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ENT Sure Success > Larynx > Flashcards

Larynx Flashcards

1
Q

Larynx extends from ……to …..
Laryngeal cartilage are ……in number.
How many are paired, how many unpaired?

A

C3-C6

9

3paired, 3 unpaired .

3 paired: 3unpaired
1. Arytenoid. Thyroid
2. Corniculate. Cricoid
3. Cuneiform. Epiglottis

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2
Q

…….(3) made up on hyaline cartilage

A

Thyroid
Cricoid
Basal part of arytenoid cartilage

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3
Q

Difference between hyaline and elastic cartilage

A

Hyaline: ossify after 25 years
Elastic : do not ossify.

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4
Q

Only complete ring of cartilage around trachea

Largest laryngeal cartilages

A

Cricoid cartilage

Thyroid cartilage

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5
Q

Thyrohyoid pierced by ….&……

2 synovial joints of laryngeal cartilages

A

SL vessels & ILN

Cricoarytenoid
Cricothyroid joints

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6
Q

Narrowest part of larynx in adults
In children

Prelaryngeal LN called ….

A
  1. Rima glottidis
  2. Subglottic region

Delphic nodes

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7
Q

Pre epiglottic space is ….

A

Space of boyer

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8
Q

Larynx in infants is different. How?

A
  1. Larynx is higher-C2-C4 and anterior
  2. Funnel shaped
  3. Tongue is larger
  4. Trachea is shorter
  5. Laryngeal cartilage are soft
  6. Epiglottis is omega shaped
  7. Arytenoids larger
  8. Thyroid cartilage flat
  9. Submucosal tissues- loose.
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9
Q

Different muscles of larynx

Cartilage that doesn’t alter with age;

A

Vocal cords: stratified squamous
Mucosa: ciliated columnar.

Epiglottis

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10
Q

Only intrinsic muscle in external aspect of larynx
It is ……
Supplied by ….

A

Cricothyroid

Tensor muscle

ELN- br of SLN

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11
Q

Only abductor of vocal cords

Safety muscle of larynx

A

Posterior cricoarytenoid

Posterior cricoarytenoid

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12
Q

Whispering muscle is …..
It is a ……..(abductor/adductor)

All muscles of larynx are paired except…

A

Transverse arytenoids.
Adductor muscle

Transverse arytenoid.

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13
Q

Sensory and motor nerve supply of larynx

A

Sensory :
1. Supraglottis- internal br of SLN-ILN
2. Subglottis: RLN
3. Glottis: both ILN & RLN

Motor supply of larynx:
All muscles :RLN except:
cricothyroid (ext br of SLN)

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14
Q

Right and left RLN

A

Right: turn around subclavian a
Left: turn around arch of aorta.
Left longer than right; paralysis of left 4times more than right.

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15
Q

Galen anastomosis is …..
Which is the human communicating nerve?

A

Connection between RLN and internal branch of SLN.

Anastomosis between external branch of SLN and distal RLN

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16
Q

Both SLN and RLN are branches of ……

Indirect laryngoscopy is done using ……..
How is process done?

A

Vagus nerve

Laryngeal mirror
Mirror warmed before use by placing glass surface on a flame.

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17
Q

Direct laryngoscopy is done using …….
Position used is …..

A

Rigid laryngoscopy

Boyce position or barking dog position.

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18
Q

What is micro laryngoscopy?

A

Combination of laryngoscopy and operating microscopy started by Kleinasser.

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19
Q

Blind areas that can’t be visualized on indirect laryngoscopy are : (5)

A
  1. Laryngeal surface of epiglottis/ infrahyoid epiglottis
  2. Ventricle of larynx
  3. Subglottis
  4. Anterior commissure
  5. Apex of pyriform fossa
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20
Q

Left is longer than right coz of ……

U/L RLN (abductor paralysis) sms.

A

Persistence of 6th arch artery- as ductus arteriosus which later fibrosis as ligamnetum arteriosum.

Affected cord lie close to midline- slight hoarseness of voice which improves over days.

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21
Q

Left RLN palsy caused by …(4)
Rx:

A
  1. Pancoast Tumor of lung
  2. Mitral stenosis
  3. Aneurysm of arch of aorta
  4. Apical TB

No Rx required.

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22
Q

What is ortner’s syndrome?
What happens in B/L RLN abductor paralysis? Rx

A

Paralysis of left RLN in cases of cardiomegaly.

Vocal cords come to the midline.
Normally we breathe with VC open and speak with VC closed.
So, in b/L abductor paralysis, speech is ok, but can’t breathe.

Rx: immediate tracheostomy —>6mo later:—-> type 2 thyroplasty.

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23
Q

What happens in B/L adductor paralysis ? Rx.

A

Both VC are in open / cadaveric position.
Sms: breathe is ok,but can’t speak,
Aspiration also.

Rx: wait for 6 months —> type 1 thyroplasty.

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24
Q

What is Bovine cough?

A

Cow-like cough- normal loss of explosive phase of normal coughing —> upon failure of cords to close the glottis.

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25
Q

Mc cause of vocal cord paralysis is….

Properties of cricothyroid. (2)

A

Iatrogenic (surgical )

  1. Adductor
  2. Tensor property
    Cricothyroid is the main tensor, which gives quality of voice.
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26
Q

Branches of SLN

A

SLN: external br: cricothyroid
internal br: sensory supply - supraglottis

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27
Q

If SLN is damaged. Features (2)

A
  1. Poor quality of voice - main tensor of VC
  2. Aspiration- loss of sensory supply to supraglottis.
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28
Q

Thyroplasty types:

A

Type1: Medialization of Vc
Type 2: Lateralization of VC
Type 3: shortening of VC- lower pitch
Type 4: lengthening of VC- increase pitch

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29
Q

Gentle abduction of VC seen in ……
Full abduction of VC seen in ….

A

Quiet respiration, paralysis of adductors

Deep inspiration

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30
Q

Position of Vc in strong whisper
Types of Thyroplasty is introduced by …..

A

Paramedian position

Isshiki

31
Q

Mc congenital abnormality of larynx is …..
In laryngomalacia, extensive flaccidity is in …..

A

Laryngomalacia

Supraglottic larynx

32
Q

Stridor of laryngomalacia is ….
Rx.

A
  1. Since birth
  2. Increased crying - crying sounds normal
  3. Decreased stridor in prone position
  4. Inspiratory stridor

Rx: conservative , reassurance.

33
Q

Conservative Rx for laryngomalacia is seen in ……(4)

A
  1. Laryngomalacia
  2. U/L vocal cord palsy
  3. CSF rhinorrhea
  4. Traumatic perforation of ear drum.
34
Q

Direct laryngoscopy shows laryngomalacia is ……shaped

Tracheomalacia associated with …..
…..cough seen

A

Omega

TEF
Barking cough

35
Q

What is laryngocele?
Affects …..professions

A

Dilatation of laryngeal saccule- arise from raised transglottic air pressure.

  1. Trumpet blowers
    Glass blowers
    Weight lifters
36
Q

External laryngocele herniates through …..

What is Bryce’s sign?

A

Thyrohyoid membrane

Gurgling sound produced on pressing external laryngocele

37
Q

Dx of laryngocele? Rx

A

Xray neck with valsalva
Rx: surgery

38
Q

Mc cause of vocal nodules is …
2nd mc cause is ….
Always ……
Junction of …….

A

Vocal abuse
GERD

B/L
Jn of anterior 1/3 & posterior 2/3

39
Q

Chief complaint of vocal nodules
Rx. (3)

A

Hoarseness of voice
Rx: voice rest + speech rx + PPI

40
Q

What is keratosis larynx?
Rx. (3)

A

Seen in smokers
Vocal cord epithelium starts shedding faster —> keratinous debris on vocal cords

Surgery-
1. stripping vocal cord mucosa/decortication
2. Quit smoking
3. CO2 laser cordectomy.

41
Q

Define Reinke’s space

What is Reinke’s edema?
Rx.

A

Vocal cord lined by stratified squamous epithelium. Below stratified squamous epithelium, there is submucosal connective tissue- Reinke’s space.

B/L diffuse swelling of VC- seen in smokers
Rx: surgery- decortication

42
Q

Tb larynx is most commonly in …..
Mc affected part is …

A

Posterior VC than anterior

Inter arytenoid fold

43
Q

Earliest symptom of tb vocal cord
First sign is …

A

Weakness of voice
Impaired adduction

44
Q

Laryngoscopy finding of TB larynx (3)

A
  1. Mamillated appearance- swelling in inter arytenoid region
  2. Mouse nibbled appearance -ulceration of VC
  3. Turban epiglottis: pseudoedema of epiglottis
45
Q

Acute laryngotracheobronchitis seen in ….
Cause is …
Age:

X-ray of acute laryngotracheobronchitis
Rx.

A

Croup
Viral parainfluenza
Age: 3 months to 3 years

Steeple sign- narrowing of subglottic area
Rx :
Humidifier O2+ bronchodilator + steroid + antibiotic — prevent secondary bacterial infection.

46
Q

When false VC take over the function of true VC; it’s called?
Voice is ….

A

Dysphonia plica ventricularis
Rough, low pitched,unpleasant

47
Q

Supraglottic larynx includes ….(5)

A

Epiglottis
False vocal cords
Ventricles
Aryepiglottic folds
Arytenoids

48
Q

The glottis includes ….(2)
The subglottic region is ….

A

True VC
Anterior and posterior commissure

1cm below true vocal cords
Extends to cricoid cartilage or first tracheal ring.

49
Q

Juvenile papilloma of larynx is ….
Seen in …… cause….
Sms.

A

Premalignant disease
Children
HPV 6,11.

Sms: warts on vocal fold —>trachea and bronchi—>chronic hoarseness +_ respiratory difficulty.

50
Q

Rx for juvenile papilloma of larynx
Prognosis

A

CO2 laser surgery
Recurrence. Patient has multiple surgeries.

51
Q

How to decrease recurrence rate of juvenile papilloma of larynx? (3)

A
  1. Intralesional Cidofovir
  2. IFN-gamma
  3. Bevacizumab
52
Q

Mc site of juvenile papilloma of larynx

Risk factors for ca larynx (7)

A

Vocal folds

  1. Smoking
  2. Alcohol
  3. GERD
  4. Asbestos
  5. Wood dust
  6. Nitrogen mustard
  7. Ionizing radiation .
53
Q

Age group of carcinoma larynx
Mc in ….
Mc type of ca larynx

A

40-70 yrs
Males

Squamous cell cancer

54
Q

Mc type of cancer of larynx is …..next is ….
Least is …..

A

Glottic cancer
Supraglottic
Subglottic

55
Q

Early presentation of glottic cancer is ….
Prognosis

A

Hoarseness

Best prognosis as LN involvement is late

56
Q

Mc site for Supraglottic cancer is ….
Sms…
Sign…
Prognosis

A

Epiglottis
Pain on swallowing
Mass on neck

Poor-patient reports late and LN involvement occurs early.

57
Q

Worst prognosis of ca larynx is ….
Presents with ….
Verrucous cancer caused by ….

A

Subglottis
Stridor

HPV 16,18

58
Q

Highest incidence of distant mets with ca larynx is with …

Laryngofissure means….

A

Lungs

Opening of larynx/ thyroid cartilage in midline.

59
Q

Stages of ca larynx

A

Type 1: only 1 named structure.
1 VC: T1A, 2 Vc= T1B
Rx: CO2 laser Rx > radiotherapy

Type 2: >1 named structure
Rx: radiotherapy
2nd option: if lung fn normal:
Partial laryngotomy

Type 3: VC is immobile and fixed.
Invasion of preglottic and paraglottic space
Rx: total laryngectomy +_ radical neck dissection—> radiotherapy

2nd option: concurrent chemoradio

Type 4: invasion of thyroid /extralaryngeal neck structures
Rx: total latyngectony +_radical neck dissection —>radiotherapy
2nd: concurrent chemoradiotherapy.

Best option for T3,T4:
Tracheoesophageo puncture device

60
Q

Rehab for speech in ca larynx
…….helps restoration of olfactory sensation after larynectomy

A

Asai laryngoplasty technique
Best now : TEF speech

Polite yawning -yawning with mouth closed

61
Q

Level or site of tracheostomy

A

High level: at first tracheal ring
Mid level:
at 2&3 tracheal rings -preferred method

Low level: at 4&5 tracheal rings

62
Q

Structures seen while bronchoscopy: (6)

A
  1. Uvula
  2. Epiglottis
  3. Vocal cords
  4. Larynx
  5. Trachea , carina
  6. Segmental/ subsegmental bronchi
63
Q

Intubation in child is done with …..

A

Straight blade and cuff tube- to decrease aspiration.

64
Q

Complications of tracheostomy (3)

A
  1. Hemorrhage
  2. Surgical emphysema-
    collection of air beneath skin
    Coz of tight skin suture
  3. Immediate complication
    Apnea—>CO2 washout —> drive for respiratory centre gone.
65
Q

………is associated with pan masala/ supari
2. Mc type of oral cancer
3. Mc site of oral cancer

A

Oral submucosal fibrosis of larynx

  1. Squamous cell ca
  2. Tongue
66
Q

Mc site of oral cancer in india

Mc site of tongue cancer

A

Buccal mucosa

Lateral border

67
Q

Mc site of lip cancer

……is investigation of choice for ca oral cavity

A

Vermilion of lower lip

MRI

68
Q

Pathology of Ludwig’s angina

A

Molar/premolar caries —> infection to chin( cellulitis of submandibular space)

This causes glottic edema and painful airway compromise

69
Q

Rx for Ludwig’s angina

A

Immediate antibiotic : cefuroxime+ metrogyl
If no response-drain submandibular triangles under local anesthesia

70
Q

Infection from molar /premolar affecting angle of mouth, but no chin swelling. D/o

Egg shell crackling seen with ….
Cyst in mandibular are is ….

A

Parapharyngeal abscess

Dental cysts-at maxilla
Follicular cyst-dentigerous cyst

71
Q

Xray s/o soap bubble /honeycomb appearance is ……

What is intubation granuloma?
Rx:

A

Adamanitoma

Results from traumatic endotracheal intubation-large granuloma arising from arytenoid
Prolonged intubation in ICU patients.
B/L disease
Surgery: microlaryngeal surgery

72
Q

Cotton Meyer staging done for …..
What are the stages ?

A

Subglottic stenosis
Type1: 0-50% conservative
Type 2: 51-70% obst- laser /dilatation
Type 3: 71-90% obst-
Type 4: no lumen detected .

Type 3&4- rx : laryngotracheal reconstruction—> Montgomery’s silicon tracheal T tube.

73
Q

Uses of mitomycin C (3)

A
  1. Laryngotracheal stenosis
  2. Prevent formation of synechiae in nose after surgery
  3. Surgery: choanal atresia mgt
74
Q
  1. Site of vocal cord nodule:
  2. Site of intubation granuloma
A
  1. Ant 1/3, post 2/3
  2. Ant 2/3, post 1/3

ENT Sure Success (4 decks)

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