Diseases of the Larynx Practice Questions

Q: Pseudosulcus in the larynx is commonly associated with which of the following conditions?

Laryngopharyngeal reflux. **Explanation:** **Pseudosulcus vocalis** is a characteristic clinical finding in **Laryngopharyngeal Reflux (LPR)**. It refers to a linear groove or furrow extending along the entire length of the upper surface of the vocal fold, caused by subglottic edema and chronic inflammation. 1. **Why Laryngopharyngeal Reflux (LPR) is correct:** In LPR, gastric acid and pepsin reflux into the pharynx and larynx, causing chronic irritation. This leads to **subglottic edema** (specifically in the Reinke’s space). This swelling creates a distinct "trough" or "false groove" (pseudosulcus) on the medial edge of the vocal fold. It is considered a highly specific (though not pathognomonic) sign of LPR, often seen alongside posterior commissure hypertrophy and interarytenoid erythema. 2. **Why other options are incorrect:** * **Vocal abuse:** Typically leads to vocal nodules (Singer’s nodes), polyps, or contact ulcers, but not a longitudinal subglottic groove. * **Tuberculosis:** Laryngeal TB usually presents with "mouse-nibbled" ulcers, posterior glottic involvement, and a pale, "apple-jelly" appearance of the mucosa. * **Chronic steroid use:** This may predispose a patient to laryngeal candidiasis (moniliasis) or mucosal thinning, but does not cause the structural edema seen in pseudosulcus. **High-Yield Clinical Pearls for NEET-PG:** * **Pseudosulcus vs. Sulcus Vocalis:** *Sulcus vocalis* is a true structural defect/invagination of the epithelium into the lamina propria (often congenital), whereas *Pseudosulcus* is merely an appearance caused by subglottic edema in LPR. * **Reflux Finding Score (RFS):** Pseudosulcus is one of the key parameters used in the RFS to diagnose LPR. * **Most common site of LPR:** Posterior commissure (Interarytenoid area).

Q: Turban epiglottitis is a clinical finding in which of the following conditions?

Tubercular laryngitis. ### Explanation **Correct Option: A. Tubercular Laryngitis** Turban epiglottitis is a classic clinical sign of **secondary laryngeal tuberculosis**. In this condition, the epiglottis becomes markedly swollen and edematous due to infiltration by tuberculous granulomas and lymphatic obstruction. This uniform, pale swelling gives the epiglottis a rounded appearance resembling a **turban**. It is typically associated with active pulmonary tuberculosis, where infected sputum causes "surface infection" of the laryngeal mucosa. **Analysis of Incorrect Options:** * **B. Tubercular pharyngitis:** While TB can affect the pharynx, it usually presents as painful ulcerations (often on the tonsils or posterior wall) rather than the specific "turban" swelling of the epiglottis. * **C. Polypoid degeneration of vocal cord:** Also known as **Reinke’s edema**, this involves bilateral, diffuse swelling of the vocal folds (Reinke’s space), typically due to smoking or vocal abuse. It does not involve the epiglottis. * **D. Subglottic hemangioma:** This is a vascular malformation found below the vocal cords, presenting as inspiratory or biphasic stridor in infants. It does not produce epiglottic changes. **Clinical Pearls for NEET-PG:** * **Most common site in Laryngeal TB:** Posterior commissure (interarytenoid area). * **Classic Appearance:** "Mouse-nibbled" appearance of the vocal cords (due to ulceration). * **Symptoms:** Severe pain (odynophagia) referred to the ear via the vagus nerve (Arnold’s nerve) is a hallmark. * **Mamillated space:** The interarytenoid area often shows a "mamillated" or granular appearance. * **Treatment:** Standard Anti-Tubercular Therapy (ATT).

Q: What is the treatment of choice for T1N0M0 glottic carcinoma?

External beam radiotherapy. ### Explanation **Concept Overview:** T1N0M0 glottic carcinoma refers to a tumor limited to the vocal cords (with normal mobility) and no nodal or distant metastasis. The primary goal of treatment in early glottic cancer is **cure with preservation of voice quality.** **Why Option D is Correct:** **External Beam Radiotherapy (EBRT)** is considered the treatment of choice because it offers excellent local control rates (85-95%) while maintaining a superior post-treatment voice quality compared to traditional surgery. Since the vocal cords are not physically altered or excised, the mucosal wave is preserved, leading to a near-normal voice. **Analysis of Incorrect Options:** * **A. Surgery:** While **Transoral Laser Microsurgery (TLM)** is an equally effective alternative for T1 lesions, "Surgery" as a general term often implies cordectomy. Surgery is usually reserved for patients who cannot commit to daily radiation schedules or for recurrences. In most standard protocols, EBRT is preferred for its functional outcome. * **B. Brachytherapy:** This involves placing radioactive sources directly into the tissue. It is rarely used for glottic cancer due to the risk of cartilage necrosis and the technical difficulty of placement in the larynx. * **C. Chemotherapy:** Early-stage (T1/T2) glottic cancer is highly radiosensitive. Chemotherapy is reserved for advanced stages (T3/T4) as part of concurrent chemoradiation for organ preservation. **NEET-PG High-Yield Pearls:** * **Most common site** of laryngeal cancer: Glottis. * **Best prognosis** in laryngeal cancer: Glottic (due to sparse lymphatic drainage, leading to late metastasis). * **Earliest symptom** of glottic cancer: Hoarseness of voice. * **Treatment for T1/T2:** Radiotherapy or Laser Surgery (TLM). * **Treatment for T3/T4:** Concurrent Chemoradiotherapy or Total Laryngectomy.

Q: About laryngomalacia, all are true except?

Curled epiglottis, flaccid arytenoids. **Laryngomalacia** is the most common congenital anomaly of the larynx and the leading cause of congenital stridor. It is characterized by an inward collapse of the supraglottic structures during inspiration. ### **Explanation of Options** * **Why Option A is the Correct Answer (The "Except"):** While the epiglottis is indeed curled (Omega-shaped), the primary pathology involves the **aryepiglottic folds**, which are characteristically short and flaccid, causing them to collapse inward. While the arytenoids may appear prominent or "fleshy," the classic description focuses on the shortening and flaccidity of the **aryepiglottic folds** rather than the arytenoids themselves in isolation. Therefore, Option A is the least accurate description compared to the standard clinical definition. * **Option B & C (True Statements):** These describe the classic pathophysiology. The supraglottic larynx is flaccid (C), and the epiglottis is typically elongated and curled upon itself (**Omega-shaped epiglottis**) with shortened, flaccid aryepiglottic folds (B). * **Option D (True Statement):** In approximately 90% of cases, the condition is self-limiting and resolves by 18–24 months of age. Therefore, **conservative management** (observation and reflux control) is the mainstay of treatment. ### **NEET-PG High-Yield Pearls** * **Clinical Presentation:** Inspiratory stridor that increases with crying, feeding, or lying supine; improves when prone. * **Diagnosis:** Flexible fiberoptic laryngoscopy (Gold Standard) showing inward collapse of supraglottic structures. * **Surgical Management:** Indicated only in severe cases (failure to thrive, cor pulmonale, sleep apnea). The procedure of choice is **Supraglottoplasty**. * **Associated Condition:** Gastroesophageal reflux disease (GERD) is frequently present and exacerbates symptoms.

Q: What is the narrowest part of an infant's larynx?

Subglottic. **Explanation:** The larynx undergoes significant anatomical changes during development. In **infants and children (under age 8-10)**, the larynx is funnel-shaped, making the **Subglottic region** (at the level of the cricoid cartilage) the narrowest part. **1. Why Subglottic is Correct:** The cricoid cartilage is the only complete cartilaginous ring in the airway. In infants, this ring is relatively small and rigid. While the vocal cords (glottis) can abduct to widen the airway, the cricoid ring is non-distensible. Therefore, any mucosal edema in this region (as seen in Croup/Laryngotracheobronchitis) significantly compromises the airway, leading to stridor. **2. Why other options are incorrect:** * **Glottic (Option C):** This is the narrowest part of the **adult** larynx. In adults, the larynx is more cylindrical, and the space between the vocal cords (Rima Glottidis) is the most constricted point. * **Supraglottic (Option A):** This area is wider and more distensible than the subglottis. While it can be affected by epiglottitis, it is not the anatomical narrowest point. **Clinical Pearls for NEET-PG:** * **Shape:** Infant larynx is **funnel-shaped**; Adult larynx is **cylindrical**. * **Position:** The infant larynx is higher (at the level of **C3-C4**) compared to the adult larynx (**C4-C6**). * **Poiseuille’s Law:** Because the subglottis is the narrowest point, 1 mm of edema reduces the cross-sectional area by over 50% in infants, explaining why pediatric airway emergencies escalate rapidly. * **Endotracheal Intubation:** Due to the narrow subglottis, **uncuffed tubes** were traditionally preferred in infants to prevent pressure necrosis (though modern practice uses specialized cuffed tubes).

Q: Omega shaped epiglottis is seen in which of the following conditions?

Laryngomalacia. **Explanation:** **Laryngomalacia** is the most common congenital anomaly of the larynx and the most frequent cause of congenital stridor in infants. It is characterized by an inward collapse of the supraglottic structures during inspiration due to abnormal flaccidity of the laryngeal tissues. The hallmark endoscopic finding is an **"Omega-shaped" (Ω) epiglottis**, caused by the lateral folds of the epiglottis curling inwards. Other characteristic findings include elongated aryepiglottic folds and bulky arytenoids that prolapse into the airway. **Analysis of Incorrect Options:** * **Acute Epiglottitis:** This is a bacterial infection (usually *H. influenzae*) characterized by a "cherry-red," swollen epiglottis. On X-ray, it presents with the **"Thumb sign."** * **Croup (Laryngotracheobronchitis):** A viral infection causing subglottic narrowing. It is classically associated with the **"Steeple sign"** (pencil-tip sign) on an AP view X-ray of the neck. * **Bronchiolitis:** This is a lower respiratory tract infection (commonly RSV) affecting the small airways (bronchioles) in infants, presenting with wheezing and respiratory distress rather than laryngeal structural changes. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Inspiratory stridor that increases with crying, feeding, or lying supine, and improves when the infant is prone. * **Diagnosis:** Flexible fiberoptic laryngoscopy is the gold standard. * **Management:** Most cases (90%) are self-limiting and resolve by 18–24 months. Severe cases with failure to thrive or cyanosis require **Supraglottoplasty**. * **Key Association:** Frequently associated with Gastroesophageal Reflux Disease (GERD).

Q: What is the most common cause of acute laryngotracheal bronchitis?

Parainfluenza virus. **Explanation:** **Acute Laryngotracheobronchitis (LTB)**, commonly known as **Croup**, is a viral infection characterized by inflammation and narrowing of the subglottic airway. 1. **Why Parainfluenza virus is correct:** The **Parainfluenza virus (Type 1 and 2)** is the most common causative agent, accounting for nearly 75% of all cases. It typically affects children between 6 months and 3 years of age. The virus causes subglottic edema, leading to the classic clinical triad of **barking cough, inspiratory stridor, and hoarseness.** 2. **Why other options are incorrect:** * **Haemophilus influenzae:** This is the primary cause of **Acute Epiglottitis**, not LTB. Epiglottitis is a medical emergency involving the supraglottic structures and is characterized by the "thumb sign" on X-ray. * **Influenza virus:** While it can cause respiratory infections and occasionally severe croup, it is less common than Parainfluenza. * **Coxsackievirus:** This is typically associated with Herpangina or Hand-Foot-and-Mouth disease, not primary laryngeal infections. **High-Yield Clinical Pearls for NEET-PG:** * **Radiological Sign:** The characteristic X-ray finding in Croup is the **"Steeple Sign"** (subglottic narrowing) on an AP view of the neck. * **Management:** Mild cases are managed with hydration and humidity. Severe cases require **nebulized adrenaline** (to reduce edema) and **corticosteroids** (Dexamethasone). * **Seasonality:** It most commonly occurs in late autumn and winter. * **Differential:** Always differentiate from Epiglottitis (high fever, drooling, sitting in tripod position) and Foreign Body Aspiration.

Q: Which of the following is a symptom of sudden onset bilateral vocal cord palsy?

Dyspnea & Stridor. In bilateral vocal cord palsy (specifically abductor paralysis), both vocal cords assume a **median or paramedian position**. Because the cords cannot move outward (abduct), the glottic airway is severely narrowed. ### Why "Dyspnea & Stridor" is Correct In **sudden onset** bilateral palsy, the patient experiences acute respiratory distress because the airway is almost completely obstructed. **Inspiratory stridor** occurs due to the Bernoulli effect, where the rapid flow of air through the narrow glottis sucks the cords even closer together. This is a medical emergency often requiring an urgent tracheostomy. ### Explanation of Incorrect Options * **B. Hoarseness of voice:** This is the hallmark of **unilateral** vocal cord palsy. In bilateral palsy, the cords are fixed near the midline; therefore, they can still vibrate against each other, often resulting in a **near-normal voice** despite the life-threatening airway obstruction. * **C. Asymptomatic:** While chronic, gradual bilateral palsy may allow for some compensation, "sudden onset" is never asymptomatic due to the immediate loss of the airway. * **D. Bovine cough:** This is a non-explosive cough characteristic of **unilateral** vocal cord palsy (specifically involving the Vagus nerve or recurrent laryngeal nerve), where the inability to close the glottis prevents the buildup of subglottic pressure. ### High-Yield Clinical Pearls for NEET-PG * **Most common cause:** Thyroid surgery (injury to bilateral Recurrent Laryngeal Nerves). * **Position of cords:** In bilateral abductor paralysis, cords lie in the **median/paramedian** position. * **The Paradox:** The better the voice, the worse the airway (and vice versa). * **Management:** Acute phase requires **Tracheostomy**; chronic phase may involve **Kashima’s procedure** (Laser posterior cordectomy) or Woodman’s medialization.

Q: High tracheostomy is indicated in which of the following conditions?

Carcinoma. **Explanation:** Tracheostomy is classified based on its relation to the thyroid isthmus: **High** (above the isthmus/1st ring), **Mid** (behind the isthmus/2nd-3rd rings), and **Low** (below the isthmus/4th-5th rings). **Why Carcinoma is the correct answer:** In cases of **Carcinoma of the Larynx**, a high tracheostomy is specifically indicated as a preliminary step before a **Total Laryngectomy**. Since the entire larynx, including the upper tracheal rings, will be surgically removed during the definitive procedure, the long-term complications of high tracheostomy (like subglottic stenosis) are irrelevant. It provides a secure airway and easy access for the subsequent radical surgery. **Analysis of Incorrect Options:** * **Tuberculosis (Laryngeal):** Tracheostomy is generally avoided in active TB due to the risk of spreading infection to the stoma (lupoid reaction). If mandatory, a **Mid-tracheostomy** is preferred to avoid proximity to the infected larynx. * **Tetanus & Diphtheria:** These conditions require prolonged ventilation or airway protection. A **Mid-tracheostomy** is the standard choice here. High tracheostomy is strictly contraindicated in these inflammatory/infectious conditions because pressure from the tube against the cricoid cartilage leads to **perichondritis and subglottic stenosis**, which is extremely difficult to treat. **NEET-PG High-Yield Pearls:** * **Standard Procedure:** Mid-tracheostomy (2nd and 3rd rings) is the most common and preferred site. * **Emergency Airway:** Cricothyroidotomy is the procedure of choice for the fastest emergency access. * **High Tracheostomy Danger:** It is generally avoided because the cricoid is the only complete cartilaginous ring; damage here leads to permanent laryngeal narrowing. * **Low Tracheostomy:** Preferred in children (to avoid the high subglottis) or for mediastinal access, but carries a risk of injury to the innominate artery.

Q: Kiss ulcer of larynx is due to:

Vocal abuse. **Explanation:** The term **"Kiss Ulcer"** in the larynx refers to a specific stage in the development of **Vocal Nodules**, which are primarily caused by **vocal abuse** (chronic voice misuse or overuse). 1. **Mechanism (Why A is correct):** Continuous vocal abuse leads to mechanical trauma at the junction of the anterior 1/3rd and posterior 2/3rd of the vocal folds (the point of maximum vibration). Initially, this causes localized edema and hemorrhage. If the trauma continues, a small breach or "ulcer" may form on one cord. Due to the constant contact during phonation, a reactive inflammatory lesion or "kissing" ulcer/nodule develops on the exactly opposite point of the contralateral vocal fold. This symmetrical presentation is the hallmark of vocal abuse. 2. **Why other options are incorrect:** * **B. Papilloma:** These are benign epithelial tumors caused by HPV (6 and 11). They present as wart-like, exophytic growths, not as symmetrical ulcers. * **C. Vocal Nodule:** While a kiss ulcer *leads* to a vocal nodule, the underlying **etiology** requested by the question is the behavior (vocal abuse). In many contexts, "Kissing Nodules" is a synonym for bilateral vocal nodules, but the primary cause remains abuse. * **D. Tuberculosis:** Laryngeal TB typically presents as a "mouse-nibbled" appearance of the vocal cords or interarytenoid pachydermia. It is usually secondary to pulmonary TB and does not follow the "kissing" pattern of mechanical trauma. **Clinical Pearls for NEET-PG:** * **Site:** Junction of anterior 1/3 and posterior 2/3 of the vocal cords. * **Synonyms:** Singer’s nodules, Teacher’s nodules, Screamer’s nodules. * **Treatment:** Conservative management (Voice rest and Speech therapy) is the first line. Surgery (Microlaryngeal surgery) is reserved for large, fibrosed nodules.

Question 1

Pseudosulcus in the larynx is commonly associated with which of the following conditions?

Accepted Answer

Laryngopharyngeal reflux

Answer

Vocal abuse

Answer

Tuberculosis

Answer

Chronic steroid use

Question 2

Turban epiglottitis is a clinical finding in which of the following conditions?

Accepted Answer

Tubercular laryngitis

Answer

Tubercular pharyngitis

Answer

Polypoid degeneration of vocal cord

Answer

Subglottic hemangioma

Question 3

What is the treatment of choice for T1N0M0 glottic carcinoma?

Accepted Answer

External beam radiotherapy

Answer

Surgery

Answer

Brachytherapy

Answer

Chemotherapy

Question 4

About laryngomalacia, all are true except?

Accepted Answer

Curled epiglottis, flaccid arytenoids

Answer

Curled epiglottis, flaccid aryepiglottic fold

Answer

Flaccidity of the supraglottic larynx

Answer

Treatment is conservative

Question 5

What is the narrowest part of an infant's larynx?

Accepted Answer

Subglottic

Answer

Supraglottic

Answer

Glottic

Answer

None of the above

Question 6

Omega shaped epiglottis is seen in which of the following conditions?

Accepted Answer

Laryngomalacia

Answer

Acute epiglottitis

Answer

Croup

Answer

Bronchiolitis

Question 7

What is the most common cause of acute laryngotracheal bronchitis?

Accepted Answer

Parainfluenza virus

Answer

Haemophilus influenzae

Answer

Influenza virus

Answer

Coxsackievirus

Question 8

Which of the following is a symptom of sudden onset bilateral vocal cord palsy?

Accepted Answer

Dyspnea & Stridor

Answer

Hoarseness of voice

Answer

Asymptomatic

Answer

Bovine cough

Question 9

High tracheostomy is indicated in which of the following conditions?

Accepted Answer

Carcinoma

Answer

Tuberculosis

Answer

Tetanus

Answer

Diphtheria

Question 10

Kiss ulcer of larynx is due to:

Accepted Answer

Vocal abuse

Answer

Papilloma

Answer

Vocal nodule

Answer

Tuberculosis

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

On this page

Practice by Chapter

Want unlimited practice?