Diseases of the Larynx Practice Questions

Q: Which of the following childhood disorders is associated with an omega-shaped epiglottis?

Laryngomalacia. **Explanation:** **Laryngomalacia** is the most common congenital anomaly of the larynx and the leading cause of congenital stridor in infants. It is characterized by an abnormal softening of the supraglottic structures, which collapse inward during inspiration. The classic endoscopic finding is an **"omega-shaped" (Ω) epiglottis**, caused by the lateral folds of the epiglottis curling inward. This is often accompanied by short aryepiglottic folds and redundant arytenoid mucosa. **Analysis of Incorrect Options:** * **Epiglottitis:** This is an acute bacterial infection (typically *H. influenzae* type B) characterized by a "cherry-red," swollen epiglottis. On a lateral neck X-ray, it presents with the **"Thumb sign,"** not an omega shape. * **Subglottic Stenosis:** This involves narrowing of the airway below the vocal cords. It is characterized by the **"Steeple sign"** (subglottic narrowing) on an AP X-ray and is often associated with prolonged intubation. * **Choanal Atresia:** This is a congenital blockage of the posterior nasal passage. It presents with cyclical cyanosis (relieved by crying) and is diagnosed by the inability to pass a catheter through the nose. **Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Inspiratory stridor that worsens when the infant is supine, crying, or feeding, and improves when prone. * **Diagnosis:** Flexible fiberoptic laryngoscopy is the gold standard (shows collapse of supraglottic tissues). * **Management:** Most cases are self-limiting and resolve by 18–24 months. Severe cases (causing failure to thrive or cor pulmonale) require **supraglottoplasty**.

Q: A Blom-Singer prosthesis is used for voice rehabilitation following which surgical procedure?

Total laryngectomy. **Explanation:** The **Blom-Singer prosthesis** is a one-way silicone valve used for **Tracheoesophageal Puncture (TEP)** speech, which is currently the "gold standard" for voice rehabilitation following a **Total Laryngectomy**. **Why Total Laryngectomy is correct:** In a total laryngectomy, the entire larynx is removed, and the trachea is diverted to a permanent stoma in the neck, completely separating the airway from the food pipe (esophagus). This results in a loss of natural phonation. The Blom-Singer prosthesis is inserted into a surgically created fistula between the posterior wall of the trachea and the anterior wall of the esophagus. When the patient occludes the stoma and exhales, air is diverted through the valve into the esophagus, causing the pharyngoesophageal segment to vibrate and produce **esophageal speech**. **Why other options are incorrect:** * **Near-total laryngectomy:** This procedure preserves a small strip of endolaryngeal mucosa (a "shunt") that allows for spontaneous voice production without the need for a prosthetic valve. * **Hemi-laryngectomy:** This is a partial laryngectomy where only one vocal cord is removed. The patient retains a functional airway and the ability to speak using the remaining laryngeal structures, so a prosthesis is not required. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** It is a **one-way valve**; it allows air to move from the trachea to the esophagus but prevents food/liquid from entering the trachea (aspiration). * **Primary vs. Secondary TEP:** The prosthesis can be placed during the initial surgery (Primary) or weeks later (Secondary). * **Common Complication:** The most common reason for prosthesis failure/leakage is **fungal (Candida) colonization** or widening of the TEP tract. * **Other Voice Options:** Other methods post-laryngectomy include the **Electrolarynx** (external device) and traditional **Esophageal Speech** (burping air).

Q: A 2-week-old neonate presents with stridor in the prone position. What is the recommended management?

Observation and watchful waiting. **Explanation:** The clinical presentation describes **Laryngomalacia**, the most common cause of congenital stridor in neonates. It is characterized by an inspiratory stridor that typically worsens when the infant is supine, crying, or feeding, and notably **improves in the prone position** (due to the forward displacement of the tongue and supraglottic structures). **Why Option C is Correct:** In over 90% of cases, laryngomalacia is a self-limiting condition. As the laryngeal cartilage matures and strengthens, the stridor typically resolves spontaneously by 18–24 months of age. Therefore, **observation and watchful waiting** is the standard management for mild to moderate cases where the infant is feeding well and gaining weight. **Why Other Options are Incorrect:** * **Option A:** Calcium supplementation is used for laryngospasm due to hypocalcemic tetany, not for structural anomalies like laryngomalacia. * **Option B:** Nebulization (e.g., adrenaline or saline) is indicated for inflammatory conditions like Croup (Laryngotracheobronchitis), but it does not correct the anatomical collapse seen in laryngomalacia. * **Option C:** Antibiotics are used for infectious causes of airway obstruction (e.g., Epiglottitis or Bacterial Tracheitis), which present with fever and acute distress, unlike this neonate. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** Usually clinical; definitive diagnosis is via **flexible fiberoptic laryngoscopy** (shows "omega-shaped" epiglottis and inward collapse of aryepiglottic folds). * **Surgical Indication:** **Supraglottoplasty** is only indicated in "Severe Laryngomalacia" (characterized by failure to thrive, cor pulmonale, or severe apnea). * **Association:** Frequently associated with **Gastroesophageal Reflux Disease (GERD)**, which can exacerbate the stridor.

Q: What is the antibiotic of choice for acute epiglottitis?

Cephalosporin. **Explanation:** **Acute Epiglottitis** is a life-threatening medical emergency characterized by rapid inflammation of the epiglottis. The primary causative agent, particularly in non-immunized children, is ***Haemophilus influenzae* type b (Hib)**. Other pathogens include *Streptococcus pneumoniae* and *Staphylococcus aureus*. **Why Cephalosporins are the Correct Choice:** Third-generation cephalosporins (e.g., **Ceftriaxone** or **Cefotaxime**) are the drugs of choice because they provide excellent coverage against beta-lactamase-producing strains of *H. influenzae* and have superior penetration into the respiratory tissues. They have replaced older regimens due to their high efficacy and lower toxicity profile. **Analysis of Incorrect Options:** * **Tetracycline (A):** Generally contraindicated in children (due to bone/teeth effects) and lacks reliable activity against the primary pathogens causing epiglottitis. * **Chloramphenicol (B):** Historically used as a first-line agent for *H. influenzae* infections; however, it has been replaced by cephalosporins due to the risk of serious side effects like bone marrow suppression (aplastic anemia). * **Penicillin (D):** Most strains of *H. influenzae* are now resistant to penicillin and its derivatives (like Ampicillin) due to the production of beta-lactamase enzymes. **High-Yield Clinical Pearls for NEET-PG:** * **X-ray Finding:** The classic **"Thumb sign"** is seen on a lateral neck X-ray (swollen epiglottis). * **Clinical Presentation:** The "4 Ds"—**D**rooling, **D**ysphagia, **D**istress (respiratory), and **D**ysphonia. * **Management Priority:** The first priority is **airway maintenance** (intubation or tracheostomy). Never examine the throat with a tongue depressor in a suspected case, as it may trigger fatal laryngospasm. * **Position:** The patient often assumes the **"Tripod position"** to maximize airway diameter.

Q: Regarding juvenile papillomas, which of the following statements is/are true?

Multiple, Seen in children, Recurrent, Associated with HPV. **Explanation:** Juvenile-onset Recurrent Respiratory Papillomatosis (JORRP) is the most common benign neoplasm of the larynx in children. The correct answer is **C** because it accurately captures the four hallmark characteristics of the disease: 1. **Multiple:** Unlike the adult form (which is often a single pedunculated lesion), juvenile papillomas are typically **multicentric** and sessile, involving the true vocal cords, false cords, and epiglottis. 2. **Seen in children:** It usually presents between ages 2 and 5. Transmission is thought to occur during childbirth through an infected birth canal. 3. **Recurrent:** These tumors are notorious for their aggressive recurrence after surgical excision, often requiring multiple procedures. 4. **Associated with HPV:** It is caused by **Human Papillomavirus (HPV) types 6 and 11**. **Analysis of Incorrect Options:** * **Options B & D:** These are incorrect because juvenile papillomas are rarely "single." A single papilloma is characteristic of the **Adult-onset** variety, which is usually solitary and has a lower rate of recurrence. * **Option A:** While these descriptors are correct, they are incomplete. In NEET-PG, the most comprehensive option that includes the viral etiology (HPV) is the preferred answer. **Clinical Pearls for NEET-PG:** * **Most common site:** True vocal cords. * **Presenting symptom:** Hoarseness of voice (most common) or stridor. * **Treatment of choice:** CO2 Laser excision or Microdebridement. * **Adjuvant therapy:** Cidofovir (antiviral) is used in severe, rapidly recurring cases. * **Malignant transformation:** Rare, but can occur (usually to Squamous Cell Carcinoma), especially if associated with HPV-16 or 18.

Q: All of the following conditions affect the posterior part of the larynx except?

Lupus. **Explanation:** The larynx is anatomically divided into anterior and posterior segments, each prone to specific pathologies based on the underlying tissue type (cartilaginous vs. membranous). **Why Lupus is the correct answer:** Lupus (Laryngeal Lupus) is a chronic granulomatous condition that characteristically involves the **anterior part** of the larynx. It most commonly affects the **epiglottis** (often leading to a "turban-shaped" epiglottis or destruction of the free edge) and the **vestibule**. Unlike other granulomatous diseases like Tuberculosis, Lupus is relatively painless and does not typically involve the posterior glottis. **Analysis of incorrect options (Posterior Laryngeal involvement):** * **Contact Ulcer:** Occurs due to mechanical trauma (vocal abuse) or LPR (Laryngopharyngeal Reflux). It specifically affects the **vocal process of the arytenoid cartilage**, which is located posteriorly. * **Pachydermia Laryngis:** A form of chronic hypertrophic laryngitis characterized by epithelial thickening. It classically involves the **interarytenoid notch** and the posterior third of the vocal cords. * **Intubation Granuloma:** This is a post-traumatic granuloma caused by the pressure of an endotracheal tube. Since the tube rests against the **posterior glottis** (vocal processes of arytenoids), the granuloma forms in this posterior location. **NEET-PG High-Yield Pearls:** * **Posterior Larynx Pathologies:** Contact ulcer, Pachydermia, Intubation granuloma, and **Tuberculosis** (TB classically affects the posterior part, presenting as a "mouse-nibbled" appearance). * **Anterior Larynx Pathologies:** Lupus, Laryngeal webs, and most Carcinomas (typically involve the anterior two-thirds of the membranous cord). * **Laryngeal Lupus vs. TB:** TB is painful and posterior; Lupus is painless and anterior.

Q: Which of the following could be an indication for performing a high tracheostomy in a middle-aged man?

Carcinoma. **Explanation:** Tracheostomy is classified based on its relationship to the thyroid isthmus: **High** (above the isthmus/1st ring), **Mid** (behind the isthmus/2nd-3rd rings), and **Low** (below the isthmus/4th-5th rings). **Why Carcinoma is correct:** In cases of **Carcinoma of the Larynx**, a high tracheostomy is indicated as a preliminary step before a **Total Laryngectomy**. Since the entire larynx and the first tracheal ring are to be removed during the definitive surgery, the high position of the stoma does not pose a long-term risk of perichondritis or subglottic stenosis, as those structures will be excised. **Why the other options are incorrect:** * **Tuberculosis, Tetanus, and Diphtheria:** These are inflammatory or infective conditions where the tracheostomy is intended to be temporary. In such cases, a **High Tracheostomy is strictly contraindicated** because the proximity of the tube to the cricoid cartilage leads to perichondritis and subsequent **subglottic stenosis**, making decannulation difficult. For these conditions, a Mid or Low tracheostomy is preferred. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Choice:** Mid-tracheostomy is the most common procedure performed. * **Emergency:** In a dire emergency where a tracheostomy cannot be done, **Cricothyroidotomy** is the procedure of choice. * **Order of Incision:** For a routine tracheostomy, a vertical or transverse skin incision is followed by a **vertical incision** in the trachea (2nd and 3rd rings). * **Avoid:** Never divide the 1st tracheal ring to prevent subglottic stenosis.

Question 1

Which of the following is NOT an indication for tracheostomy?

Accepted Answer

Respiratory distress in carcinoma of the larynx

Answer

Flail chest

Answer

Foreign body aspiration

Answer

Tetanus

Question 2

Which of the following childhood disorders is associated with an omega-shaped epiglottis?

Accepted Answer

Laryngomalacia

Answer

Epiglottitis

Answer

Subglottic stenosis

Answer

Choanal atresia

Question 3

A Blom-Singer prosthesis is used for voice rehabilitation following which surgical procedure?

Accepted Answer

Total laryngectomy

Answer

Near total laryngectomy

Answer

Hemi laryngectomy

Answer

None of the above

Question 4

A 2-week-old neonate presents with stridor in the prone position. What is the recommended management?

Accepted Answer

Observation and watchful waiting

Answer

Oral calcium supplementation

Answer

Nebulization therapy

Answer

Antibiotic administration

Question 5

Which substance is associated with minimal tissue reaction in injection laryngoplasty?

Accepted Answer

Calcium hydroxyapatite

Answer

Fat

Answer

Gelfoam

Answer

Bioplastique

Question 6

What is the antibiotic of choice for acute epiglottitis?

Accepted Answer

Cephalosporin

Answer

Tetracycline

Answer

Chloramphenicol

Answer

Penicillin

Question 7

Regarding juvenile papillomas, which of the following statements is/are true?

Accepted Answer

Multiple, Seen in children, Recurrent, Associated with HPV

Answer

Multiple, Seen in children, Recurrent

Answer

Single, Multiple, Seen in children

Answer

Single, Seen in children, Recurrent, Associated with HPV

Question 8

All of the following conditions affect the posterior part of the larynx except?

Accepted Answer

Lupus

Answer

Contact ulcer

Answer

Pachydermia laryngis

Answer

Intubation granuloma

Question 9

A 64-year-old female develops chronic lung disease requiring intubation in the ICU for an 8-week period following a respiratory tract infection. Tracheal stenosis is noted. What is the most likely cause of tracheal stenosis?

Accepted Answer

Prolonged intubation

Answer

Tuberculosis

Answer

Scleroderma

Answer

Riedel struma (fibrous thyroiditis)

Question 10

Which of the following could be an indication for performing a high tracheostomy in a middle-aged man?

Accepted Answer

Carcinoma

Answer

Tuberculosis

Answer

Tetanus

Answer

Diphtheria

Diseases of the Larynx — MCQs

Diseases of the Larynx — MCQs

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