Diseases of the Larynx Practice Questions

Q: A patient with a long-standing habit of smoking presents with hoarseness of voice. Which nerve is most likely to be affected?

Recurrent laryngeal nerve. ***Recurrent laryngeal nerve*** - **Hoarseness of voice** is the most common symptom of **recurrent laryngeal nerve (RLN) palsy**, as this nerve innervates most of the intrinsic muscles of the larynx responsible for vocal cord movement. - In a long-standing smoker, **lung cancer** (especially tumors in the apex of the lung या mediastinum) or metastatic disease can compress or invade the RLN, particularly on the **left side** due to its longer intrathoracic course [1]. *Vagus nerve* - The recurrent laryngeal nerve is a **branch of the vagus nerve (CN X)**; however, direct **vagus nerve** compression would also result in other symptoms such as dysphagia, dysarthria, or cardiac arrhythmias, which are not mentioned here. - While damage to the vagus nerve can lead to hoarseness, the **recurrent laryngeal nerve** is the more specific and direct cause of isolated hoarseness. *Phrenic nerve (controls diaphragm movement)* - The **phrenic nerve** primarily innervates the **diaphragm**, controlling its movement for respiration. - Damage to the phrenic nerve would cause **diaphragmatic paralysis** and **respiratory difficulties**, not hoarseness. *Hypoglossal nerve (innervates tongue muscles)* - The **hypoglossal nerve (CN XII)** controls the **movements of the tongue**. - Dysfunction of this nerve would lead to **dysarthria** (difficulty with speech articulation) and **tongue deviation or atrophy**, but not hoarseness.

Q: Inspiratory stridor is typically associated with which type of airway lesion?

Supraglottic lesions. ***Supraglottic lesions*** - **Inspiratory stridor** occurs due to turbulent airflow during inspiration, which is characteristic of **supraglottic obstruction** as the negative pressure during inspiration causes collapse of the lax tissues above the vocal cords [1]. - Common causes include **laryngomalacia**, epiglottitis, and foreign body aspiration in the pharynx or larynx above the vocal cords [1]. *Subglottic lesions* - **Subglottic lesions** typically cause **biphasic stridor** or expiratory stridor, as obstruction below the vocal cords affects both inspiratory and expiratory airflow. - Examples include **subglottic stenosis** or croup, where turbulent airflow occurs in both phases of respiration. *Tracheal lesions* - **Tracheal lesions** often lead to **biphasic inspiratory and expiratory stridor**, as the trachea is a rigid structure and obstruction affects airflow in both directions [1]. - Conditions like **tracheal stenosis** or tumors in the trachea cause constant airway narrowing [1]. *Bronchial lesions* - **Bronchial lesions** are more likely to cause **expiratory wheezing** or stridor, particularly if they are distal to the trachea. - Obstruction in the bronchi leads to air trapping and restricted outflow during expiration, producing a high-pitched whistling sound.

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 sites of Ca larynx has the best prognosis?

Glottic. ***Glottic*** - **Glottic carcinomas** tend to have the best prognosis among laryngeal cancers because they present early with symptoms like **hoarseness of voice**, leading to earlier detection. - The **vocal cords** lack extensive lymphatic drainage, which delays metastatic spread compared to other laryngeal subsites. *Supraglottis* - **Supraglottic carcinomas** often present at an advanced stage because early symptoms are vague or absent. - This region has a **rich lymphatic network**, leading to a higher incidence of regional lymph node metastases and a poorer prognosis compared to glottic tumors. *Subglottis* - **Subglottic carcinomas** are very rare and often present at an advanced stage due to the late onset of symptoms. - They also have a **higher likelihood of early distant metastasis** and regional lymph node involvement, contributing to a worse prognosis. *All have poor prognosis* - This statement is incorrect because there is a significant difference in prognosis among the various laryngeal subsites. - While laryngeal cancer can be serious, the **glottic region** generally has a much better prognosis due to early detection and limited lymphatic spread relative to supraglottic and subglottic cancers.

Q: Which of the following statements about Laryngeal carcinoma is false?

More common in females. ***More common in females*** - This statement is **false** because laryngeal carcinoma is significantly **more common in males** than in females, with a male-to-female ratio of about 4:1. - The higher incidence in males is primarily attributed to higher rates of **smoking and alcohol consumption**, which are major risk factors. *After laryngectomy, esophageal voice can be used* - This statement is **true**; an **esophageal voice** is one method of voice rehabilitation after a total laryngectomy, where air is swallowed and then expelled to vibrate the pharyngoesophageal segment. - Other options for voice restoration include **tracheoesophageal puncture (TEP) with a voice prosthesis** and **electrolarynx**. *Smoking is the most important risk factor* - This statement is **true**; **smoking** is the single most significant modifiable risk factor for laryngeal carcinoma, increasing the risk by many-fold depending on duration and intensity. - **Alcohol consumption** acts synergistically with smoking to further elevate the risk. *Common in patients over 40 years of age* - This statement is **true**; laryngeal carcinoma predominantly affects individuals in **middle to older age groups**, with peak incidence typically occurring between 50 and 70 years. - The disease is rare in individuals under 40, although incidence in younger patients may be increasing due to rising **HPV-related oropharyngeal cancers**.

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: Membrane incised during hemilaryngectomy is

Thyrohyoid membrane. ***Thyrohyoid membrane*** - During a **hemilaryngectomy**, the **thyrohyoid membrane** is typically incised to allow access to the laryngeal structures for tumor resection. - This membrane connects the **thyroid cartilage** to the hyoid bone, and its incision facilitates surgical manipulation of the larynx. *Cricothyroid membrane* - The **cricothyroid membrane** is located between the **cricoid** and **thyroid cartilages** and is primarily used for emergency airway access (cricothyrotomy), not for routine hemilaryngectomy. - Incising this membrane would provide inadequate surgical access for a hemilaryngectomy and is not the primary target for this procedure. *Aryepiglottic fold* - The **aryepiglottic fold** forms the lateral boundary of the laryngeal inlet and contains the **aryepiglottic muscle**. - While it is a key structure in the larynx, it is part of the laryngeal framework and is not a membrane that is typically incised to gain surgical access during a hemilaryngectomy. *Infralaryngeal space* - The **infralaryngeal space** refers to the region below the larynx, primarily the trachea. - This is not a membrane; instead, it is an anatomical region, and incising it would not provide direct access to the laryngeal structures for tumor removal in a hemilaryngectomy.

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: Identify the lesion of the vocal cord.

Laryngeal papilloma. ***Laryngeal papilloma*** - Characterized by **wart-like lesions** on the vocal cords, often caused by **HPV infection**. - Can lead to **hoarseness** and **breathing difficulties** due to obstruction. *Reinke’s edema* - Presents as **swelling of the vocal cords**, primarily due to **chronic irritation** or **smoking**, rather than discrete lesions. - Symptoms include a **lowered pitch** and a **breathy quality** to the voice, not typically associated with discrete growths. *Malignancy of the vocal cords* - Usually presents with **persistent hoarseness**, sometimes with **difficulty breathing** or **pain**, but does not describe discrete lesions. - Often involves **abnormal masses** but is differentiated from benign lesions like papillomas by other signs such as **weight loss** or **hemoptysis**. *Tracheomalacia* - Refers to **weakness** of the tracheal walls leading to **collapse**, unrelated to vocal cord lesions. - Symptoms include **stridor** and **wheezing**, indicating airway obstruction rather than vocal cord pathology.

Question 1

A patient with a long-standing habit of smoking presents with hoarseness of voice. Which nerve is most likely to be affected?

Accepted Answer

Recurrent laryngeal nerve

Answer

Vagus nerve

Answer

Phrenic nerve (controls diaphragm movement)

Answer

Hypoglossal nerve (innervates tongue muscles)

Question 2

Inspiratory stridor is typically associated with which type of airway lesion?

Accepted Answer

Supraglottic lesions

Answer

Subglottic lesions

Answer

Tracheal lesions

Answer

Bronchial lesions

Question 3

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 4

Which of the following sites of Ca larynx has the best prognosis?

Accepted Answer

Glottic

Answer

Supraglottis

Answer

All have poor prognosis

Answer

Subglottis

Question 5

Which of the following statements about Laryngeal carcinoma is false?

Accepted Answer

More common in females

Answer

After laryngectomy, esophageal voice can be used

Answer

Smoking is the most important risk factor

Answer

Common in patients over 40 years of age

Question 6

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 7

Membrane incised during hemilaryngectomy is

Accepted Answer

Thyrohyoid membrane

Answer

Aryepiglottic fold

Answer

Cricothyroid membrane

Answer

Infralaryngeal space

Question 8

A patient presents with cancer of the larynx involving the left false cord, left arytenoid, and left aryepiglottic fold, with bilateral mobile true cords. What is the treatment of choice in this patient?

Accepted Answer

Supraglottic laryngectomy (Horizontal partial laryngectomy)

Answer

Total laryngectomy

Answer

Radiotherapy followed by chemotherapy

Answer

Vertical hemilaryngectomy

Question 9

Inspiratory stridor is found in what kind of lesions:

Accepted Answer

Supraglottic

Answer

Subglottic

Answer

Tracheal

Answer

Bronchus

Question 10

Identify the lesion of the vocal cord.

Accepted Answer

Laryngeal papilloma

Answer

Reinke’s edema

Answer

Malignancy of the vocal cords

Answer

Tracheomalacia

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

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