Clinical Fundamentals

Question 1

zaq

___ therapy is associated with development of nutritional deficiencies, CAP, osteopenia, atrophic gastritis and C.diff.

Answer 1

PPI therapy

Question 2

What is the role of HPV as a causative agent in laryngeal cancer?

Answer 2

has not been established

Question 3

Idiopathic VF paralysis comprises ___ of all cases of unilateral VF paralysis.

Answer 3

25%

Question 4

Tracheo-innominate fistula risk is highest between __ weeks following tracheostomy.

Answer 4

3-4 weeks

Question 5

What hormone decreases LES pressure?

Answer 5

Glucagon

Question 6

Approximately __% of VC paralysis in children is b/l.

Answer 6

50%

Question 7

__ is the first-line treatment for VC nodules.

Answer 7

Voice therapy

Question 8

The GRBAS voice assessment scale stands for ___, and evaluates voice quality.

Answer 8

Grade (overall degree of voice abnormality)
Roughness
Breathiness
Asthenia (voice weakness)
Strain

Graded 0-3 on 4pt scale

Question 9

As we age, vocal cord tissue collagen ___ and elastin ___

Answer 9

Collagen increases, and Elastin decreases

Question 10

An idopathic cough (no structural abnormality or laryngopharyntitis) can be treated with a trial of ___.

Answer 10

Amitriptyline

Question 11

What component of refluxate causes pharyngeal and laryngeal inflammation?

Answer 11

Pepsin (**produced by chief cells)

Question 12

laryngeal EMG (LEMG) is most reliable at identifying when a VC *will/will not recover?

Answer 12

will not

Question 13

The earliest time point where LEMG fibrillation potentials and positive sharp waves may be seen on LEMG is ___ weeks?

Answer 13

3 weeks

Question 14

Zargar classification:
Grade __: Edema and erythema of the mucosa

Answer 14

Grade I

Question 15

Zargar classification:
Grade __: extensive deep gray necrosis or brownish/black ulcers

Answer 15

Grade 3B

Question 16

Zargar classification:
Grade __: Normal mucosa

Answer 16

Grade 0

Question 17

Zargar classification:
Grade __: circumferential and deep ulcerations

Answer 17

Grade 2B

Question 18

Zargar classification:
Grade __: Perforation

Answer 18

Grade 4

Question 19

Zargar classification:
Grade __: Hemorrhage, erosions, blisters, superficial localized ulcers

Answer 19

Grade 2A

Question 20

Zargar classification:
Grade __: Focal deep gray or brownish/black ulcers

Answer 20

Grade 3A

Question 21

Diagnosis and Treatment

Answer 21

Intubation granuloma.

Tx: anti-reflux meds, PPI, diet reflux precautions

Question 22

_____ causes endothelial edema and thickening of arterioles/arteries.

Answer 22

Radiation therapy

Question 23

_____ has been linked to reduced collagen synthesis.

Answer 23

Hypothyroidism

Question 24

___ leads to diminished fibroblast activity and reduced collagen synthesis.

Answer 24

Protein deficiency

Question 25

___ impairs wound healing by reducing RBC proliferation and O2 transport.

Answer 25

Nicotine

Question 26

False negative stimulation using intraoperative nerve monitoring can occur due to: **1)_** 2) distal stimulation relative to the injured nerve segment 3) delayed neuropraxia (traumatic peripheral nerve injury) 3) injury subsequent to the last testing stimulation

Answer 26

False negative stimulation using intraoperative nerve monitoring can occur due to: **1) posterior branch injury (branch to the PCA)** 2) distal stimulation relative to the injured nerve segment 3) delayed neuropraxia (traumatic peripheral nerve injury) 3) injury subsequent to the last testing stimulation

Question 27

False negative stimulation using intraoperative nerve monitoring can occur due to: **1) ** 2) distal stimulation relative to the injured nerve segment 3) delayed neuropraxia (traumatic peripheral nerve injury) 4) injury subsequent to the last testing stimulation

Answer 27

False negative stimulation using intraoperative nerve monitoring can occur due to: **1) posterior branch injury (branch to the PCA)** 2) distal stimulation relative to the injured nerve segment 3) delayed neuropraxia (traumatic peripheral nerve injury) 4) injury subsequent to the last testing stimulation

Question 28

False negative stimulation using intraoperative nerve monitoring can occur due to: 1) posterior branch injury (branch to the PCA) **2) _** 3) delayed neuropraxia (traumatic peripheral nerve injury) 4) injury subsequent to the last testing stimulation

Answer 28

False negative stimulation using intraoperative nerve monitoring can occur due to: 1) posterior branch injury (branch to the PCA) 2) distal stimulation relative to the injured nerve segment 3) delayed neuropraxia (traumatic peripheral nerve injury) 4) injury subsequent to the last testing stimulation

Question 29

False negative stimulation using intraoperative nerve monitoring can occur due to: 1) posterior branch injury (branch to the PCA) **2) _** 3) delayed neuropraxia (traumatic peripheral nerve injury) 4) injury subsequent to the last testing stimulation

Answer 29

False negative stimulation using intraoperative nerve monitoring can occur due to: 1) posterior branch injury (branch to the PCA) **2) distal stimulation relative to the injured nerve segment** 3) delayed neuropraxia (traumatic peripheral nerve injury) 4) injury subsequent to the last testing stimulation

Question 30

False negative stimulation using intraoperative nerve monitoring can occur due to: 1) posterior branch injury (branch to the PCA) 2) distal stimulation relative to the injured nerve segment **3)_** 4) injury subsequent to the last testing stimulation

Answer 30

False negative stimulation using intraoperative nerve monitoring can occur due to: 1) posterior branch injury (branch to the PCA) 2) distal stimulation relative to the injured nerve segment **3) delayed neuropraxia (traumatic peripheral nerve injury)** 4) injury subsequent to the last testing stimulation

Question 31

False negative stimulation using intraoperative nerve monitoring can occur due to: 1) posterior branch injury (branch to the PCA) 2) distal stimulation relative to the injured nerve segment 3) delayed neuropraxia (traumatic peripheral nerve injury) **4) _**

Answer 31

False negative stimulation using intraoperative nerve monitoring can occur due to: 1) posterior branch injury (branch to the PCA) 2) distal stimulation relative to the injured nerve segment 3) delayed neuropraxia (traumatic peripheral nerve injury) **4) injury subsequent to the last testing stimulation**

Question 32

The use of __ significantly *reduces* the prevalence of dysphonia in long-term inhaler users

Answer 32

Metered dose inhaler + Spacer

Question 33

How does menopause affect the voice (in terms of *frequency*)?

Answer 33

Decreases fundamental frequency by 25 Hz

Question 34

___ medication can improve the chance of RLN and FN recovery after injury.

Answer 34

Nimodipine (Ca-channel blocker)

Question 35

Patient intubated x3wks. On exam, you hear a breathy voice and decreased volume. b/l VCs are mobile and the membranous cords appear normal. A still of the larynx is shown. Diagnosis?

Answer 35

**Post-intubation phonatory insufficiency** (a.k.a. posterior glottic diastasis/insufficiency), resulting from ulceration of the arytenoids' medial mucosa w/associated scar 2/2 prolonged orotracheal intubation.

Question 36

Most common treatment options for posterior glottic stenosis:

Answer 36

Cordotomy w/arytenoidectomy