Diseases of the Larynx Practice Questions

Q: What is the approximate width of the glottic chink in the cadaveric position of the vocal cords?

7 mm. ### Explanation The **glottic chink** (rima glottidis) refers to the space between the vocal cords. Its width varies significantly depending on the position of the vocal cords, which is determined by the intrinsic muscles of the larynx and their nerve supply. **Why 7 mm is correct:** The **cadaveric position** is the neutral position assumed by the vocal cords after death or complete paralysis of all laryngeal muscles (total lesion of both Recurrent Laryngeal Nerve and Superior Laryngeal Nerve). In this state, the vocal cords lie midway between the midline and the abducted position. The width of the glottic chink in this position is approximately **7 mm**. **Analysis of Incorrect Options:** * **A & B (3 mm / 3.5 mm):** These values are too narrow for the cadaveric position. A width of approximately **3.5 mm** is seen in the **paramedian position**, which occurs in isolated Recurrent Laryngeal Nerve (RLN) palsy (where the cricothyroid muscle, supplied by the Superior Laryngeal Nerve, remains intact and adducts the cord). * **D (19 mm):** This is far too wide. In **full abduction** (forced inspiration), the glottic chink reaches its maximum width, which is approximately **13–14 mm** in males. 19 mm exceeds the anatomical limits of the adult glottis. **High-Yield Clinical Pearls for NEET-PG:** * **Median Position:** 0 mm (Vocal cords meet in the midline; seen during phonation). * **Paramedian Position:** 3.5 mm (Seen in isolated RLN palsy). * **Cadaveric Position:** 7 mm (Seen in combined RLN and SLN palsy). * **Quiet Respiration:** 13.5 mm (Intermediate position). * **Full Abduction:** 18–19 mm (Total width including the posterior cartilaginous glottis; however, the membranous chink is ~13-14 mm). * **Semon’s Law:** States that in progressive organic lesions of the RLN, the abductor fibers (Posterior Cricoarytenoid) are paralyzed before the adductor fibers.

Q: A 4-year-old child presents with a history of hoarseness, croupy cough, and aphonia. The child has dyspnea with wheezing. What is the most probable diagnosis?

Laryngeal foreign body. ### Explanation The clinical presentation of **hoarseness, croupy cough, and aphonia** (loss of voice) specifically points toward a pathology localized in the **larynx**. **1. Why Laryngeal Foreign Body (FB) is correct:** A foreign body lodged in the larynx typically presents with a sudden onset of the "triad" of symptoms: **hoarseness/aphonia, croupy cough, and inspiratory stridor**. While wheezing is more common in bronchial foreign bodies, a laryngeal FB can cause generalized respiratory distress and transmitted sounds (wheezing/stridor) due to upper airway obstruction. The presence of **aphonia** is a hallmark sign that the vocal cords are being physically obstructed or irritated, which is highly characteristic of a laryngeal FB in a toddler. **2. Why other options are incorrect:** * **Asthmatic bronchitis:** Typically presents with recurrent wheezing and productive cough, but it does **not** cause aphonia or a croupy cough. * **Bronchopneumonia:** Characterized by high-grade fever, tachypnea, and crepitations. It involves the lower respiratory tract and does not affect the voice (no aphonia). * **Retropharyngeal abscess:** Presents with fever, drooling, muffled "hot potato" voice, and neck stiffness. It causes difficulty swallowing (dysphagia) rather than aphonia or a croupy cough. **3. NEET-PG High-Yield Pearls:** * **Most common site for FB aspiration:** Right main bronchus (due to it being wider, shorter, and more vertical). * **Most common site for FB causing Aphonia:** Larynx. * **Gold Standard Investigation:** Rigid Bronchoscopy (both diagnostic and therapeutic). * **Radiology:** Most FBs are radiolucent (e.g., peanuts); look for indirect signs like obstructive emphysema or air trapping on expiratory films.

Q: What is the initial management for a newborn presenting with stridor attributed to laryngomalacia?

Observation and supportive care. ### Explanation **Laryngomalacia** is the most common congenital anomaly of the larynx and the leading cause of congenital stridor in infants. It is characterized by the collapse of supraglottic structures (epiglottis, arytenoids) into the airway during inspiration. **Why Option A is Correct:** The vast majority (over 90%) of laryngomalacia cases are **mild to moderate** and self-limiting. The stridor typically appears at 2 weeks of age, peaks at 6–9 months, and resolves spontaneously by 18–24 months as the laryngeal cartilage matures and the airway widens. Therefore, the initial management is **observation, parental reassurance, and supportive care** (such as upright positioning during feeding). **Why Other Options are Incorrect:** * **Option B:** Urgent surgery is reserved only for "Severe Laryngomalacia" (approx. 10% of cases) presenting with cyanosis, apnea, failure to thrive, or cor pulmonale. * **Option C:** Corticosteroids are not the primary treatment for laryngomalacia; they are more relevant in inflammatory conditions like croup or subglottic hemangioma. However, treating comorbid **Gastroesophageal Reflux (GERD)** with PPIs is often necessary as reflux exacerbates laryngeal edema. * **Option D:** If surgery (Supraglottoplasty) is required, it is performed when symptoms are severe, regardless of age. Waiting until age two is counterintuitive, as the condition usually resolves naturally by then. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Presentation:** Inspiratory stridor that **worsens** when the infant is supine, crying, or feeding, and **improves** when prone. * **Diagnostic Finding:** Flexible laryngoscopy shows "Omega-shaped" epiglottis and short aryepiglottic folds. * **Associated Condition:** GERD is present in up to 80% of these patients and must be managed to improve outcomes.

Q: Which of the following structures are NOT removed in a vertical partial laryngectomy?

Epiglottis. **Explanation:** **Vertical Partial Laryngectomy (VPL)**, also known as a **Hemilaryngectomy**, is a voice-conserving surgery indicated for T1 and select T2 glottic carcinomas. The fundamental principle of VPL is the removal of the affected side of the larynx along a vertical plane, specifically targeting the glottic region. **Why Epiglottis is the Correct Answer:** The **Epiglottis** is a supraglottic structure. Vertical partial laryngectomy is designed for glottic lesions (vocal cords). In a standard VPL, the resection remains below the level of the false vocal cords and does not involve the supraglottis. Therefore, the epiglottis is preserved to maintain airway protection during swallowing. **Analysis of Incorrect Options:** * **True Vocal Cord:** This is the primary structure removed. The surgery is performed for tumors involving one vocal cord. * **Thyroid Cartilage:** The overlying thyroid cartilage ala (on the affected side) is resected as part of the specimen to ensure adequate margins. * **Arytenoid Cartilage:** Depending on the posterior extent of the tumor, the vocal process or the entire arytenoid cartilage on the involved side may be removed to achieve oncological clearance. **NEET-PG High-Yield Pearls:** * **Horizontal Partial Laryngectomy:** Also known as Supraglottic Laryngectomy. It removes the epiglottis and false cords but **preserves** both true vocal cords. * **Prerequisite for VPL:** The contralateral vocal cord must be mobile and healthy. * **Voice Quality:** Post-VPL, the voice is "hoarse but functional" because the remaining cord vibrates against a scarred neo-glottis. * **Key Contraindication for VPL:** Extension of the tumor to the subglottis (>10mm) or fixed vocal cords (T3).

Q: A 10-month-old child presents with an abnormal inspiratory sound. The mother complains that the sound increases with crying and decreases when the child sleeps in a prone position. What is the probable diagnosis?

Laryngomalacia. **Explanation:** The clinical presentation is classic for **Laryngomalacia**, the most common cause of congenital stridor. It is characterized by an inward collapse of supraglottic structures (like the epiglottis and arytenoids) during inspiration due to delayed laryngeal cartilage maturation. **Why Laryngomalacia is correct:** * **Inspiratory Stridor:** The hallmark sign, usually appearing within the first few weeks of life. * **Positional Variation:** Stridor **improves in the prone position** because gravity pulls the tongue and supraglottic structures forward, opening the airway. It worsens in the supine position, during feeding, or when the child is agitated/crying. * **Age:** It typically presents in infancy (peak at 6 months) and resolves spontaneously by 18–24 months. **Why other options are incorrect:** * **Croup (Laryngotracheobronchitis):** Presents with a "barking" cough, hoarseness, and fever. It is an acute viral infection, not a chronic positional sound. * **Acute Epiglottitis:** A medical emergency characterized by high fever, drooling, and a "tripod position." It has a rapid onset and the child appears toxic. * **Laryngitis:** Usually presents with hoarseness and throat pain in older children/adults, often following a viral upper respiratory infection. **NEET-PG High-Yield Pearls:** * **Diagnosis:** Definitive diagnosis is made via **Flexible Fiberoptic Laryngoscopy**, showing "Omega-shaped" epiglottis and collapse of aryepiglottic folds. * **Management:** Mostly conservative (observation) as 90% resolve spontaneously. Severe cases with failure to thrive or cyanosis require **Supraglottoplasty**. * **Key Differentiator:** If the stridor were **expiratory**, think of Tracheomalacia. If **biphasic**, think of Subglottic Stenosis.

Question 1

Which of the following is FALSE regarding unilateral Recurrent Laryngeal Nerve palsy?

Accepted Answer

Difficulty in breathing

Answer

Has normal speech

Answer

No risk of aspiration

Answer

Conservative management

Question 2

Which of the following statements about papilloma is incorrect?

Accepted Answer

Solitary papilloma is more aggressive, has a poor prognosis, and malignant transformation is common.

Answer

Solitary papilloma is more common in adults, and the most common presentation is a change in voice.

Answer

Multiple papilloma is more common in children, and the most common presentation is a hoarse cry.

Answer

Early treatment leads to better results in multiple papilloma.

Question 3

Which of the following are features of laryngeal carcinoma?

Accepted Answer

Laryngeal compartments act as a barrier

Answer

Glottis is the most common site

Answer

Commonly metastasizes to cervical lymph nodes

Answer

Lesions are seen at the edge of the vocal cord

Question 4

What is the treatment of choice for laryngeal carcinoma of the glottis extending to the supraglottic region with vocal cord fixation and a palpable solitary ipsilateral lymph node?

Accepted Answer

Total laryngectomy with radical neck dissection

Answer

Conservative laryngectomy

Answer

Total laryngectomy

Answer

Palliative therapy

Question 5

What is the approximate width of the glottic chink in the cadaveric position of the vocal cords?

Accepted Answer

7 mm

Answer

3 mm

Answer

3.5 mm

Answer

19 mm

Question 6

A 4-year-old child presents with a history of hoarseness, croupy cough, and aphonia. The child has dyspnea with wheezing. What is the most probable diagnosis?

Accepted Answer

Laryngeal foreign body

Answer

Asthmatic bronchitis

Answer

Bronchopneumonia

Answer

Retropharyngeal abscess

Question 7

Cricothyrotomy is converted to tracheostomy:

Accepted Answer

To avoid subglottic stenosis

Answer

To avoid hypoxia

Answer

To facilitate oxygenation

Answer

Easy consumption of food

Question 8

What is the initial management for a newborn presenting with stridor attributed to laryngomalacia?

Accepted Answer

Observation and supportive care

Answer

Urgent surgical intervention

Answer

Corticosteroid therapy

Answer

Surgical correction after the age of two years

Question 9

Which of the following structures are NOT removed in a vertical partial laryngectomy?

Accepted Answer

Epiglottis

Answer

True vocal cord

Answer

Arytenoid cartilage

Answer

Thyroid cartilage

Question 10

A 10-month-old child presents with an abnormal inspiratory sound. The mother complains that the sound increases with crying and decreases when the child sleeps in a prone position. What is the probable diagnosis?

Accepted Answer

Laryngomalacia

Answer

Croup

Answer

Acute epiglottitis

Answer

Laryngitis

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

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