Larynx and Trachea

Question 1

History in evaluation of larynx nd trachea

Answer 1

symptoms such as hoarseness, change in the quality of the voice, dyspnoea, difficulty in breathing, stridor, cough, expectoration, haemoptysis, pain, dysphagia or choking

Question 2

Stridor

Answer 2

used to describe noisy breathing

Question 3

Inspiratory vs. expiratory stridor

Answer 3

Inspiratory stridor suggests obstruction of the larynx. Expiratory stridor implies tracheobronchial obstruction

Question 4

Biphasic stridor suggests

Answer 4

a subglottic or glottic anomaly.

Question 5

Laryngomalacia

Answer 5

Laryngomalacia (or congenital flaccid larynx) is the most frequent congenital anomaly of the larynx. It produces partial obstruction of the supraglottic airway

Question 6

Clinical features of Laryngomalacia

Answer 6

The newborn typically will develop intermittent, inspiratory, low-pitched stridor within the first 2 weeks of life, which resolves slowly over several months. The symptom worsens during feeding

Question 7

D iagnosis and treatement of Laryngomalacia

Answer 7

Laryngoscopy

t consists of careful observation and reassurance of the parents. A small number of these infants seen by a paediatric otolaryngologist will require surgical intervention

Question 8

Character of stricor in Vocal fold paralysis

Answer 8

inspiratory or biphasic, with a high-pitched musical quality

Question 9

Causes of Paralysis of the vocal folds in a newbor

Answer 9

idiopathic or can result from birth trauma,

central or peripheral neurologic diseases,

or thoracic diseases or procedures.

Approximately 70% of noniatrogenic unilateral vocal fold paralyses will resolve spontaneously, most within the first six months of lif

Question 10

Subglottic stenosis

Answer 10

cricoid diameter of less than 3.5 mm

Question 11

Congenital stenosis can present as

Answer 11

a membranous and cartilaginous type and is typically the result of malformation of the cricoid cartilage

Question 12

The stridor of subglottic stenosis may be

Answer 12

inspiratory or biphasic and will worsen when the patient is agitated (increased airflow)

Question 13

Subglottic stenosis diagnosis

Answer 13

Direct laryngoscopy and bronchoscopy are needed to fully evaluate subglottic narrowing

Question 14

Tracheal stenosis may result from

Answer 14

complete tracheal rings or other cartilage deformities

Question 15

Diagnosis of tracheal stenosis

Answer 15

Endoscopic evaluation with a rigid bronchoscope is clearly the most accurate means of diagnosing tracheal stenosis

Question 16

Treatment. Tracheal stenoses can be managed

Answer 16

endoscopically, whereas longer stenoses are better corrected through an open approach

r segmental resection and reanastomosis for short-segment stenosis and use of slide tracheoplasty or augmentation of longsegment stenosis

Question 17

Acute laryngitis

Answer 17

an inflammatory process of the larynx, which can affect mucosa

(superficial type) or deeper laryngeal structures (muscle, cartilage)

Question 18

Main symptoms of acute laryngitis

Answer 18

Hoarseness, aphonia, pain in the larynx, and coughing attacks are the main symptoms of acute laryngitis

Question 19

Acute laryngitis is usually due to

Answer 19

ascending or descending viral infections from other parts of the airway. The cause is viral or, rarely, bacterial infection

Question 20

Diagnosis of . Acute laryngitis

Answer 20

Laryngoscopy reveals oedematous and eryhematous vocal folds. Depending on the underlying disease, the neighbouring pharyngeal or tracheal mucosa may also be inflamed

Question 21

Treatment of Acute laryngitis

Answer 21

steam inhalation, analgesia, and sufficient oral intake of fluids. Steroids are indicated for marked oedema

Question 22

Diphtheritic croup usually begins with

Answer 22

laryngeal membranes and obstruction

Question 23

Diphtheritic laryngitis

Answer 23

greyish-white membranes, occurring as an isolated condition, is also rare

Question 24

The term “pseudocroup” includes a group of

Answer 24

acute laryngotracheal diseases mainly affecting children.

Question 25

Acute subglottic laryngitis (laryngotracheitis) in children

Answer 25

A dry, barking cough following an upper respiratory tract infection that rapidly becomes worse.

Question 26

Clinical features of Acute subglottic laryngitis (laryngotracheitis) in children

Answer 26

Hoarseness, inspiratory, expiratory or mixed stridor, retraction of the suprasternal notch and of the intercostal spaces during inspiration, and cyanosis. The severity of respiratory obstruction depends on the degree of mucosal swelling in the subglottis. Worsening symptoms in children lead to concern due to potential airway obstruction

Question 27

pathogenesis. of (laryngotracheitis) in children

Answer 27

inflammatory mucosal swelling of the elastic cone in the subglottic space

Question 28

Diagnosis of (laryngotracheitis) in children

Answer 28

The clinical picture is usually very typical. Laryngoscopy reveals glottal mucosal oedema and redness, potentially with crust formation

Answer 29

antibiotic and steroid treatment

If treatment fails and dyspnoea increases oxygen therapy and standby for an endotracheal intubation

Tracheostomy is carried out when there is severe obstruction and progressive formation of the crust

Question 30

Acute epiglottitis is essentially

Answer 30

laryngeal supraglottitis

Question 31

clinical triad of Acute epiglottitis

Answer 31

drooling, dysphagia, and distress

Question 32

Severe pain of acute epiglottitis during swallowing and refusal of food and liquid intake may lead to

Answer 32

dehydration and potential circulatory collapse

Question 33

Clinical features of Acute epiglottitis

Answer 33

Inspiratory stridor usually forces the patient to sit upright in bed with the nose pointing upwards in a “sniffing the morning air position”.

Speech is muffled (“hot potato speech”) and temperature is elevated

Question 34

Causative pathogen and aetiology of Acute epiglottitis

Answer 34

The main cause is infection with haemophilus influenzae. The disease can also be caused by mucosal damage resulting from swallowing sharp-edged food, allowing pathogenic organisms to enter

Question 35

Diagnosis in Acute epiglottitis

Answer 35

thick, swollen, red epiglottic rim

Question 36

Treatment Acute epiglottitis

Answer 36

hospital if a diagnosis of epiglottitis is suspected. If respiratory arrest occurs, the airway is secured by intubation but tracheostosmy might be required

Question 37

Bacterial tracheitis in children

Answer 37

(bacterial laryngotracheobronchitis, pseudomembranous croup, or membranous laryngotracheobronchitis) is a rare acute infection of the upper airway that does not involve the epiglottis but can cause life-threatening sudden airway obstruction, particularly in children

Question 38

The infectious inflammatory process in Bacterial tracheitis in children involves the

Answer 38

subglottis and trachea with marked edema in the subglottis as in those with viral croup

Question 39

Clinical features Bacterial tracheitis in children

Answer 39

brassy cough, high fever, worsening inspiratory stridor.

Question 40

Diagnosis in Bacterial tracheitis in children

Answer 40

confirmed by endoscopic examination

Question 41

The most commonly isolated pathogens Bacterial tracheitis in children

Answer 41

Staphylococcus aureus, Moraxella catarrhalis and H. influenzae

Question 42

Chronic nonspecific laryngitis

Answer 42

This is laryngitis caused by a recurrent irritation, or following acute laryngitis

Question 43

Symptoms of Chronic nonspecific laryngitis

Answer 43

hoarseness, a deeper voice, and sometimes a dry cough. The voice is less robust and there is a globus sensation in the larynx and a feeling of needing to clear the throat, but little or no pain

Question 44

Chronic nonspecific laryngitis pathogenesis

Answer 44

mainly due to exogenous toxins such as cigarette smoking, occupational air pollution, and climatic influences.

Another cause is vocal overuse in bartenders, construction workers, call centre agents, and other professional speakers. Nasal obstruction may also be a factor in the pathogenesis.

Question 45

An importan cause of chronic laryngitis is also

Answer 45

untreated laryngopharyngeal reflux

Question 46

Vocal fold polyp Definition. Polyps are

Answer 46

fluid-filled collections that form on the edge of a vocal cord

Question 47

Clinical features. Polyps

Answer 47

hoarseness, dys/aphonia, and attacks of coughing. If the polyp has a pedicle and is floating between the folds, the voice may return to normal for short intervals

Question 48

Reinke’s oedema is a

Answer 48

pathologic condition of the vocal fold that involves an accumulation of a gelatinous type of fluid throughout the superficial aspect of the lamina propria

Question 49

Clinicl feataures of Reinke’s oedema

Answer 49

hoarseness and deepening of the voice. Stridor may occur, particularly on exertion, if the oedema is marked

Question 50

Recurrent respiratory papillomatosis

Answer 50

benign disease presenting with wart-like growths in upper airway which is caused by the human papillomavirus (HPV)

Question 51

Clinical features of Recurrent respiratory papillomatosis

Answer 51

Hoarseness, often severe, and respiratory obstruction, depending on the site and extent of the lesions.

Question 52

Carcinoma of the larynx accounts for approximately

Answer 52

40% of carcinomas of the head and neck

Question 53

Carcinoma of the larynx t is most common between the ages of

Answer 53

45 and 75 years

Question 54

Carcinoma of the larynx Clinical features

Answer 54

Hoarseness

foreign-body sensation

clearing the throat,

pain in the throat or

referred to the ears

dyspnoea,

dysphagia,

cough,

and haemoptysis.

Metastases to regional lymph nodes may also occur

Question 55

Invasive carcinoma may develop from

Answer 55

epithelial dysplasia, particularly carcinoma in situ.

Question 56

The clinical diagnosis of Carcinoma of the larynx

Answer 56

indirect laryngoscopy, video laryngoscopy, and stroboscopy