Laryngeal Papillomatosis — MCQs
A patient presents with hoarseness and laryngoscopy reveals a warty, cauliflower-like growth on the vocal cord. Identify the most likely lesion.
Most common benign lesion of vocal cord in pediatric age group 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?
A 50-year-old male chronic smoker complains of hoarseness of voice for the past 4 months. Microlaryngoscopic biopsy shows it to be keratosis of the larynx. All are suggested treatment modalities for this condition, except:
Most common type of HPV associated with cervical cancer?
In an infant brought with stridor, diagnosed with laryngomalacia, which of the following is NOT typically observed?
A patient presents with hoarseness of voice and a clinical condition as shown in the image. Identify the lesion:
Killian's Dehiscence is seen at the level of:
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:
Laryngeal Papillomatosis Indian Medical PG Practice Questions and MCQs
Question 1: 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 2: Most common benign lesion of vocal cord in pediatric age group is
- A. Chondroma
- B. Granular cell tumor
- C. Juvenile papillomatosis (Correct Answer)
- D. Solitary papilloma
Explanation: ***Juvenile papillomatosis*** - This condition, caused by the **human papillomavirus (HPV)**, is the most common benign laryngeal tumor in children. - It presents with **recurrent wart-like lesions** on the vocal cords, leading to hoarseness and airway obstruction. *Chondroma* - This is a rare, **benign cartilaginous tumor** that can affect the larynx, but it is exceedingly uncommon in children. - It is more commonly seen in adults and typically arises from the **cricoid cartilage**. *Granular cell tumor* - This is a rare, usually benign tumor originating from **Schwann cells**, which can occur in various locations including the larynx. - It is much more common in **adults** and is distinctly rare in the pediatric age group. *Solitary papilloma* - While papillomas can affect the vocal cords, the term "solitary papilloma" more commonly refers to the **adult form of papillomatosis** (often single lesions) rather than the multiple, recurrent lesions seen in children. - In children, the lesions are typically **multiple and recurrent**, hence "juvenile" and "papillomatosis" (multiple papillomas).
Question 3: 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 4: A 50-year-old male chronic smoker complains of hoarseness of voice for the past 4 months. Microlaryngoscopic biopsy shows it to be keratosis of the larynx. All are suggested treatment modalities for this condition, except:
- A. Stop smoking
- B. Stripping of vocal cord
- C. Laser vaporization
- D. Partial laryngectomy (Correct Answer)
Explanation: ***Partial laryngectomy*** - **Partial laryngectomy** is a surgical procedure typically reserved for **laryngeal cancer** that has invaded deeper tissues or is extensive. - Laryngeal keratosis, even with atypia, is a **premalignant lesion** and does not usually warrant such an aggressive surgical intervention as a primary treatment. *Stop smoking* - **Cigarette smoking** is a major causative factor for laryngeal keratosis and its progression to dysplasia or carcinoma. - **Cessation of smoking** can often lead to regression of the keratosis and is a crucial first step in management. *Laser vaporization* - **Laser vaporization** using CO2 laser is an effective method for precise removal of the keratotic lesions. - It allows for **accurate tissue ablation** while preserving surrounding healthy tissue and maintaining vocal function. *Stripping of vocal cord* - **Vocal cord stripping** is a common surgical technique used to remove superficial lesions like keratosis from the vocal cords. - This procedure involves **peeling off the superficial layer** of the vocal cord while aiming to preserve the deeper structures essential for voice quality.
Question 5: Most common type of HPV associated with cervical cancer?
- A. 6, 11
- B. 5, 8
- C. 16, 18 (Correct Answer)
- D. 6, 8
Explanation: ***16, 18*** - **HPV types 16 and 18** are considered **high-risk HPV types** and are responsible for approximately **70% of all cervical cancer cases** globally. - These types produce **oncoproteins E6 and E7** that interfere with tumor suppressor genes (p53 and Rb), leading to uncontrolled cell growth and malignancy. *6, 11* - **HPV types 6 and 11** are considered **low-risk HPV types** and are primarily associated with **genital warts (condyloma acuminata)**. - While they can cause benign lesions, they are **rarely associated with cervical cancer**. *5, 8* - **HPV types 5 and 8** are **cutaneous HPV types** primarily associated with **epidermodysplasia verruciformis**, a rare genetic condition predisposing to skin cancers. - These types affect the **skin** and are **not associated with cervical cancer**, making them incorrect for this question. *6, 8* - This combination includes **HPV 6**, which is a **low-risk type** primarily associated with genital warts. - **HPV 8** is a cutaneous type associated with skin lesions, not cervical cancer. - This pairing does not represent the most common types responsible for cervical cancer.
Question 6: In an infant brought with stridor, diagnosed with laryngomalacia, which of the following is NOT typically observed?
- A. Stridor will be inspiratory
- B. Hoarseness (Correct Answer)
- C. Prominent arytenoids
- D. Floppy aryepiglottic folds
Explanation: ***Correct: Hoarseness*** - **Laryngomalacia** primarily involves the collapse of supraglottic structures during inspiration, leading to inspiratory stridor - Hoarseness is NOT typically observed because laryngomalacia does **not directly affect the vocal cords** - Hoarseness indicates pathology at the level of the **vocal cords** themselves (such as vocal cord paralysis or inflammation), which is a different entity - The supraglottic collapse in laryngomalacia occurs above the vocal cords, leaving vocal cord function intact *Incorrect: Stridor will be inspiratory* - **Inspiratory stridor** is the hallmark feature of laryngomalacia - The collapse of supraglottic structures during inspiration creates a narrow airway, producing the characteristic high-pitched sound on inhalation - This is the most common presenting symptom in affected infants *Incorrect: Prominent arytenoids* - Laryngoscopy in laryngomalacia often reveals **prominent or redundant arytenoid mucosa** - The collapse of redundant tissue over the arytenoids makes them appear more prominent due to inward movement during inspiration - This contributes to the airway obstruction seen in the condition *Incorrect: Floppy aryepiglottic folds* - **Floppy, shortened aryepiglottic folds** are a hallmark anatomical feature of laryngomalacia - These folds collapse inward during inspiration, obstructing the laryngeal inlet - This collapse is the primary mechanism causing the inspiratory stridor in laryngomalacia
Question 7: A patient presents with hoarseness of voice and a clinical condition as shown in the image. Identify the lesion:
- A. Diphtheria (Correct Answer)
- B. Follicular tonsillitis
- C. Aphthous ulcer
- D. Membranous tonsillitis
Explanation: ***Diphtheria*** - The image shows a **thick, grayish-white pseudomembrane** covering the tonsils and likely extending to other parts of the pharynx, which is a classic sign of diphtheria. - **Hoarseness** indicates laryngeal involvement, a severe complication of diphtheria due to pseudomembrane formation extending to the larynx, potentially causing airway obstruction. *Follicular tonsillitis* - This condition presents with **pus-filled follicles** or spots on the tonsils, which are typically yellow or white, rather than a confluent membrane. - While it causes throat pain and fever, it generally does not lead to the formation of a **firm, adherent pseudomembrane** or significant hoarseness from laryngeal obstruction as seen in diphtheria. *Aphthous ulcer* - An aphthous ulcer is a **small, painful, shallow sore** with a white or yellowish center and a red border, typically found on the non-keratinized oral mucosa. - It does not present as a widespread, thick membranous lesion covering the tonsils and causing hoarseness. *Membranous tonsillitis* - While "membranous tonsillitis" describes the presence of a membrane on the tonsils, this term is often used generally. However, the specific characteristics in the image (thick, grayish, adherent membrane with severe symptoms like hoarseness) are pathognomonic for **diphtheria**. - Other causes of membranous tonsillitis, such as infectious mononucleosis, typically present with a less adherent membrane and often lack the severe systemic toxicity and potential for rapid airway compromise seen in diphtheria.
Question 8: Killian's Dehiscence is seen at the level of:
- A. Inferior Constrictor (Correct Answer)
- B. Superior Constrictor
- C. Middle constrictor
- D. Thyroepiglottic
Explanation: ***Inferior Constrictor*** - **Killian's dehiscence** is a triangular area of weakness in the posterior pharyngeal wall, located between the **thyropharyngeal** and **cricopharyngeal** parts of the inferior constrictor muscle. - This anatomical weakness is a common site for the formation of a **Zenker's diverticulum**. *Superior Constrictor* - The superior constrictor muscle is located higher up in the pharynx and is not associated with Killian's dehiscence. - Its weakness is related to **Passavant's ridge**, which is important for speech and swallowing, not Zenker's diverticulum. *Middle constrictor* - The middle constrictor muscle is positioned between the superior and inferior constrictors, and there is no specific dehiscence named after it associated with diverticula. - Its function primarily involves constricting the pharynx during swallowing. *Thyroepiglottic* - The thyroepiglottic is a muscle of the **larynx**, not the pharynx, and it is involved in vocal fold tension and airway protection. - It does not contribute to the structure of the pharyngeal wall or the formation of Killian's dehiscence.
Question 9: 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 10: 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.
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