Diseases of the Larynx Practice Questions

Q: What is the most common site in the larynx for sarcoidosis?

Epiglottis. **Explanation:** Laryngeal sarcoidosis is a rare manifestation of systemic sarcoidosis, occurring in approximately 1–5% of cases. It is characterized by the formation of non-caseating granulomas in the laryngeal tissues. **Why Epiglottis is the Correct Answer:** The disease has a strong predilection for the **supraglottic larynx** because of its rich lymphatic network. Within the supraglottis, the **epiglottis** is the most frequently involved site. On examination, it typically appears thickened, pale, and edematous (often described as "turban-shaped"), which can lead to symptoms like globus sensation, dysphagia, or airway obstruction. **Analysis of Incorrect Options:** * **Vocal Cords (Glottis):** Involvement of the true vocal cords is extremely rare. Sarcoidosis primarily affects the "loose" mucosa of the supraglottis rather than the tightly bound squamous epithelium of the vocal folds. * **Cartilage:** While sarcoidosis can affect various connective tissues, it is primarily a mucosal and submucosal disease in the larynx. It does not typically originate in or primarily target the laryngeal cartilages. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Epiglottis (Supraglottis). * **Classic Appearance:** Pale, edematous, "turban-like" epiglottis. * **Presenting Symptom:** Most patients are asymptomatic, but the most common symptom is hoarseness or inspiratory stridor if the airway is narrowed. * **Diagnosis:** Definitive diagnosis requires a biopsy showing **non-caseating granulomas** and exclusion of other causes like tuberculosis (which usually involves the posterior larynx). * **Treatment:** Systemic or intralesional corticosteroids are the mainstay of management.

Q: What is the approximate width of the glottic chink in the cadaveric position of the vocal cords?

7 mm. ### Explanation The **glottic chink** (rima glottidis) refers to the space between the vocal cords. Its width varies significantly depending on the position of the vocal cords, which is determined by the intrinsic muscles of the larynx and their nerve supply. **Why 7 mm is correct:** The **cadaveric position** is the neutral position assumed by the vocal cords after death or complete paralysis of all laryngeal muscles (total lesion of both Recurrent Laryngeal Nerve and Superior Laryngeal Nerve). In this state, the vocal cords lie midway between the midline and the abducted position. The width of the glottic chink in this position is approximately **7 mm**. **Analysis of Incorrect Options:** * **A & B (3 mm / 3.5 mm):** These values are too narrow for the cadaveric position. A width of approximately **3.5 mm** is seen in the **paramedian position**, which occurs in isolated Recurrent Laryngeal Nerve (RLN) palsy (where the cricothyroid muscle, supplied by the Superior Laryngeal Nerve, remains intact and adducts the cord). * **D (19 mm):** This is far too wide. In **full abduction** (forced inspiration), the glottic chink reaches its maximum width, which is approximately **13–14 mm** in males. 19 mm exceeds the anatomical limits of the adult glottis. **High-Yield Clinical Pearls for NEET-PG:** * **Median Position:** 0 mm (Vocal cords meet in the midline; seen during phonation). * **Paramedian Position:** 3.5 mm (Seen in isolated RLN palsy). * **Cadaveric Position:** 7 mm (Seen in combined RLN and SLN palsy). * **Quiet Respiration:** 13.5 mm (Intermediate position). * **Full Abduction:** 18–19 mm (Total width including the posterior cartilaginous glottis; however, the membranous chink is ~13-14 mm). * **Semon’s Law:** States that in progressive organic lesions of the RLN, the abductor fibers (Posterior Cricoarytenoid) are paralyzed before the adductor fibers.

Q: A 4-year-old child presents with a history of hoarseness, croupy cough, and aphonia. The child has dyspnea with wheezing. What is the most probable diagnosis?

Laryngeal foreign body. ### Explanation The clinical presentation of **hoarseness, croupy cough, and aphonia** (loss of voice) specifically points toward a pathology localized in the **larynx**. **1. Why Laryngeal Foreign Body (FB) is correct:** A foreign body lodged in the larynx typically presents with a sudden onset of the "triad" of symptoms: **hoarseness/aphonia, croupy cough, and inspiratory stridor**. While wheezing is more common in bronchial foreign bodies, a laryngeal FB can cause generalized respiratory distress and transmitted sounds (wheezing/stridor) due to upper airway obstruction. The presence of **aphonia** is a hallmark sign that the vocal cords are being physically obstructed or irritated, which is highly characteristic of a laryngeal FB in a toddler. **2. Why other options are incorrect:** * **Asthmatic bronchitis:** Typically presents with recurrent wheezing and productive cough, but it does **not** cause aphonia or a croupy cough. * **Bronchopneumonia:** Characterized by high-grade fever, tachypnea, and crepitations. It involves the lower respiratory tract and does not affect the voice (no aphonia). * **Retropharyngeal abscess:** Presents with fever, drooling, muffled "hot potato" voice, and neck stiffness. It causes difficulty swallowing (dysphagia) rather than aphonia or a croupy cough. **3. NEET-PG High-Yield Pearls:** * **Most common site for FB aspiration:** Right main bronchus (due to it being wider, shorter, and more vertical). * **Most common site for FB causing Aphonia:** Larynx. * **Gold Standard Investigation:** Rigid Bronchoscopy (both diagnostic and therapeutic). * **Radiology:** Most FBs are radiolucent (e.g., peanuts); look for indirect signs like obstructive emphysema or air trapping on expiratory films.

Question 1

Which laryngeal condition can present with hoarseness and stridor?

Accepted Answer

Neither unilateral nor bilateral vocal cord abductor paralysis

Answer

Unilateral vocal cord abductor paralysis

Answer

Bilateral vocal cord abductor paralysis

Answer

Both unilateral and bilateral vocal cord abductor paralysis

Question 2

What is the most common site in the larynx for sarcoidosis?

Accepted Answer

Epiglottis

Answer

Vocal cord

Answer

Cartilage

Answer

None of the above

Question 3

What is the gold standard treatment for intractable aspiration in a patient with an incompetent larynx due to complete laryngeal paralysis?

Accepted Answer

Tracheal division and permanent tracheostoma

Answer

Type I Thyroplasty

Answer

Tracheostomy

Answer

Feeding jejunostomy

Question 4

Which of the following is FALSE regarding unilateral Recurrent Laryngeal Nerve palsy?

Accepted Answer

Difficulty in breathing

Answer

Has normal speech

Answer

No risk of aspiration

Answer

Conservative management

Question 5

Which of the following statements about papilloma is incorrect?

Accepted Answer

Solitary papilloma is more aggressive, has a poor prognosis, and malignant transformation is common.

Answer

Solitary papilloma is more common in adults, and the most common presentation is a change in voice.

Answer

Multiple papilloma is more common in children, and the most common presentation is a hoarse cry.

Answer

Early treatment leads to better results in multiple papilloma.

Question 6

Which of the following are features of laryngeal carcinoma?

Accepted Answer

Laryngeal compartments act as a barrier

Answer

Glottis is the most common site

Answer

Commonly metastasizes to cervical lymph nodes

Answer

Lesions are seen at the edge of the vocal cord

Question 7

What is the treatment of choice for laryngeal carcinoma of the glottis extending to the supraglottic region with vocal cord fixation and a palpable solitary ipsilateral lymph node?

Accepted Answer

Total laryngectomy with radical neck dissection

Answer

Conservative laryngectomy

Answer

Total laryngectomy

Answer

Palliative therapy

Question 8

What is the approximate width of the glottic chink in the cadaveric position of the vocal cords?

Accepted Answer

7 mm

Answer

3 mm

Answer

3.5 mm

Answer

19 mm

Question 9

A 4-year-old child presents with a history of hoarseness, croupy cough, and aphonia. The child has dyspnea with wheezing. What is the most probable diagnosis?

Accepted Answer

Laryngeal foreign body

Answer

Asthmatic bronchitis

Answer

Bronchopneumonia

Answer

Retropharyngeal abscess

Question 10

Cricothyrotomy is converted to tracheostomy:

Accepted Answer

To avoid subglottic stenosis

Answer

To avoid hypoxia

Answer

To facilitate oxygenation

Answer

Easy consumption of food

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

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