Diseases of the Larynx Practice Questions

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: 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.

Q: Reinke's layer is seen in:

Vocal cord. ***Vocal cord*** - **Reinke's space**, also known as Reinke's layer, is the superficial layer of the **lamina propria** of the vocal cord. - This layer is crucial for the **vibration of the vocal folds**, which is essential for sound production. *Tympanic membrane* - The **tympanic membrane**, or eardrum, is a thin membrane that separates the external ear from the middle ear [1]. [2]. - It vibrates in response to **sound waves** and transmits these vibrations to the ossicles, playing a role in hearing, not vocalization [1], [2]. *Cochlea* - The **cochlea** is a spiral-shaped cavity in the inner ear involved in the sense of hearing [2]. - It contains the **organ of Corti**, which converts sound vibrations into nerve impulses but has no connection to vocal cord anatomy [2]. *Reissner's membrane* - **Reissner's membrane** (vestibular membrane) is a thin membrane that separates the scala vestibuli from the scala media within the cochlea. - Its primary function is to maintain the **composition of the endolymph** in the scala media, and it is part of the auditory system, not the larynx.

Q: What condition is characterized by a mouse-nibbled appearance of the vocal cord?

Laryngeal tuberculosis. ***Laryngeal tuberculosis*** - A **mouse-nibbled appearance** of the vocal cord, characterized by **irregular, ragged edges**, is a classic endoscopic finding in laryngeal tuberculosis. - This presentation results from **granulomatous inflammation** and **ulceration** of the vocal cord tissue. *Vocal cord nodules* - Vocal cord nodules typically present as **bilateral, symmetrical swellings** on the free edge of the vocal cords, often described as "singer's nodules." - They tend to be **smooth and rounded**, not "mouse-nibbled." *Vocal cord paralysis* - Vocal cord paralysis involves an **absence or impairment of vocal cord movement**, leading to an altered glottic closure and voice change. - The vocal cord itself usually appears **structurally normal** in terms of its surface and edges, distinguishing it from an erosive process. *Laryngeal carcinoma* - Laryngeal carcinoma can present with various appearances, including **ulcerations, exophytic masses, or infiltrative lesions**. - While it can cause irregular surfaces, the specific "mouse-nibbled" description is more pathognomonic for **tuberculous laryngitis** due to its characteristic pattern of superficial erosion.

Q: A 50-year-old male chronic smoker complains of hoarseness of voice for the past 4 months. Microlaryngoscopic biopsy shows it to be keratosis of the larynx. All are suggested treatment modalities for this condition, except:

Partial laryngectomy. ***Partial laryngectomy*** - **Partial laryngectomy** is a surgical procedure typically reserved for **laryngeal cancer** that has invaded deeper tissues or is extensive. - Laryngeal keratosis, even with atypia, is a **premalignant lesion** and does not usually warrant such an aggressive surgical intervention as a primary treatment. *Stop smoking* - **Cigarette smoking** is a major causative factor for laryngeal keratosis and its progression to dysplasia or carcinoma. - **Cessation of smoking** can often lead to regression of the keratosis and is a crucial first step in management. *Laser vaporization* - **Laser vaporization** using CO2 laser is an effective method for precise removal of the keratotic lesions. - It allows for **accurate tissue ablation** while preserving surrounding healthy tissue and maintaining vocal function. *Stripping of vocal cord* - **Vocal cord stripping** is a common surgical technique used to remove superficial lesions like keratosis from the vocal cords. - This procedure involves **peeling off the superficial layer** of the vocal cord while aiming to preserve the deeper structures essential for voice quality.

Question 1

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

Accepted Answer

Posterior

Answer

Answer

Middle

Answer

Anywhere

Question 2

Hot potato voice is characteristic of ?

Accepted Answer

Supraglottic carcinoma

Answer

Nasopharyngeal carcinoma

Answer

Glottic carcinoma

Answer

Subglottic carcinoma

Question 3

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 4

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 5

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 6

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 7

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

Question 8

Reinke's layer is seen in:

Accepted Answer

Vocal cord

Answer

Tympanic membrane

Answer

Cochlea

Answer

Reissner's membrane

Question 9

What condition is characterized by a mouse-nibbled appearance of the vocal cord?

Accepted Answer

Laryngeal tuberculosis

Answer

Vocal cord nodules

Answer

Vocal cord paralysis

Answer

Laryngeal carcinoma

Question 10

A 50-year-old male chronic smoker complains of hoarseness of voice for the past 4 months. Microlaryngoscopic biopsy shows it to be keratosis of the larynx. All are suggested treatment modalities for this condition, except:

Accepted Answer

Partial laryngectomy

Answer

Stop smoking

Answer

Stripping of vocal cord

Answer

Laser vaporization

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

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