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ENT Written Board Prep > Laryngology > Flashcards

Laryngology Flashcards

1
Q

What muscle attaches to the vocal process of the larynx?

A

vocal process: thyroarytenoid

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2
Q

What structure(s) attach to the muscular process?

A

muscular process: LCA, PCA

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3
Q

Motion of the CA joint and impact on vocal process position?

A

CA joint - rotation of arytenoids outward leads to elevation and lateral displacement of the vocal process. rotation inwards leads depression and medial displacement.

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4
Q

Motion of the cricothyroid joint and function?

A

Cricothyroid joint - hinge/visor like movement anteriorly; lengthens VF

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5
Q

Where are the quadrangular membrane and conus elasticus located relative to VF?

A

quadrangular membrane is superior, runs between epiglottis and false VF

conus elasticus is inferior to that — superior border on conus elasticus is vocal process/vocal ligament; inferior is cricoid cartilage

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6
Q

What is the only abductor of the larynx? What is its effect on the muscular process? The vocal process? Arytenoids?

A

PCA - muscular process depression and posterior. vocal process elevation and lateral deviation. arytenoids lateral rotation.

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7
Q

The only unpaired muscle of the larynx?

A

interarytenoid

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8
Q

Innervation of the cricothyroid muscle? Impact on length and tension in vocal cords? How does it accomplish this?

A

superior laryngeal nerve; increases length and tension in the vocal cords by causing anterior closure of the cricothyroid space

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9
Q

Define: vestibule, ventricle, rima glottidis

A

vestibule - space in the supraglottis from inlet to the false VF, ventricle - invagination/recess between FVF and TVF; rima glottitidis - space between the TVF

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10
Q

Histology: cell type in the vocal fold/upper vestibule? cell type everywhere else in larynx?

A

Stratified squamous epithelium; ciliated columnar squamous epithelium everywhere else. NOTE: false vocal folds are pseudostratified.

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11
Q

Layers of the membranous vocal fold?

A

Epithelium, superficial/middle/deep layers of the superficial lamina propria, vocalis muscle.

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12
Q

General description of the layers of the lamina propria?

A

Superficial to deep gets progressively denser. hyaluronic acid in superficial layer, cross-linked collagen in deep.

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13
Q

Course of the left RLN? Course of the right RLN?

A

Left RLN wraps around ligamentum arteriosum, RLN wraps around the subclavian.

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14
Q

Course of a non-recurrent right RLN and associated developmental anomaly?

A

Non-recurrent right RLN comes off of vagus and directly to TE groove; a/w retroesophageal subclavian.

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15
Q

Associated developmental anomaly in the rare event of a non-recurrent left RLN?

A

Non-recurrent left RLN a/w situs inversus.

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16
Q

Origin of the superior thyroid artery vs the inferior thyroid artery?

A

superior thyroid artery comes off of external carotid. inferior thyroid artery comes off of thyrocervical trunk.

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17
Q

Lymphatic drainage of the supraglottis, infraglottis, and glottis?

A

supraglottis - upper jugular, infraglottis - lower jugular/pretracheal; glottis - no significant lymphatic drainage

18
Q

Position of the larynx (relative to cervical vetebrae) at birth vs adults? When does this descent occur?

A

Birth - C2-3, adult - C5, descent occurs around 6-8 years old in both genders; second descent at puberty in men

19
Q

Branchial cleft embryology of the larynx: a) which arch develops into cricothyroid muscle? which nerve associated? b) which arch develops remainder of laryngeal muscles? which nerve associated?

A

a) 4th arch; superior laryngeal nerve. b) 6th arch; recurrent laryngeal nerve

20
Q

Cause/Management of nodules

A

phonotrauma/“overuse”, voice therapy.

21
Q

Cause/management of VF polyp

A

like a mucocele/outpouching of mucosa, treatment is surgery.

22
Q

Cause/management of granuloma/contact ulcer

A

often trauma- intubation or phonotrauma, GERD. medical management +PPI unless obstructive, then surgery with high recurrence rate

23
Q

Contrast cyst vs sulcus vs pseudocyst: a) location b) management

A

cyst - epithelial lined. surgery but significant risk of persistent voice change. sulcus - deep invagination of the vocal fold w/wo epithelial lining. surgery or injection (with variable results). pseudocyst - submucosal; surgery.

24
Q

Management of leukoplakia/keratosis: a) possible etiologies b) conservative management options

A

both are premalignant. a) smoking, GERD, chronic phonotrauma, vitamin deficiencies b) if low suspicion for malignancy can initially watch closely with smoking cessation/PPI/voice therapy -> DL/excision with subsequent serial follow-up

25
Q

RRP: a) implicated HPV subtypes? b) management? adjunctive options?

A

a) serotypes 6&11. b) management is surgery. Adjunctive therapies include cidofovir, laser/photodynamic, cryotherapy

26
Q

VF paralysis: surgical options for unilateral?

A

injection, medialization +/- arytenoid adduction.

27
Q

most common cause for bilateral VF paralysis ? surgical options for bilateral?

A

most common cause for bilateral is THYROIDECTOMY. Surgical options include cordotomy/cordectomy, tracheotomy, arytenoid abduction. Innervation for either.

28
Q

Laryngeal reinnervation procedure: expected impact on function/outcome?

A

restore bulk/tone position, does not restore function; does not restore abductor function

29
Q

Spasmodic dysphonia, adductor vs abductor: a) which one more common? b) what type of words have breaks? c) options for management?

A

a) adductor more common; b) sixties/puppy for abductor spasmodic dysphonia, eighties/elephant for ADductor spasmodic dysphonia; c) botox injection to TA or lateralization thyroplasty for adductor. medialization thyroplasty for abductor.

30
Q

Classic X-ray finding for epiglottitis vs croup?

A

epiglottitis - thumb sign; croup - steeple sign

31
Q

Histological difference between pemphigus and pemphigoid?

A

pemphigus = intraepithelial blisters, pemphigoid = subepithelial blisters

32
Q

Systemic conditions that can affect the larynx based on buzzwords: non-caseating granulomas? what site(s) most commonly affected?

A

sarcoidosis; supraglottis, especially epiglottis.

33
Q

Systemic conditions that can affect the larynx based on buzzwords: cricoarytenoid joint fixation? what other conditions can cause this?

A

RA. Also SLE, TB, Crohn’s, syphilis, gonorrhea.

34
Q

Systemic conditions that can affect the larynx based on buzzwords: waxy gray or orange lesions on the epiglottis, nonspecific findings on H&E? What kind of stain needed to make the diagnosis?

A

amyloidosis; congo-red with birefrigence.

35
Q

Systemic conditions that can affect the larynx based on buzzwords: necrotizing granulomatous subglottic process and capillary thrombosis?

A

Wegener’s/PGA

36
Q

Systemic conditions that can affect the larynx based on buzzwords: oral ulcers that progress caudally to involve the larynx with 15% mortality?

A

pemphigoid

37
Q

Systemic conditions that can affect the larynx based on buzzwords: relapsing polychondritis - what site of dysfunction in the airway?

A

tracheal stenosis

38
Q

How to manage an acute unstable airway in laryngeal fracture? What is the one “exception” to this?

A

tracheotomy UNLESS complete cricotracheal separation — in which case theoretically attempt fiberoptic but may be extremely difficult and end up with slash trach anyway

39
Q

How to approach workup for a stable airway in laryngeal fracture?

A

If stable and no fracture suspected - observe. If stable but scope shows significant hematoma/fracture suspected - CT first, possible OR pending results. If stable but scope shows exposed cartilage/significant mucosal injury -> OR.

40
Q

Surgical treatment options for supraglottic, glottic, and subglottic stenosis?

A

Supraglottic - supraglottic laryngectomy most effective, other targeted expansion/stenting high risk for recurrence.

Glottic - can attempt cordotomy/cordectomy, possible trach. Issue is posterior VF usually fixed so need static opening but sacrifices voice.

Subglottic - can try endoscopic interventions but often may need tracheal resection

41
Q

Laryngeal cleft staging?

A

type 1 - interarytenoid cleft, does not pass TVF. type 2 - past TVF, into but not through cricoid. type 3 - through cricoid into cervical trachea, not into thoracic inlet. type 4 - into thoracic inlet/thoracic trachea

42
Q

X-ray findings on inspiration vs expiration for bronchial foreign body?

A

inspiration - atelectasis. expiration - hyperinflation

ENT Written Board Prep (13 decks)

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