Larynx (Anatomy, Carcinoma, Vocal Cord Disorders, Stridor) MCQs

ENT · 78 free questions with answers & explanations.

1. A 60-year-old male with a T3N0M0 supraglottic squamous cell carcinoma (involving the epiglottis and pre-epiglottic space, cord mobile) is being counselled about surgical options. The appropriate voice-preserving surgical option is:
2. The subglottis has a rich network of lymphatics that crosses the midline. This explains the clinical behaviour of subglottic carcinoma compared to glottic carcinoma in terms of:
3. A 45-year-old teacher presents with progressive bilateral vocal cord polyps refractory to voice therapy. Microlaryngoscopic surgery is planned. The surface of a vocal polyp on microlaryngoscopy appears:
4. Which structure forms the pre-epiglottic space posteriorly and is important because tumour invasion of this space upstages a supraglottic carcinoma to at least T3?
5. A 25-year-old patient presents with recurrent respiratory papillomatosis. Histology shows koilocytes, and HPV typing reveals type 6 and 11. Regarding HPV 11 compared to HPV 6, which statement is correct?
6. A 58-year-old chronic smoker presents with hoarseness for 4 months. Laryngoscopy reveals a lesion involving the anterior commissure with extension to the contralateral cord and subglottis. According to AJCC TNM staging, this is classified as:
7. The Reinke's space is critical to understanding vocal cord pathology. Which of the following correctly describes Reinke's space?
8. A neonate presents with biphasic (both inspiratory and expiratory) stridor from birth, worse in prone position, with a normal cry. Flexible nasopharyngoscopy shows posterior displacement of the arytenoids and aryepiglottic folds. Which diagnosis is MOST likely?
9. Which surgical landmark defines the boundary between the supraglottis and glottis for staging laryngeal carcinoma?
10. In the management of early glottic carcinoma (T1N0M0), which statement best reflects current evidence-based guidelines regarding oncologic outcomes of radiotherapy versus laser cordectomy?
11. Subglottic carcinoma (below the free edge of vocal cord to the lower border of cricoid cartilage) has the worst prognosis among laryngeal carcinomas primarily because:
12. A patient with bilateral vocal cord palsy in adduction presents in the emergency. Immediate management is:
13. The 'Reinke's space' is a potential space between the epithelium and the vocal ligament. In Reinke's oedema, accumulation of fluid occurs in this space due to:
14. In laryngeal framework surgery, the procedure of choice to medialise a paralysed vocal cord without entering the laryngeal lumen is:
15. A 3-year-old presents with acute onset 'seal-bark' cough, low-grade fever, and inspiratory stridor. X-ray neck shows the 'steeple sign.' The diagnosis is croup (laryngotracheobronchitis). The FIRST-LINE treatment for moderate croup is:
16. A patient with carcinoma of the larynx has T2N0M0 disease involving the supraglottis with normal cord mobility. According to current TNM staging (AJCC 8th edition) and oncologic principles, the preferred management is:
17. Reinke's edema (polypoid degeneration of the vocal cord) involves pathological accumulation of fluid in which anatomical layer?
18. An infant presents at birth with high-pitched inspiratory stridor that worsens when supine and improves when prone. Laryngoscopy shows retroflexion of a soft, omega-shaped epiglottis with prolapse of aryepiglottic folds on inspiration. The diagnosis and appropriate initial management are:
19. During thyroid surgery, the recurrent laryngeal nerve is at greatest risk at which specific anatomical location, and what vocal cord finding results from its complete bilateral division?
20. In a patient with T1a glottic carcinoma (confined to one vocal cord with normal mobility), the preferred primary treatment option in a specialized center that offers equivalent oncological outcomes to radiotherapy while providing an immediate histological specimen is:
21. A 45-year-old male with progressive biphasic stridor since childhood, now exacerbating, undergoes laryngoscopy showing warty growths at bilateral vocal cords. Biopsy confirms recurrent respiratory papillomatosis (RRP). The causative HPV serotypes and current adjuvant therapy used after surgical debulking are:
22. The paraglottic space is a key pathway for the spread of laryngeal cancer that determines resectability. It is bounded medially by which structure and laterally by which structure?
23. A 3-year-old child presents with sudden onset inspiratory stridor, fever 39°C, drooling, and sitting in tripod position. X-ray lateral neck shows widening of the epiglottis ('thumb sign'). The most common causative organism is:
24. During thyroid surgery, the external branch of the superior laryngeal nerve (EBSLN) is at risk of injury. What specific voice change would a singer report if this nerve were transected, and which muscle does it innervate?
25. A 55-year-old smoker presents with a T1a glottic carcinoma (confined to one vocal cord with normal mobility). What is the preferred treatment option with equal cure rates but better voice preservation?
26. The 'dangerous area' of the larynx — the subglottis — has specific lymphatic drainage characteristics. Which statement is MOST accurate regarding subglottic carcinoma?
27. A 6-year-old child presents with recurrent respiratory papillomatosis (RRP). HPV typing confirms HPV 6 and 11 infection. Which HPV types cause the most aggressive form with higher risk of malignant transformation?
28. In acute epiglottitis in an adult, the characteristic radiological finding on lateral soft tissue neck X-ray is:
29. During a total laryngectomy for advanced laryngeal carcinoma, the surgeon identifies the pre-epiglottic space. What structures bound this space?
30. The subglottis is the laryngeal subsite with the worst prognosis for carcinoma despite being rare. The primary reason for late diagnosis and poor prognosis is:
31. A young teacher presents with bilateral symmetric sessile swellings at the junction of the anterior and middle thirds of the vocal cords after a semester of heavy voice use. Stroboscopy reveals mucosal wave disruption and incomplete glottic closure at the lesion site. Histology shows hyalinised subepithelial fibrous tissue. What is the FIRST-LINE treatment?
32. A child is brought with congenital stridor present since birth. The stridor is inspiratory, high-pitched, worse when supine, and the child feeds poorly but is growing along the 10th centile. Flexible nasopharyngoscopy shows an omega-shaped epiglottis with short aryepiglottic folds prolapsing over the glottis on inspiration. Which finding would indicate a need for surgical intervention (supraglottoplasty)?
33. After thyroid surgery, a patient develops a hoarse, breathy voice with an ineffective cough. Laryngoscopy shows the left vocal cord in the cadaveric (paramedian) position. The nerve most likely injured is:
34. In the TNM staging of laryngeal carcinoma (AJCC 8th edition), a supraglottic tumour with invasion of the pre-epiglottic space and normal vocal cord mobility is classified as:
35. A 58-year-old smoker is found to have T1a carcinoma of the left vocal cord on laryngoscopy. The lesion is confined to one vocal cord with normal mobility and no regional or distant metastasis. According to current NCCAP/NCCN guidelines, what is the preferred primary treatment offering the best voice outcome?
36. The recurrent laryngeal nerve (RLN) supplies all intrinsic laryngeal muscles EXCEPT one. Which muscle is the exception, and what nerve supplies it?
37. A 3-year-old child presents with inspiratory stridor, fever, and a barking cough that worsened at night. X-ray neck AP view shows the 'steeple sign' (subglottic narrowing). The MOST appropriate pharmacological first-line treatment is:
38. A patient with carcinoma of the supraglottis (T2N0M0) is being considered for a supraglottic laryngectomy. Which of the following pre-operative assessments is MOST critical to determine candidacy for this procedure?
39. Bilateral vocal cord paralysis most commonly results in which position of the vocal cords, and what is the primary clinical consequence?
40. A 55-year-old male smoker presents with progressive hoarseness for 6 months. Laryngoscopy reveals an exophytic lesion of the right vocal cord occupying the anterior third with involvement of the anterior commissure. Pathology confirms SCC. What is the significance of anterior commissure involvement for surgical planning?
41. A 35-year-old female presents with progressive biphasic stridor worsening over 2 years. She has a history of prolonged intubation 3 years ago. Laryngoscopy shows circumferential subglottic narrowing at 1 cm below the vocal cords, with normal cords. The Cotton-Myer grade III subglottic stenosis (71–99% obstruction) is best managed by:
42. A patient presents with a 3 cm carcinoma of the true vocal cord with normal cord mobility, extending to the subglottis, with no nodal disease. According to AJCC TNM staging (8th edition), this is classified as:
43. Recurrent laryngeal nerve (RLN) palsy on the left side following thyroidectomy produces which voice quality change and which laryngoscopic finding?
44. Juvenile-onset recurrent respiratory papillomatosis (JORRP) is caused by which HPV subtypes and is most commonly acquired:
45. A patient undergoes total laryngectomy for T4a glottic carcinoma. Six months later, he presents with successful tracheoesophageal voice via a Blom-Singer prosthesis. The underlying mechanism of this voice production is:
46. A 45-year-old smoker presents with progressive hoarseness for 4 months. Laryngoscopy reveals a white leukoplakic lesion on the anterior commissure crossing to involve both vocal cords bilaterally. The Delphian (prelaryngeal) lymph node is the sentinel node for which part of the larynx?
47. Which laryngeal carcinoma subsite carries the best prognosis for early-stage disease due to the relative absence of lymphatics in that region?
48. A 55-year-old smoker has a T1a squamous cell carcinoma of the left true vocal cord confined to the mobile cord without anterior commissure involvement. The preferred treatment modality that preserves voice quality with the highest local control rate is:
49. Bilateral abductor vocal cord paralysis presents with which symptom pattern, and what is the immediate airway intervention?
50. A patient presents with progressive dysphagia, 'hot potato' voice, drooling, and neck stiffness. Lateral neck X-ray shows widening of the prevertebral soft tissue shadow. The most appropriate immediate investigation and management is:
51. Subglottic hemangioma is a common cause of biphasic stridor in infants under 6 months. Which cutaneous finding strongly suggests the diagnosis before endoscopy?
52. In recurrent respiratory papillomatosis (RRP), the causative HPV types and the preferred medical adjuvant to surgery are:
53. A 55-year-old male smoker presents with progressive hoarseness for 4 months. Laryngoscopy shows a lesion involving the anterior commissure with bilateral vocal cord involvement. On microlaryngoscopy, the tumor is limited to the vocal cords with no fixation. CT shows tumor crossing the anterior commissure. Under AJCC staging this is classified as T2 or T3 based on the specific AJCC 8th edition criterion. Which feature would upgrade this to T3?
54. Subglottic stenosis following prolonged endotracheal intubation is most commonly due to pressure necrosis at which specific level of the tracheal/subglottic airway?
55. A 6-month-old infant presents with intermittent inspiratory stridor since birth, exacerbated by crying and feeding, with no cyanosis. The cry is normal. Laryngoscopy in the awake state shows an omega-shaped epiglottis and prolapse of the aryepiglottic folds on inspiration. The diagnosis and initial treatment are:
56. A 50-year-old with T1N0M0 glottic carcinoma (limited to one true vocal cord, normal mobility) is being evaluated for treatment. Which treatment offers equivalent 5-year local control with maximum laryngeal preservation?
57. A 3-year-old presents with acute onset inspiratory stridor, a barking cough, and mild fever following an upper respiratory tract infection. Lateral neck X-ray shows a 'steeple sign' (subglottic narrowing). What is the pathogenesis and FIRST-LINE treatment?
58. A 45-year-old female singer notices progressive dysphonia over 6 months. Laryngoscopy shows bilateral symmetrical pedunculated swellings at the junction of the anterior and middle thirds of both vocal cords. She reports voice abuse and acid reflux. These lesions are BEST described as:
59. The pre-epiglottic space of the larynx is clinically important in laryngeal carcinoma because:
60. A 45-year-old woman presents with progressive dysphonia and is found to have a firm submucosal mass at the right vocal cord. Biopsy reveals a neoplasm with spindle cells arranged in fascicles, with focal cartilage formation. Immunohistochemistry is positive for desmin and negative for cytokeratin. The most likely diagnosis is:
61. In a patient with bilateral recurrent laryngeal nerve palsy following thyroid surgery, the vocal cords are found to lie in the paramedian position. What is the expected clinical presentation?
62. A 55-year-old male smoker presents with progressive hoarseness. Laryngoscopy reveals a whitish lesion covering the entire right vocal cord. Biopsy shows moderate dysplasia (CIN II equivalent). The most appropriate management is:
63. Reinke's oedema (polypoid corditis) is characterised by accumulation of oedematous fluid in the Reinke's space. This space is located:
64. In a neonate with stridor present at rest that worsens with agitation and feeding, associated with a 'crowing' inspiratory noise but normal cry, the most likely diagnosis is:
65. Contact ulcers of the larynx most commonly occur at:
66. Bilateral abductor palsy of the vocal cords presents with which clinical picture?
67. Which glottic subsites have the richest lymphatic drainage, making early lymph node metastasis most likely?
68. Juvenile recurrent respiratory papillomatosis (JRRP) is most commonly caused by which HPV type(s)?
69. A 50-year-old smoker presents with progressive dysphonia, dysphagia, and right-sided otalgia with a normal ear examination. The otalgia is most likely referred via which nerve?
70. A 55-year-old male smoker presents with progressive hoarseness for 8 months. Laryngoscopy shows a lesion limited to one true vocal cord with normal cord mobility. Biopsy confirms squamous cell carcinoma. According to TNM staging, this is:
71. A 3-year-old child presents with inspiratory stridor that is worse when lying supine and improves in the prone position. The stridor is soft and musical, present since birth. The most likely diagnosis is:
72. The only abductor muscle of the vocal cord is:
73. A 40-year-old teacher develops hoarseness at the end of each working day that recovers overnight. Laryngoscopy shows a translucent swelling at the junction of the anterior and middle thirds of both vocal cords. The most appropriate initial management is:
74. Which laryngeal cartilage does NOT ossify in normal adults?
75. A child presents with biphasic (inspiratory and expiratory) stridor since birth that worsens with crying but is relieved in the prone position. Flexible laryngoscopy shows omega-shaped epiglottis and collapse of the arytenoid mucosa during inspiration. The most appropriate initial management is:
76. A 40-year-old woman develops progressive bilateral vocal cord palsy after total thyroidectomy. She develops stridor at rest. Her preferred treatment for airway restoration while preserving voice quality is:
77. Reinke's oedema (polypoid corditis) is characterised by accumulation of oedema in which space of the vocal cord?
78. A 55-year-old male smoker undergoes laryngoscopy and is found to have a vocal cord lesion. Biopsy shows carcinoma in situ (CIS) of the glottis. The most appropriate management is: