Diseases of the Larynx Practice Questions

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: 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: Vallecula sign is seen in?

Acute epiglottitis. ***Acute epiglottitis*** - The **vallecula sign** is a characteristic radiological finding in acute epiglottitis, where the swollen epiglottis protrudes into the vallecula, obliterating it on lateral neck X-ray. - This is often seen alongside the **thumb sign** (the swollen epiglottis resembles a thumb), both indicating severe inflammation and edema of the **epiglottis**. - This is a life-threatening condition due to potential airway obstruction requiring urgent airway management. *TB laryngitis* - Characterized by **granulomatous inflammation** of the larynx, often presenting with hoarseness and odynophagia. - Radiologically, it typically shows **ulcerations**, granulomas, or diffuse laryngeal swelling, rather than the vallecula sign. *Vocal nodule* - **Vocal nodules** are bilateral, benign lesions on the vocal folds, usually caused by voice abuse. - They present as small, symmetrical swellings on the true vocal cords and do not affect the epiglottis or vallecula. *Inverted papilloma* - **Inverted papilloma** is a benign, locally aggressive tumor of the sinonasal tract. - It does not involve the epiglottis or present with a vallecula sign; its typical presentation is nasal obstruction and epistaxis.

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**.

Q: All the following statements about laryngeal carcinoma are true except:

Laryngeal carcinoma has a poor prognosis.. ***Laryngeal carcinoma has a poor prognosis.*** - While prognosis depends on stage and treatment, laryngeal carcinoma, especially when detected early, often has a **relatively good prognosis** compared to other head and neck cancers, with overall survival rates exceeding 50-60%. - Many patients, particularly those with early-stage disease, can be cured with **surgery or radiation therapy** while preserving laryngeal function. *Laryngeal carcinoma is more common in males.* - **Laryngeal carcinoma** demonstrates a significant **male predominance**, with incidence rates typically 4 to 5 times higher in men than in women. - This disparity is largely attributable to historically higher rates of **smoking and alcohol consumption** among men. *Laryngeal carcinoma is associated with smoking.* - **Smoking** is the most significant and well-established **risk factor** for laryngeal carcinoma, with the risk directly correlated to the intensity and duration of tobacco use. - Exposure to **carcinogens in tobacco smoke** directly damages laryngeal epithelial cells, leading to dysplasia and eventual malignant transformation. *Laryngeal carcinoma is more common in individuals over 40 years of age.* - The incidence of **laryngeal carcinoma** significantly increases with age, with the majority of cases diagnosed in individuals **over the age of 50 or 60 years**. - This age distribution reflects the cumulative exposure to **environmental carcinogens** like tobacco and alcohol over a longer lifespan.

Q: The voice in a patient with bilateral abductor paralysis of the larynx is most likely to be?

Normal voice. ***Normal voice*** - In **bilateral abductor paralysis**, both posterior cricoarytenoid muscles (the only intrinsic laryngeal muscles that abduct the vocal cords) are paralyzed - The vocal cords remain fixed in a **paramedian position** (nearly closed but not completely closed) - This position is **ideal for phonation** as the vocal cords are adequately approximated for normal voice production - Therefore, voice quality remains **normal or near-normal** despite the paralysis - The **primary clinical problem** is severe **inspiratory stridor and respiratory distress** due to narrowed airway, not voice quality - This is a **life-threatening emergency** requiring urgent airway management *Weak or breathy voice* - A **breathy voice** occurs when vocal cords cannot adequately **adduct** (close), allowing air to escape during phonation - This is characteristic of **adductor paralysis** (recurrent laryngeal nerve injury causing vocal cord paralysis in abducted position) or **unilateral vocal cord paralysis** - In bilateral abductor paralysis, the cords are already in near-midline position, so phonation is preserved *Strained voice* - A **strained or pressed voice** is associated with **muscle tension dysphonia**, **paradoxical vocal fold motion**, or **hyperkinetic voice disorders** - It occurs when excessive laryngeal tension is present during phonation - This is **not** characteristic of bilateral abductor paralysis where the cords are passively positioned near midline *Voice fatigue* - **Voice fatigue** is a symptom of prolonged voice use or underlying pathologies like **vocal nodules**, **polyps**, or **muscle tension dysphonia** - It describes deterioration of voice quality with use, not a baseline voice characteristic - Not a primary feature of bilateral abductor paralysis

Q: In an infant brought with stridor, diagnosed with laryngomalacia, which of the following is NOT typically observed?

Hoarseness. ***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

Q: All of the following statements about laryngomalacia are true, except for:

Surgical Tracheostomy is the treatment of choice. ***Surgical Tracheostomy is the treatment of choice*** - While laryngomalacia is the most common cause of **stridor** in infants, most cases are **mild and self-limiting**, resolving spontaneously by **12 to 18 months of age**. - **Surgical tracheostomy** is reserved for severe cases with significant **airway obstruction**, **failure to thrive**, or **life-threatening apneic spells** after failed conservative management and supraglottoplasty. *It is the most common congenital anomaly of the larynx* - This statement is **true**; laryngomalacia is indeed the most frequent congenital anomaly of the larynx, affecting approximately **60% of all congenital laryngeal anomalies**. - It is the most common cause of **inspiratory stridor** in infants. *It is associated with an omega shaped epiglottis* - This statement is **true**; the characteristic finding in laryngomalacia is the collapse of the **supraglottic structures** during inspiration. - This often includes a **long, curled, 'omega-shaped' epiglottis**, which contributes to the airway obstruction. *Stridor is increased on crying and relieved on lying prone* - This statement is **true**; the inspiratory stridor in laryngomalacia is typically **worsened by agitation, crying, feeding, or supine positioning**. - Lying **prone** or **side-lying** positions can help relieve the stridor by allowing the supraglottic tissues to fall forward and open the airway.

Question 1

Hot potato voice is characteristic of ?

Accepted Answer

Supraglottic carcinoma

Answer

Nasopharyngeal carcinoma

Answer

Glottic carcinoma

Answer

Subglottic carcinoma

Question 2

Laryngitis sicca is associated with ?

Accepted Answer

Klebsiella rhinoscleromatosis

Answer

Rhinosporidium

Answer

M. leprae

Answer

Klebsiella ozaenae

Question 3

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 4

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

Accepted Answer

Posterior

Answer

Answer

Middle

Answer

Anywhere

Question 5

Vallecula sign is seen in?

Accepted Answer

Acute epiglottitis

Answer

TB laryngitis

Answer

Vocal nodule

Answer

Inverted papilloma

Question 6

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.

Question 7

All the following statements about laryngeal carcinoma are true except:

Accepted Answer

Laryngeal carcinoma has a poor prognosis.

Answer

Laryngeal carcinoma is more common in males.

Answer

Laryngeal carcinoma is associated with smoking.

Answer

Laryngeal carcinoma is more common in individuals over 40 years of age.

Question 8

The voice in a patient with bilateral abductor paralysis of the larynx is most likely to be?

Accepted Answer

Normal voice

Answer

Weak or breathy voice

Answer

Voice fatigue

Answer

Strained voice

Question 9

In an infant brought with stridor, diagnosed with laryngomalacia, which of the following is NOT typically observed?

Accepted Answer

Hoarseness

Answer

Stridor will be inspiratory

Answer

Prominent arytenoids

Answer

Floppy aryepiglottic folds

Question 10

All of the following statements about laryngomalacia are true, except for:

Accepted Answer

Surgical Tracheostomy is the treatment of choice

Answer

It is associated with an omega shaped epiglottis

Answer

It is the most common congenital anomaly of the larynx

Answer

Stridor is increased on crying and relieved on lying prone

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

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