Diseases of the Larynx Practice Questions

Q: A patient presents with a hoarse voice and cough for two weeks. Laryngoscopy reveals inflammation of the vocal cords. What is the most likely diagnosis?

Laryngitis. ***Correct: Laryngitis*** - The symptoms of a **hoarse voice** and **cough** for two weeks, coupled with **inflammation of the vocal cords** on laryngoscopy, are classic for laryngitis. - This condition is typically caused by viral infections, vocal cord overuse, or irritants, leading to swelling of the vocal cords. *Incorrect: Vocal cord paralysis* - While it causes **hoarseness**, **vocal cord paralysis** would present as a lack of movement or immobility of one or both vocal cords on laryngoscopy, not primarily inflammation. - It often results from nerve damage, surgery, or underlying neurological conditions, which are not suggested here. *Incorrect: Vocal cord nodules* - **Vocal cord nodules** (often called "singer's nodes") are bilateral, symmetrical lesions that develop on the vocal cords due to chronic voice abuse. - While they cause hoarseness, laryngoscopy would reveal distinct **nodular growths**, not general inflammation. *Incorrect: Reinke's edema* - **Reinke's edema** is characterized by diffuse gelatinous swelling of the superficial lamina propria of the vocal folds, usually associated with **chronic smoking**. - While it causes hoarseness, the laryngoscopic appearance would be a characteristic **edematous, fluid-filled appearance**, not simply inflammation.

Q: A patient presents with hoarseness and laryngoscopy reveals a warty, cauliflower-like growth on the vocal cord. Identify the most likely lesion.

Laryngeal papilloma. ***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.

Q: Which of the following statements about laryngeal cancer is correct?

Glottic cancer is the most common type of laryngeal cancer.. ***Glottic cancer is the most common type of laryngeal cancer.*** - **Glottic carcinomas** (involving the true vocal cords) account for roughly **60%** of all laryngeal cancers, making them the most prevalent subtype. - Early symptoms like **hoarseness** lead to earlier detection and better prognosis compared to other sites. *Subglottic cancer is the most common type of laryngeal cancer.* - **Subglottic cancers** (below the true vocal cords) are actually the **rarest** type, accounting for only **1-2%** of laryngeal cancers. - They often present at an advanced stage and have the **poorest prognosis** among all laryngeal subsites. *Supraglottic cancer has the best prognosis.* - **Supraglottic cancers** (involving the epiglottis, false vocal cords) tend to present at a **later stage** due to vague initial symptoms (e.g., throat discomfort, muffled voice), leading to a poorer prognosis than glottic cancer. - They also have a **richer lymphatic supply**, increasing the likelihood of early nodal metastasis. *Lymphatic spread is most common in subglottic cancer.* - While **subglottic cancers** can metastasize, **supraglottic cancers** generally have a higher incidence of lymphatic spread due to their more extensive lymphatic drainage network. - The true vocal cords (glottis) have sparse lymphatic drainage, while the supraglottis has rich bilateral lymphatic networks.

Q: Inspiratory stridor is found in what kind of lesions:

Supraglottic. ***Supraglottic*** - Lesions in the **supraglottic** region (e.g., epiglottitis, supraglottic foreign body) cause inspiratory stridor due to the collapse of soft tissues above the vocal cords during inspiration. - The narrowed airway during inspiration creates a high-pitched, harsh sound. *Subglottic* - **Subglottic** lesions typically cause a **biphasic stridor**, meaning stridor is present during both inspiration and expiration. - This is because the subglottis is a rigid area; narrowing at this level causes turbulent airflow during both phases of breathing. *Tracheal* - **Tracheal** lesions can produce **biphasic stridor** if they are in the cervical trachea due to fixed airway narrowing. - If the lesion is in the lower, intrathoracic trachea, it might primarily cause **expiratory stridor** or a biphasic stridor depending on the degree of narrowing and its fixity. *Bronchus* - Lesions in the **bronchus** (e.g., foreign body, tumor) typically lead to **expiratory stridor** or wheezing. - Airway narrowing at this level causes air trapping and turbulent flow predominantly during exhalation when the bronchial walls naturally constrict.

Q: Which part of the larynx is most commonly involved in tuberculosis (TB)?

Posterior. ***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.

Q: Laryngitis sicca is associated with ?

Klebsiella rhinoscleromatosis. ***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.

Q: Moure's sign (lateral displacement of the soft palate) is associated with which of the following conditions?

Peritonsillar abscess. ***Peritonsillar abscess (Quinsy)*** - **Moure's sign** refers to the **lateral displacement of the soft palate** toward the affected side, which is a classic finding in **peritonsillar abscess**. - This occurs due to the **accumulation of pus** between the tonsillar capsule and the superior constrictor muscle, causing the soft palate to bulge and deviate. - Other features include **severe throat pain**, trismus, drooling, and a "hot potato" voice. *Laryngeal carcinoma* - **Laryngeal carcinoma** presents with **hoarseness**, dysphagia, and potential airway obstruction. - While laryngeal examination may show mass lesions or vocal cord fixation, **soft palate displacement is not a feature** of laryngeal malignancy. *Chronic tonsillitis* - **Chronic tonsillitis** involves recurrent throat infections with tonsillar hypertrophy and cryptic debris. - It does **not cause acute soft palate displacement** like peritonsillar abscess does. *Acute epiglottitis* - **Acute epiglottitis** is characterized by **supraglottic inflammation** causing severe dysphagia, drooling, and stridor. - The pathology is at the **epiglottis level**, not the peritonsillar space, so **Moure's sign is absent**.

Q: Which of the following statements about Laryngomalacia is false?

Stridor disappears when the infant is in a supine position.. ***Stridor disappears when the infant is in a supine position.*** - In laryngomalacia, the **omega-shaped epiglottis** and redundant supraglottic tissues **prolapse into the airway** upon inspiration. - The stridor typically **worsens** when the infant is in a **supine position** or crying, as gravity causes further collapse of the airways. *It is the most common congenital anomaly of the larynx.* - **Laryngomalacia** is indeed the **most frequent congenital cause of stridor** in infants. - It results from the **immaturity of the laryngeal cartilages**, leading to their collapse during inspiration. *Symptoms typically manifest many weeks after birth.* - Symptoms of laryngomalacia usually appear in the first few weeks of life, typically around **2-4 weeks post-birth**, and rarely at birth. - This delay is often due to the time it takes for the infant's respiratory efforts to become more vigorous. *Most cases do not require treatment.* - The majority of infants with laryngomalacia have **mild symptoms** that **resolve spontaneously** as the larynx matures, usually by 12 to 18 months of age. - Only a small percentage of severe cases require surgical intervention, such as a **supraglottoplasty**.

Question 1

A patient presents with a hoarse voice and cough for two weeks. Laryngoscopy reveals inflammation of the vocal cords. What is the most likely diagnosis?

Accepted Answer

Laryngitis

Answer

Vocal cord paralysis

Answer

Vocal cord nodules

Answer

Reinke's edema

Question 2

A patient presents with hoarseness and laryngoscopy reveals a warty, cauliflower-like growth on the vocal cord. Identify the most likely lesion.

Accepted Answer

Laryngeal papilloma

Answer

Laryngeal malignancy

Answer

Tracheomalacia

Answer

Reinke’s edema

Question 3

Which of the following statements about laryngeal cancer is correct?

Accepted Answer

Glottic cancer is the most common type of laryngeal cancer.

Answer

Supraglottic cancer has the best prognosis.

Answer

Lymphatic spread is most common in subglottic cancer.

Answer

Subglottic cancer is the most common type of laryngeal cancer.

Question 4

Inspiratory stridor is found in what kind of lesions:

Accepted Answer

Supraglottic

Answer

Subglottic

Answer

Tracheal

Answer

Bronchus

Question 5

Hot potato voice is characteristic of ?

Accepted Answer

Supraglottic carcinoma

Answer

Nasopharyngeal carcinoma

Answer

Glottic carcinoma

Answer

Subglottic carcinoma

Question 6

Which part of the larynx is most commonly involved in tuberculosis (TB)?

Accepted Answer

Posterior

Answer

Answer

Middle

Answer

Anywhere

Question 7

Which of the following statements about laryngeal tuberculosis (TB) is true?

Accepted Answer

It presents with a mouse-nibbled appearance of the vocal cord.

Answer

It commonly involves the posterior 1/3 of the vocal cord.

Answer

It is more common in females.

Answer

It is a common form of tuberculosis.

Question 8

Laryngitis sicca is associated with ?

Accepted Answer

Klebsiella rhinoscleromatosis

Answer

Rhinosporidium

Answer

M. leprae

Answer

Klebsiella ozaenae

Question 9

Moure's sign (lateral displacement of the soft palate) is associated with which of the following conditions?

Accepted Answer

Peritonsillar abscess

Answer

Laryngeal carcinoma

Answer

Chronic tonsillitis

Answer

Acute epiglottitis

Question 10

Which of the following statements about Laryngomalacia is false?

Accepted Answer

Stridor disappears when the infant is in a supine position.

Answer

It is the most common congenital anomaly of the larynx.

Answer

Symptoms typically manifest many weeks after birth.

Answer

Most cases do not require treatment.

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

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