Larynx

Question 1

Cervical position of larynx

Answer 1

C3 - C6

C2 - C3 in children

Question 2

3 processes of arytenoid

Answer 2

Muscular
Vocal
Apical

Question 3

Ligaments of the larynx

Answer 3

Thyroepiglottic
True vocal cords
False vocal cords

Question 4

Which compartment can you find the false vocal cords

Answer 4

Supraglottis

Question 5

Which compartment can you find the true vocal cords

Answer 5

Glottis

Question 6

arterial supply of larynx

Answer 6

branch of superior and inferior thyroid arteries

Question 7

distinguishing features of larynx of a child

Answer 7

1. Positioned higher than an adult larynx. Reaches the soft palate when swallowing
2. Laryngeal cartilages are soft and collapse easily. Epiglottis
   is omega shaped
3. Thyroid cartilage in an infant is flat.
4. Infant’s larynx is small and conical. The diameter of cricoid
   cartilage is smaller than the size of glottis
5. Submucosal tissues of infant’s larynx are comparatively loose and easily undergo oedematous change with trauma or inflammation leading to obstruction.

Question 8

landmarks of trachea

Answer 8

bifurcates at t5
commences at C6
10cm in length
bifurcation at t6 in full inspiration

Question 9

laryngeal symptoms

Answer 9

Hoarseness
Stridor
Dyspnea
Cough
Hemoptysis
Dysphagia

Question 10

mechanism of hoarseness

Answer 10

loss of approximation
size of the cord
stiffness

Question 11

Common cause of hoarseness of acute onset

Answer 11

local inflammation of the larynx. e.g. acute laryngitis

Question 12

Other causes of acute hoarseness

Answer 12

bacteria

brieft periods of vocal overuse

Question 13

time duration of chronic onset of hoarseness

Answer 13

longer than 2 weeks

Question 14

cause of chronic hoarseness

Answer 14

Pharyngeal reflux ,Benign polyps, Vocal cords nodules, Laryngeal papillomatosis, malignancy, Neurological disorders, or Chronic inflammation secondary to Smoking or voice abuse.

Question 15

systemic diseases that cause hoarseness

Answer 15

• Hypothyroidism
  
  • Multiple sclerosis
  • Rheumatoid arthritis
  • Parkinson’s dx.
  • Systemic lupus

Question 16

where are vocal nodules usually seen

Answer 16

free edge of the anterior 3rd of the VC

Question 17

How are vocal nodules formed

Answer 17

Pathologically, trauma to the vocal cord in the form of vocal abuse or misuse causes oedema and haemorrhage in the submucosal space.
This undergoes hyalinization and fibrosis. The overlying epithelium also undergoes hyperplasia forming a nodule

Question 18

in which of the pathologies is referred otalgia seen

Answer 18

vocal cord nodules

Question 19

Stridor

Answer 19

Noisy respiration produced by turbulent airflow through a partially obstructed airway.

Question 20

causative organism of juvenille papillomatosis

Answer 20

hpv 6 11

Question 21

which of the hpvs have high risk of malignancy

Answer 21

11

Question 22

Classic triad of juvenile papiloomatosis

Answer 22

being firstborn
vaginal delivery
having a mother younger than 20 years

Question 23

differential for JP

Answer 23

asthma

acute laryngitis

Question 24

imaging for JP

Diagnosis

Answer 24

soft tissue lateral neck xray

flexible fibreoptic laryngoscopy

Question 25

treatment for JP

Answer 25

repeated surgical debulking via microlaryngoscopy and CO2 laser excision avoiding injury to vocal ligament In the absence of CO2 laser, tumour can be removed under microscope with cup forceps or a debrider

Question 26

adjuvant therapy in JP

Answer 26

Intralesional injxn of cidofovir Indole-3-carbinol Vaccination with a quadrivalent vaccine. Protects against HPV 6, 11, 16 and 18

Question 27

Cause of acute laryngitis

Answer 27

infectious more of viral origin non - infectious..more of alcohol, trauma, etc.

Question 28

significant negative in laryngitis

Answer 28

dyspnea

Question 29

Age range of acute epiglottitis

Answer 29

2-7 years

Question 30

causative organism in acute epiglottitis

Answer 30

H. influenza type B | Strept species

Question 31

significant negative in epiglottitis

Answer 31

no hoarseness

Question 32

mnemonic for epiglottis

Answer 32

A - airway obstruction I - increased pulse R - Restlessness R - Retractions A - Anxiety increased I - Inspiratory stridor D - drooling

Question 33

which radiological sign is seen in epiglottis

Answer 33

thumb sign

Question 34

Most common cause of upper airway obstruction in infants and young children aged 6mo to 6yrs.

Answer 34

Croup or acute LTB

Question 35

Causative organism in ALTB

Answer 35

parainfluenza type 1 & 2 influenza virus

Question 36

which radiological sign is seen in LTB

Answer 36

steeple sign

Question 37

name of manoeuvre in fb aspiration

Answer 37

heimelich manuvre

Question 38

narrowest portion of upper airway in children and aldults

Answer 38

subglottic region | glottic region

Question 39

indications of cricothyroidectomy

Answer 39

- Emergency situations. - Palliative respiratory hygiene in the terminally ill. - In the presence of anatomic variations.

Question 40

indications of Tracheostomy

Answer 40

Bypass an UAO Bronchial toileting Assisted respiration.

Question 41

disadvantages of tracheostomy

Answer 41

``` Anosmia Aphonia Inability to lift heavy weights Inability to swim Inability to perform strenuous exercises Risk of aspiration if a cuffed tube is not used ```

Question 42

types of tracheostomyh

Answer 42

``` 1. TIMING Emergency/Elective tracheostomy 2. PURPOSE Permanent/ Temporary tracheostomy 3. POSITION High/Mid/Low tracheostomy ```

Question 43

borders of jackson's safety triangle

Answer 43

Base: Lower end of thyroid cartilage Apex: Suprasternal notch Sides: Inner edges of sternocleidomastoid muscle

Question 44

Significance of Jackson's safety triangle

Answer 44

So named as this marks the area through which safe dissection can be done for tracheostomy Also represents the area into which infiltration anesthesia is given during tracheostomy under local anesthesia

Question 45

Immediate complication of tracheostomy

Answer 45

``` Haemorrhage Air embolism Apnoea Cardiac arrest Damage to local structures False passage of the tracheostomy tube Puncture of the posterior tracheal wall Premature extubation during the procedure and loss of the airway ```

Question 46

early complication of tracheostomy

Answer 46

``` Dislodgement Surgical emphysema Pneumothorax/pneumomediastinum Scabs and crusts Infection- Tracheitis, cellulitis Tracheal necrosis Tracheoarterial fistula Dysphagia Early bleeding: Increased blood pressure as the patient emerges from anesthesia and begins to cough ```

Question 47

late complications of tracheostomy

Answer 47

``` Scarring Stenosis Difficult decannulation Bleeding - tracheoinnominate fistula Tracheoesophageal fistula Tracheo cutaneous fistula ```