Diseases of the Larynx Practice Questions

Q: True about laryngitis sicca?

Caused by Klebsiella rhinoscleromatis. **Explanation:** **Laryngitis Sicca** (also known as Atrophic Laryngitis) is a chronic inflammatory condition characterized by the atrophy of the laryngeal mucosa and mucous-secreting glands. 1. **Why Option B is Correct:** While Laryngitis Sicca is often associated with environmental factors (dust, dry air) or post-radiotherapy, its specific infectious etiology is linked to **Klebsiella rhinoscleromatis** (the Frisch bacillus). This organism is the causative agent of Rhinoscleroma, which can involve the larynx (Scleroma of the larynx), leading to crusting and mucosal atrophy. 2. **Why other options are incorrect:** * **Option A:** *Klebsiella ozaenae* is primarily associated with Atrophic Rhinitis (Ozena) of the nasal cavity, not specifically the laryngeal manifestation of sicca. * **Option C:** The hallmark of Laryngitis Sicca is the formation of **foul-smelling, greenish-black crusts** that are dry and tenacious. Hemorrhagic (bloody) crusts are more characteristic of acute viral infections or specific granulomatous diseases like Wegener’s. * **Option D:** Since the condition is bacterial or environmental in origin, **antifungals have no role**. Treatment focuses on humidification, alkaline glottic washes, and sometimes Ammonium chloride to liquefy secretions. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of Atrophy:** Often co-exists with atrophic rhinitis and atrophic pharyngitis. * **Clinical Presentation:** The most common symptom is **hoarseness of voice** and a dry, irritating cough, which improves once the crusts are coughed out. * **Key Pathology:** Squamous metaplasia of the laryngeal epithelium and atrophy of the seromucinous glands. * **Management:** Steam inhalation and "Mandl's paint" (iodine-based) are frequently used to stimulate glandular secretion.

Q: Laryngocele arises as a herniation of laryngeal mucosa through which membrane?

Thyrohyoid. ### Explanation **1. Why Thyrohyoid is Correct:** A laryngocele is an abnormal cystic dilatation of the **saccule of the laryngeal ventricle**. The saccule (or pouch of Hilton) is a blind-ending pouch located between the vestibular fold and the inner surface of the thyroid cartilage. When the saccule distends with air and extends superiorly, it eventually exits the larynx by piercing the **thyrohyoid membrane**. Specifically, it passes through the same opening used by the **internal laryngeal nerve and superior laryngeal artery**. * **Internal Laryngocele:** Remains within the thyroid cartilage (displaces false vocal folds). * **External Laryngocele:** Herniates through the thyrohyoid membrane and presents as a neck mass. **2. Why Other Options are Incorrect:** * **Cricothyroid Membrane:** This membrane connects the cricoid and thyroid cartilages. It is the site for emergency cricothyrotomy, not the exit point for the saccule. * **Crico-tracheal Membrane:** This connects the cricoid cartilage to the first tracheal ring. It is involved in subglottic pathology or trauma, not laryngocele formation. * **Cricosternal:** This is not a standard anatomical membrane of the larynx; the larynx is separated from the sternum by the trachea and strap muscles. **3. NEET-PG High-Yield Pearls:** * **Etiology:** Often seen in individuals with increased intra-laryngeal pressure (e.g., **trumpet players, glass blowers**, or chronic coughers). * **Clinical Presentation:** External laryngoceles typically present as a **reducible, resonant neck swelling** that increases in size with the Valsalva maneuver (Bryce’s Sign). * **Association:** In adults, a laryngocele may be secondary to a **squamous cell carcinoma** obstructing the ventricular orifice; thus, endoscopic evaluation is mandatory. * **Investigation of Choice:** CT scan (shows an air-filled sac).

Q: All of the following are true about adult laryngeal papilloma except:

Typically found in the posterior half of the vocal cord. **Explanation:** Laryngeal papillomas are benign epithelial tumors caused by Human Papillomavirus (HPV types 6 and 11). They are classified into Juvenile-onset and Adult-onset types, which have distinct clinical profiles. **Why Option C is the Correct Answer (The False Statement):** Laryngeal papillomas, especially the adult variety, typically involve the **anterior half** of the vocal cords or the anterior commissure. They tend to occur at "junctional zones" where ciliated columnar epithelium meets squamous epithelium. Finding a lesion primarily in the posterior larynx is atypical and should raise suspicion for other pathologies like contact granulomas or tuberculosis. **Analysis of Other Options:** * **Option A (More common in males):** Unlike the juvenile form (which has an equal sex distribution), adult-onset laryngeal papilloma shows a significant **male preponderance**. * **Option B (Do not recur):** While adult papillomas are often solitary, they **frequently recur** after surgery. Although the recurrence rate is lower than in the juvenile-onset respiratory papillomatosis (JORP), multiple sittings are often required. * **Option D (Treatment is primarily surgical):** The gold standard treatment is **Microlaryngeal Surgery (MLS)** using CO2 laser or microdebrider to debulk the lesion while preserving the underlying vocal cord structure. **High-Yield Clinical Pearls for NEET-PG:** * **Etiology:** HPV 6 and 11 (Low risk for malignancy, though adult types have a slightly higher risk of malignant transformation than juvenile types). * **Presentation:** Hoarseness of voice is the most common presenting symptom. * **Adjuvant Therapy:** Cidofovir (intralesional injection) is the most common adjuvant used for aggressive recurrences. * **Key Difference:** Juvenile type is often multiple and aggressive; Adult type is usually solitary and less aggressive.

Q: 'Thumbprint' sign is seen in which of the following conditions?

Epiglottitis. **Explanation:** The **'Thumbprint' sign** is a classic radiological finding seen on a **lateral neck X-ray** in patients with **Acute Epiglottitis**. It represents a swollen, edematous epiglottis that loses its normal thin, leaf-like appearance and instead resembles the distal silhouette of a human thumb. **Why Epiglottitis is correct:** Acute Epiglottitis is a life-threatening inflammatory condition, most commonly caused by *Haemophilus influenzae* type B (HiB). The inflammation leads to massive supraglottic edema. On a lateral soft tissue X-ray of the neck, this swelling narrows the vallecula and creates the characteristic rounded "thumb-like" opacity. **Why the other options are incorrect:** * **Options A, B, and C (Fungal Infections):** Candida, Aspergillus, and Thermomyces are fungal pathogens. While they can cause laryngeal infections (especially in immunocompromised patients), they typically present with white plaques, ulcerative lesions, or necrotizing tissue rather than the acute, massive supraglottic edema required to produce the thumbprint sign. These are not associated with this specific radiological hallmark. **Clinical Pearls for NEET-PG:** * **Clinical Triad:** Drooling, Dysphagia, and Distress (the 3 D’s). * **Positioning:** Patients often assume the **'Tripod position'** (leaning forward with hands on knees) to maintain the airway. * **Management:** The priority is **airway maintenance** (intubation or tracheostomy). **Never** examine the throat with a tongue depressor in a suspected case, as it can trigger fatal laryngospasm. * **Differential Diagnosis:** Contrast this with **Croup (Laryngotracheobronchitis)**, which shows the **'Steeple sign'** (subglottic narrowing) on an Anteroposterior (AP) view.

Q: Which of the following can cause bilateral recurrent laryngeal nerve palsy?

Thyroid surgery, thyroid malignancy, and viral infection. **Explanation:** Recurrent Laryngeal Nerve (RLN) palsy can be unilateral or bilateral. For a condition to cause **bilateral** palsy, it must either involve a midline structure, affect both sides of the neck/mediastinum simultaneously, or be a systemic process. 1. **Why Option B is correct:** * **Thyroid Surgery:** This is the most common cause of bilateral RLN injury. During total thyroidectomy, both nerves are at risk due to their proximity to the gland. * **Thyroid Malignancy:** Advanced thyroid carcinoma (especially anaplastic or invasive papillary) can infiltrate both nerves as they ascend in the tracheoesophageal groove. * **Viral Infection:** Post-viral neuritis (e.g., following Influenza or Herpes) can cause idiopathic bilateral vocal cord paralysis, often presenting as sudden onset airway compromise. 2. **Why other options are incorrect:** * **Aneurysm of the Arch of Aorta (Options A & C):** This is a classic cause of **unilateral** (left-sided) RLN palsy (Ortner’s syndrome). The left RLN loops under the aortic arch, while the right RLN loops under the subclavian artery. An aortic aneurysm cannot anatomically cause bilateral palsy unless there is a separate pathology on the right side. * **Option D:** While correct, it is incomplete. Viral infections are a recognized clinical etiology for bilateral involvement. **High-Yield Clinical Pearls for NEET-PG:** * **Position of cords:** In bilateral RLN palsy, cords usually lie in the **median or paramedian position** because the cricothyroid muscle (supplied by the Superior Laryngeal Nerve) is still functional and adducts the cords. * **Clinical Presentation:** The primary symptom of bilateral RLN palsy is **stridor and dyspnea**, whereas the primary symptom of unilateral palsy is **hoarseness**. * **Management:** Acute bilateral palsy is a medical emergency often requiring **tracheostomy** to secure the airway.

Question 1

Which of the following is NOT a contraindication for bronchoscopy?

Accepted Answer

Active bleeding

Answer

Lesions of the cervical spine

Answer

Cardiac failure

Answer

Trismus

Question 2

When caring for a male patient who has just had a total laryngectomy, what should the nurse plan to do?

Accepted Answer

Develop an alternative communication method

Answer

Encourage oral feeding as soon as possible

Answer

Keep the tracheostomy cuff fully inflated

Answer

Keep the patient flat in bed

Question 3

True about laryngitis sicca?

Accepted Answer

Caused by Klebsiella rhinoscleromatis

Answer

Caused by Klebsiella ozaenae

Answer

Hemorrhagic crust formation seen

Answer

Antifungal are effective

Question 4

Laryngocele arises as a herniation of laryngeal mucosa through which membrane?

Accepted Answer

Thyrohyoid

Answer

Cricothyroid

Answer

Crico-tracheal

Answer

Cricosternal

Question 5

All of the following are true about adult laryngeal papilloma except:

Accepted Answer

Typically found in the posterior half of the vocal cord

Answer

More common in males than females

Answer

Do not recur

Answer

Treatment is primarily surgical

Question 6

A 10-year-old boy developed hoarseness of voice following an attack of diphtheria. On examination, his right vocal cord was paralyzed. What is the treatment of choice for a paralyzed vocal cord in this scenario?

Accepted Answer

Wait for spontaneous recovery of the vocal cord

Answer

Gel foam injection of the right vocal cord

Answer

Fat injection of the right vocal cord

Answer

Thyroplasty type-I

Question 7

Tracheostomy reduces dead space by which of the following mechanisms?

Accepted Answer

By-passing the upper airway

Answer

Increased V/Q ratio

Answer

Reducing airflow resistance

Answer

By all of the above mechanisms

Question 8

'Thumbprint' sign is seen in which of the following conditions?

Accepted Answer

Epiglottitis

Answer

Candida infection

Answer

Aspergillus infection

Answer

Thermomyces infection

Question 9

In the erect posture, what is the most common site for a foreign body in the bronchus?

Accepted Answer

Right lower lobe

Answer

Right upper lobe

Answer

Carina

Answer

Left lower lobe

Question 10

Which of the following can cause bilateral recurrent laryngeal nerve palsy?

Accepted Answer

Thyroid surgery, thyroid malignancy, and viral infection

Answer

Thyroid surgery, aneurysm of the arch of aorta, and viral infection

Answer

Thyroid surgery, thyroid malignancy, and aneurysm of the arch of aorta

Answer

Thyroid surgery and thyroid malignancy

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

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