculosis (TB)?
True about carcinoma of the larynx?
Which of the following is NOT used in the treatment of Juvenile Laryngeal Papillomatosis?
Chronic Laryngitis Indian Medical PG Practice Questions and MCQs
Question 1: Patient following peanut consumption presented with laryngeal edema, stridor, hoarseness of voice and swelling of tongue. Most likely diagnosis is:
- A. Foreign body bronchus
- B. Angioneurotic edema (Correct Answer)
- C. Foreign body larynx
- D. Pharyngeal abscess
Explanation: ***Angioneurotic edema*** - The rapid onset of **laryngeal edema**, **stridor**, **hoarseness**, and **tongue swelling** following peanut consumption points to an allergic reaction, specifically **anaphylaxis** causing angioedema [1], [2]. - This is a life-threatening condition due to potential **airway obstruction**. *Foreign body bronchus* - While a foreign body could cause **stridor** if large enough to impact the trachea, symptoms like **laryngeal edema** and **tongue swelling** are not typical. - It usually presents with sudden coughing, wheezing, and possibly dyspnea, often without rapid-onset, diffuse swelling. *Foreign body larynx* - A foreign body in the larynx might cause hoarseness and stridor, but **laryngeal edema** and **tongue swelling** are not primary features of a simple foreign body obstruction. - The history of peanut ingestion and rapid systemic inflammatory response makes an allergic reaction more likely [2]. *Pharyngeal abscess* - A pharyngeal abscess typically develops more slowly, with symptoms including **severe sore throat**, **fever**, and **difficulty swallowing**. - It would not usually present with the rapid onset of severe **laryngeal edema** and **tongue swelling** immediately after peanut consumption.
Question 2: 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 3: Mouse-nibbled vocal cords are seen in which condition?
- A. Leprosy
- B. Laryngeal papilloma
- C. Epiglottitis
- D. Tuberculosis (Correct Answer)
Explanation: ***Tuberculosis*** - **Laryngeal tuberculosis** can cause irregular, eroded, and edematous vocal cords, often described as having a **"mouse-nibbled"** appearance due to granular ulcerations [1]. - This characteristic appearance is due to the chronic inflammatory and destructive nature of **Mycobacterium tuberculosis** infection on the laryngeal mucosa [1]. *Leprosy* - **Laryngeal leprosy** can cause diffuse infiltration, nodules, and thickening of the vocal cords, but typically does not present with the specific **"mouse-nibbled"** appearance of erosions [2]. - The lesions tend to be more nodular and less ulcerative in nature compared to tuberculosis [2]. *Laryngeal papilloma* - **Laryngeal papillomas** are benign tumors that present as wart-like growths on the vocal cords, often appearing as **mulberry-like** or **cauliflower-like** lesions [1]. - They do not typically cause the irregular, eroded, or "mouse-nibbled" pattern associated with tuberculosis. *Epiglottitis* - **Epiglottitis** is an acute inflammation of the epiglottis, primarily characterized by a **cherry-red, swollen epiglottis** and surrounding structures [1]. - While it can cause airway obstruction, it does not involve the characteristic erosions or "mouse-nibbled" appearance of the vocal cords [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 745-746. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 385-386.
Question 4: A child presents with high grade fever, inspiratory stridor and develops swallowing difficulty with drooling of saliva since last 4-6 hours. Which of the following treatment is recommended apart from general airway management?
- A. IV ceftriaxone (Correct Answer)
- B. Anti-diphtheria toxin
- C. Corticosteroids
- D. Nebulized racemic epinephrine
Explanation: ***IV ceftriaxone*** - The symptoms (high-grade fever, inspiratory stridor, swallowing difficulty with drooling, rapid onset) are highly suggestive of **acute epiglottitis**, a life-threatening emergency. - **Empiric intravenous antibiotics** like ceftriaxone are crucial for treating the bacterial infection (commonly *Haemophilus influenzae* type b or *Streptococcus pneumoniae*) causing epiglottitis. *Anti-diphtheria toxin* - This treatment is specific for **diphtheria**, which causes a pseudomembrane and can lead to airway obstruction, but the clinical picture here is more consistent with epiglottitis due to its rapid and severe presentation without mention of a pseudomembrane. - Diphtheria typically has a more gradual onset and is characterized by a **grayish pseudomembrane** in the throat, unmentioned in this case. *Corticosteroids* - While corticosteroids are used in other forms of upper airway obstruction (like **croup**), their role in acute epiglottitis is controversial and not a primary life-saving measure; antibiotics and airway management are paramount. - Their primary benefit lies in reducing inflammation, but they do not address the acute bacterial cause of epiglottitis directly and are secondary to antibiotics. *Nebulized racemic epinephrine* - This treatment is primarily used for **laryngotracheobronchitis (croup)**, which presents with a barking cough and stridor, but typically lacks the high fever and severe drooling seen in epiglottitis. - Nebulized racemic epinephrine helps to reduce subglottic edema in croup but would not be effective against the severe supraglottic swelling of epiglottitis, nor would it treat the underlying bacterial infection.
Question 5: Which of the following is a precancerous lesion?
- A. Keratosis of larynx (Correct Answer)
- B. Laryngitis sicca
- C. Scleroma larynx
- D. Pachydermia of larynx
Explanation: ***Keratosis of larynx*** - **Keratosis of the larynx**, particularly with **dysplasia**, is considered a **precancerous lesion** due to the potential for malignant transformation into squamous cell carcinoma [1]. - It involves abnormal thickening and keratinization of the laryngeal mucosa, often linked to irritants like **smoking** and **alcohol** [1]. *Laryngitis sicca* - This condition involves **dryness and crusting of the laryngeal mucosa**, typically due to environmental factors or systemic drying conditions. - While uncomfortable, it is generally an **inflammatory** condition and not considered precancerous. *Scleroma larynx* - **Laryngeal scleroma** is a chronic inflammatory condition caused by infection with **Klebsiella rhinoscleromatis**, leading to granulomatous changes and fibrosis. - It results in progressive airway obstruction but is a bacterial infection and **not a precancerous lesion**. *Pachydermia of larynx* - **Pachydermia of the larynx** refers to a benign thickening of the laryngeal mucosa, often in the interarytenoid region, typically due to **chronic irritation** or reflux. - Although it indicates chronic inflammation and hyperkeratosis, it is generally considered a **benign reactive change** rather than a true precancerous condition, unless significant dysplasia is also present (which would classify it under keratosis). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 746-747.
Question 6: Laryngitis sicca is associated with ?
- A. Rhinosporidium
- B. M. leprae
- C. Klebsiella ozaenae
- D. Klebsiella rhinoscleromatosis (Correct Answer)
Explanation: ***Klebsiella rhinoscleromatis*** - **Laryngitis sicca** is characterized by extreme dryness and crusting of the laryngeal mucosa, which is a known manifestation of complications due to **Rhinoscleroma**. - **Rhinoscleroma** is a chronic granulomatous disease caused by *Klebsiella rhinoscleromatis* (formerly *K. rhinoscleromatosis*), primarily affecting the upper respiratory tract including the larynx. *Rhinosporidium* - **Rhinosporidium seeberi** is an aquatic protistan parasite that causes **rhinosporidiosis**, characterized by friable, polypoidal lesions, often in the nose, but typically not laryngitis sicca. - The lesions caused by Rhinosporidium are usually vascular and bleeding, rather than dry and crusting. *M. leprae* - **Mycobacterium leprae** is the causative agent of **leprosy**, a chronic infectious disease primarily affecting the skin, peripheral nerves, upper respiratory tract mucosa, eyes, and testes. - While *M. leprae* can affect the larynx, it typically causes **granulomatous infiltration** and nodule formation leading to hoarseness and stridor, not specifically laryngitis sicca. *Klebsiella ozaenae* - *Klebsiella ozaenae* is associated with **ozena**, a form of chronic atrophic rhinitis characterized by a foul odor, crusting, and atrophy of nasal mucosa. - While it causes dryness and crusting, its primary manifestation is in the **nasal cavity**, and it is not directly linked to laryngitis sicca in the context tested here.
Question 7: 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 8: Which part of the larynx is most commonly involved in tuberculosis (TB)?
- A. Anterior
- B. Posterior (Correct Answer)
- C. Middle
- D. Anywhere
Explanation: ***Posterior*** - The **posterior larynx**, specifically the **arytenoids** and **interarytenoid area**, is the most common site for tuberculosis involvement. - This region is susceptible due to its rich **lymphatic supply** and direct exposure to infected secretions from the lungs. *Anterior* - While TB can affect any part of the larynx, the **anterior laryngeal structures** are less frequently the primary site of involvement. - The vocal cords, which are in the anterior-middle aspect, are less commonly affected initially compared to the posterior structures. *Middle* - The middle part of the larynx, including the **vocal cords**, is not the predominant site for initial tuberculous lesions. - Involvement here often occurs as the disease progresses from more commonly affected areas. *Anywhere* - Although TB can theoretically affect any part of the larynx, it demonstrates a strong predilection for the **posterior laryngeal region**. - Stating "anywhere" does not accurately reflect the statistically significant preference for specific anatomical sites.
Question 9: True about carcinoma of the larynx?
- A. Glottis is the most common site. (Correct Answer)
- B. It rarely presents with metastasis.
- C. Adenocarcinoma is the commonest type.
- D. It responds to chemotherapy very well.
Explanation: ### Explanation **Correct Option: A. Glottis is the most common site.** In the Indian subcontinent and globally, the **glottis (vocal cords)** is the most common site for laryngeal carcinoma (approx. 60-65%), followed by the supraglottis (30-35%) and the subglottis (1-5%). Glottic tumors often present early due to hoarseness of voice, which occurs even with tiny lesions. **Analysis of Incorrect Options:** * **B. It rarely presents with metastasis:** This is incorrect. While glottic cancers have a low rate of metastasis due to sparse lymphatic drainage, **supraglottic cancers** have a rich lymphatic network and frequently present with early cervical lymph node metastasis (often bilateral). * **C. Adenocarcinoma is the commonest type:** Incorrect. Over 95% of laryngeal cancers are **Squamous Cell Carcinomas (SCC)**. Adenocarcinoma is rare and usually arises from minor salivary glands. * **D. It responds to chemotherapy very well:** Incorrect. The primary treatment modalities for laryngeal cancer are **Surgery and Radiotherapy**. Chemotherapy is typically used as an adjuvant or for "organ preservation" protocols (e.g., Cisplatin) rather than being the definitive treatment of choice. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognosis:** Glottic cancer (due to early symptoms and poor lymphatics). * **Worst Prognosis:** Subglottic cancer (presents late and has a high risk of paratracheal node involvement). * **Most Common Site of Distant Metastasis:** Lungs. * **Staging:** T1a involves one vocal cord; T1b involves both cords. T3 implies vocal cord fixation. * **Risk Factors:** Smoking (strongest association) and Alcohol (synergistic effect).
Question 10: Which of the following is NOT used in the treatment of Juvenile Laryngeal Papillomatosis?
- A. Interferon alpha (INF α)
- B. Interferon beta (INF β) (Correct Answer)
- C. Bevacizumab
- D. Cedofovir
Explanation: **Explanation:** Juvenile Laryngeal Papillomatosis (JLP), caused by **HPV types 6 and 11**, is characterized by recurrent benign epithelial tumors. The primary treatment is surgical debulking (CO2 laser or microdebrider), but adjuvant medical therapy is indicated when the disease is aggressive (requiring >4 surgeries per year). **Why Option B is Correct:** **Interferon beta (INF β)** is not a standard treatment for JLP. While Interferons have antiviral and antiproliferative properties, clinical evidence and established protocols specifically utilize **Interferon alpha (INF α)**. INF β does not have a proven role in the management of this condition. **Analysis of Incorrect Options:** * **Interferon alpha (INF α):** Historically the first-line adjuvant therapy. It slows the rate of recurrence by inducing antiviral states in cells, though it rarely provides a permanent cure and has significant side effects (flu-like symptoms, growth retardation). * **Cidofovir:** A potent antiviral (cytosine nucleotide analog) administered via **intralesional injection**. It is currently one of the most commonly used adjuvant agents for recalcitrant cases. * **Bevacizumab:** An anti-VEGF monoclonal antibody. It is a newer, highly effective treatment (administered systemically or intralesionally) that inhibits the angiogenesis required for papilloma growth. **High-Yield Clinical Pearls for NEET-PG:** * **Most common benign tumor** of the larynx in children. * **Triad of symptoms:** Hoarseness (most common), stridor, and respiratory distress. * **Diagnosis:** Direct laryngoscopy shows "cauliflower-like" masses. * **Gold Standard Adjuvant:** Cidofovir (Intralesional). * **Newer Trend:** Bevacizumab is increasingly preferred for severe cases. * **Note:** Tracheostomy should be avoided as it may lead to "stomal seeding" of the papilloma.
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