Annual 2003

a.
b.
c.
d.
e.
f.
g.
h.
a.
b.
c.

Q.No.2
Write short note on causes of (L) recurrent NERVE PALSY?
Ans:
These are
Carcinoma of bronchus
Carcinoma of the cervical and thoracic esophagus
Carcinoma of thyroid gland
Operative trauma from throidectomy, radical neck dissection, pharyngeal
pouch removal, cricopharyngeal myotomy, ligation of patent ductus and
other cardiac and pulmonary surgery.
Mediastinal nodes or tumours, e.g. Hodgkins disease
Any enlargement of the left atrium, e.g. mitral stenosis
Peripheral neuritis
Aortic aneurysm
OTHER CAUSES MAY BE
High vagal lesions
Systemic causes i.e. Diabetes, syphilis, diphtheria, typhoid, streptococcal or
viral infections, lead poisoning
Idiopathic
Page 181 Logan Turners ENT and PAGE
298 Dhingra
Annual 2004
Q.NO.3
How will you investigate a fifty years old man who presents with
hoarseness of voice?
Ans:
Investigations:
1. History. Mode of onset and duration of illness, patient's occupation,
habits and associated complaints are important and would often help to
elucidate the cause. Any hoarseness persisting for more than three weeks
deserves examination of larynx. Malignancy should be excluded in patients
above 40 years.
2. Indirect laryngoscopy. Many of the local laryngeal causes can be
diagnosed.
3. Examination of neck, chest, cardiovascular and neurological
system would help to find cause for laryngeal paralysis.
4. Laboratory investigations and radiological examination should be
done as perdictates of the cause suspected on clinical examination.
5. Direct laryngoscopy and microlaryngoscopy help in detailed
examination, biopsy of the lesions and assessment of the mobility of
cricoarytenoid joints.
6. Bronchoscopy and oesophagoscopy may be required in cases of
paralytic lesions of the cord to exclude malignancy.
Reference Dhingra Page 289 4th edition
Supplementary 2004

Q.NO.4
Discuss indications and complications of tracheostomy?

1.
2.
3.
4.
5.

a)
b)

1.
2.

Annual 2005
Q.NO.6
A Fifty years old man presents with hoarseness. His hospital record
shows T3N1M0 lesion of left vocal cord. How will you manage this
case? Enumerate the Carcinoma Larynx?
Ans:
Treatment:
In the UK cure is achieved with radiotherapy in over 95% of T1 cases. If
there is no recurrence, the patient will have good voice but if there is a
recurrence surgery will be necessary. Either a HEMILARYNGECTOMY or a
TOTAL LARYNGECTOMY may be offered. A Hemilaryngectomy involves the
removal of half of thyroid cartilage with the false or true vocal cords, part of
supraglottis and upper half of cricoids cartilage. The resulting gap is closed
by the strap muscles, fashioned so as to form new fixed vocal cords. If a
hemilaryngectomy is used as a salvage procedure after failed radiotherapy
the results will be poorer than if it had been used as primary treatment. It
does, however, give the patient a chance of keeping some sort of voice
instead of having to learn oesophageal speech after total laryngectomy.
Lymph node is also removed surgically through radical neck surgery.
Carcinoma Larynx:
Leucoplakia
Supraglottic cancer
Glottic cancer
Transglottic cancer
Subglottic cancer
PAGE 176 LOGAN TURNERS ENT , PAGE
310 DHINGRA
Supplementary 2005
Q.NO.7
What are the causes of left recurrent LARYNGEAL NERVE PALSY?
How will you confirm the diagnosis in such a case?
Ans:
see Q.NO.2
Diagnosis:
The diagnosis in such case is mainly done on the basis of SYMPTOMS
and Laryngoscopy and is confirmed on the basis of two theories which
are
Simons theory
Wagner and Grossmans theory
Simons theory
In all progressive organic lesions of the centres and trunks of
motor laryngeal nerves, the fibers supplying the ABDUCTORS of the
vocal cord become involved much earlier than do the ADDUCTORS.

Wagner and Grossman theory

A high lesion of the vagus nerve will leave the paralyzed cord
further from the midline (Paramedian) than the paralysis of the
recurrent laryngeal nerve.
PAGE 180 LOGAN TURNER, PAGE 299 DHINGRA
Annual 2006

a)

b)

c)

a)
b)
c)
d)
a)
b)

Q.NO.9
a) What are Vocal Nodules?
b) Give the etiology and clinical features of this condition.
c) What is its prevention?
Ans:
Vocal Nodules:
They appear symmetrically on the free edge of vocal cord, at the
junction of anterior one-third, with the posterior two-thirds, as this is
the area of maximum vibration of the cord and thus subject to
maximum trauma. Their size varies from that of pin-head to half a pea.
Etiology:
They are the result of vocal trauma when person speaks in
unnatural low tones for prolonged periods or at high intensities.
They mostly affect teachers, actors, vendors or pop singers. They
are also seen in school going children who are too assertive and
talkative.
Clinical Features
Patients with vocal nodules complain of hoarseness. Vocal fatigue
and pain in the neck on prolonged phonation are other common
symptoms.
Prevention:
Speech therapy and re-education in voice production are essential
to prevent this disease.
PAGE 303 DHINGRA
Annual 2007
Q.NO.10
A Four year old child presents in emergency with Inspiratory stridor
and drooling of saliva. He feels somewhat comfortable only in
sitting position. His temperature is 102C.
What is the likely Diagnosis?
Which investigations are required to confirm the diagnosis?
Which antibiotic will you prescribe?
How will you secure the airway?
Ans:
Diagnosis:
Acute epiglotitis
Investigations:
Indirect laryngoscopy may show oedema and congestion of Supraglottic
structure.

 Lateral soft tissue X-ray of neck may show swollen epiglottis (thumb sign).
c) Antibiotic:
Ampicillin or third generation cephalosporin are effective.
d) Airway:
Intubation or tracheostomy.
Bronchoscopy.
Oxygen Inhalation.
PAGE 289 DHINGRA
Annual 2008
Q.NO.11
A male 50 years of age presented with Hoarseness of voice for 6
months. It is progressive. On indirect laryngoscopy there is a mass
on the right vocal cord which extends supraglotically across the
ventricle of the larynx. The right hemilarynx is fixed. There is no
neck nodes and no evidence of distant metastasis.
a) What is probable diagnosis?
b) How will you confirm your diagnosis and stage the disease?
c) How will you manage the patient?
Ans:
a) Diagnosis:
Carcinoma of larynx
b) Confirmation of Diagnosis:
1) History
2) Indirect laryngoscopy
Appearance of lesion
Vocal cord mobility
Extend of disease
3) Examination of neck
To find out extra laryngeal spread of disease
4) Radiography
Chest X-ray, soft tissue lateral view neck, contrast laryngogram
5) CT scan
6) Direct laryngoscopy
7) Microlaryngoscopy
8) Biopsy
STAGE
T3N0M0
c) Management:
See Q.NO.6
PAGE 308 309 DHINGRA
Annual 2009
Q.NO.12
A 3 year old fit boy started having sore throat which developed into
dysphagia quickly. Inspiratory stridor with drooling of saliva
followed soon. The child looks terrified and feels comfortable only in
sitting and leaning forward position.

a) What is the probable diagnosis?

b) How will you secure the airway in this patient?
c) Name three other conditions which can easily mimic this clinical
picture?
Ans:
a) See Q.NO.10
b) See Q.NO.10
c) Laryngomalacia
Retrophyrangeal abscess
Laryngeal web
Page 289 Dhingra
Q.NO.13
A 70 years old man, smoker is suffering from hoarseness of voice for
last 2 years. Recently he developed noisy breathing and at times
spells of respiratory distress. But for last 2 days respiratory distress
was persistent compelling the family to seek medical advice in
accident and emergency department.
a) What will be your immediate action?
b) How will you execute your action?
c) What complications can occur during the process/procedure?
d) How will you manage the patient further?
Ans:
a) Tracheostomy
b) Procedure:
A vertical incision is made in the midline of neck, extending from cricoid
cartilage to just above the sternal notch. This is the most favored incision
and can be used in emergency and elective procedures. It gives rapid access
with minimum of bleeding and tissue dissection. A transverse incision, 5 cm
long, made 2 fingers' breadth above the sternal notch can be used in elective
procedures. It has the advantage of a cosmetically better scar.
After incision, tissues are dissected in the midline. Dilated veins are either
displaced or ligated.
Strap muscles are separated in the midline and retracted laterally.
Thyroid isthmus is displaced upwards or divided between the clamps, and
suture-ligated.
A few drops of 4% lignocaine are injected into the trachea to suppress the
cough when trachea is incised.
Trachea is fixed with a hook and opened with a vertical incision in the region
of 3rd and 4th or 3rd and 2nd rings. T his is then converted into a circular
opening. The first tracheal ring is never divided as perichondritis of cricoid
cartilage with stenosis can result.
Tracheostomy tube of appropriate size is inserted and secured by tapes (see
page 406 for different types and size of tracheostomy tubes).
Skin incision should not be sutured or packed tightly as it may lead to
development of subcutaneous emphysema.

 Gauze dressing is placed between the skin and flange of the tube around the
stoma.
c) See Q.NO.4
d) See Q.NO.6 Treatment of Carcinoma larynx.
Pages 317-318 dhingra.
Annual 2010
Q.NO.14
A 2 year old baby boy is having a fever of 101F. The child is having
BARKING COUGH.
a) What is the pathophysiology of this disease?
b) What is its natural history?
c) How do you treat it?
Ans:
a)
Acute Laryngo-Tracheo-Bronchitis
Pathophysiology:
Mostly, it is viral infection (parainfluenza type I and II) affecting children
between 6 months to 3 years of age. The loose areolar tissue in the
Subglottic region swells up and causes respiratory obstruction and stridor.
This coupled with thick tenacious secretions and crusts, may completely
occlude the airway.
b)
History:
Disease starts as upper respiratory infection with hoarseness and
croupy/Barking cough. There is fever of 39-40 C. This may be followed
by difficulty in breathing and Inspiratory type of stridor. Respiratory
difficulty may gradually increase with signs of upper airway
obstruction, i.e. suprasternal and intercostal recession.
c)
Treatment:
Hospitalization is often essential because of the increasing difficulty in
breathing.
Antibiotics like ampicillin 50 mg/kg/day in divided doses are effective against
secondary infections due to gram-positive cocci and H. influenzae.
Humidification helps to soften crusts and tenacious secretions wh.ich block
tracheobronchial tree.
Parenteral fluids are essential to combat dehydration.
Steroids, e.g. hydrocortisone 100mg i.v. may be useful to relieve oedema.
Adrenaline, racemic adrenaline administered via a respirator is a
bronchodilator and may relieve dyspnoea and avert tracheostomy.
Intubation/tracheostomy is done, should respiratory obstruction increase in
spite of the above measures. Tracheostomy is done if intubation is required
beyond n hours. Assisted ventilation may be required.
PAGE 290 DHINGRA
Q.NO.15
a) What are the complications of tracheostomy?
b) How do you treat them?
Ans:

a) See Q.NO.4
b) Treatment:
Depends upon situation hemorrhage can be treated by electrocauterizing the bleeding vessel. Surgeon should take care while putting
tube so that it does not cause any damage to surrounding tissues.
Post-op caring steps should be followed strictly.

a)

b)

a)
b)
c)

Q.NO.16
a) What is the etiology of carcinoma larynx?
b) What is the treatment?
ANS
Etiology:
Both tobacco and alcohol are well established risk factors in
laryngeal cancer. Cigarette smoke contains benzopyrene and other
hydrocarbons which are carcinogenic in man. Combination of alcohol
and smoking increases the risk 15-folds compared to each factor alone
(2-3 folds). Previous radiation to neck for benign lesions or laryngeal
papilloma may induce laryngeal carcinoma. Japanese and Russian
workers have reported cases of familial laryngeal malignancy
incriminating genetic factors. Occupational exposure to asbestos,
mustard gas and other chemical or petroleum products has also been
related to the genesis of laryngeal cancer but without conclusive
evidence.
See Q.NO.6
PAGE 307 DHINGRA
Annual 2011
Q.NO.17
A 2 year old child presented in pediatric emergency room with
severe Inspiratory stridor for the last 24 hours in the month of
December.
Give 3 likely causes of stridor?
Give 3 ways of securing his airway?
Give radiological investigation with positive findings in each
diagnosis?

Ans:
a) Causes:
Inspiratory stridor is often produced in obstructive lesions of supraglottis or
pharynx, e.g. laryngomalacia or retropharyngeal abscess.
Expiratory stridor is produced in lesions of thoracic trachea, primary and
secondary bronchi, e.g. bronchial foreign body, tracheal stenosis.
Biphasic stridor is seen in lesions of glottis, subglottis and cervical trachea,
e.g. laryngeal papillomas, vocal cord paralysis and subglottis stenosis.
b) Ways Of Securing Airway:
Direct Laryngoscopy
General anesthesia followed by Bronchoscopy

Microlaryngoscopy
Tracheostomy in some types
Radiological Investigations:
X-ray of chest and soft tissue neck both in anteroposterior and lateral views.
Fluoroscopy to see chest movements both during inspiration and expiration.
Tomography of chest for Mediastinal mass.
Oesophagogram with lipoidal for atresia of oesophagus, tracheobronchial
fistula or aberrant vessels.
Angiography, if aberrant vessels are suspected.
Xeroradiography is useful to show soft tissue lesions in the neck.
CT scan.
Page 296-297 Dhingra, Page 382 Logan Turner
Q.NO.18
Enumerate Complications of tracheostomy?
Ans:
See Q.NO.4

c)

Q.no.19
A 40 year old lady teacher, Married, has 5 children and complains of
hoarseness for last 6 months.
a) Enumerate 4 causes of Hoarseness of voice?
b) How will you treat vocal nodules?
Ans:
a) Causes:
Inflammation
Acute

Acute laryngitis usually following

cold, influenza, exanthematous fever,
laryngo-tracheo-bronchitis,
diphtheria.

Chronic
1) Specific.
Tuberculosis, syphilis, scleroma,
fungal infections.
2) Non-specific.
Chronic laryngitis, atrophic
laryngitis
Tumors
Benign
Malignant
Tumor like mases

Trauma

Papilloma (solitary and multiple),

haemangioma, chondroma, fibroma,
leukoplakia.
Carcinoma
Vocal nodule, vocal polyp,
angiofibroma, amyloid tumor, contact
ulcer, cysts, laryngocele
Submucosal haemorrhage, laryngeal

trauma (blunt and sharp), foreign

bodies, intubation
Paralysis of recurrent, superior
laryngeal or both nerves
Arthritis or fixation of cricoarytenoid
joints
Laryngeal web, cyst, laryngocele
Dysphonia plica ventricularis,
myxoedema, gout
Hysterical aphonia

Paralysis
Fixation of cords
Congenital
Miscellaneous
Functional

a)
b)
c)
d)

b)
Treatment:
Early cases of vocal nodules can be treated conservatively by
educating the patient in proper use of voice. With this treatment, many
nodules in children disappear completely. Surgery is required for large
nodules or nodules of long-standing in adults. They are excised with
precision under operating microscope avoiding any trauma to the
underlying vocal ligament.
Page 303 and Page 313 Dhingra
Supplementary 2011
Q.NO.20
A 4 year old child was bought to emergency room with severe
stridor. On examination he had fever, looked very ill, and was
cyanotic. He was comfortable only in sitting position.
What is the most likely Diagnosis?
Which radiological investigation will you order and what will be
positive finding on it?
Which organism is responsible for this condition?
How will you treat him?

ANS
a) See Q.NO.10
b) See Q.NO.10
c) Organism:
H. influenzae
d) Treatment:
Hospitalization. Essential because of the danger of respiratory obstruction.
Antibiotics. Ampicillin or third generation cephalosporin are effective
against H. influenzae and are given by Parenteral route (I.M. or I.V.) without
waiting for results of throat swab and blood culture.
Steroids. Hydrocortisone or dexamethasone is given in appropriate doses
I.M. or I.V. They relieve oedema and may obviate need for tracheostomy.
Adequate hydration. Patient may require parenteral fluids.
Humidification and oxygen. Patient may require mist tent or a croupette.
Intubation or tracheostomy may be required for respiratory obstruction.

Page 289-290 DHINGRA

a)

b)

Q.NO.21
What is postoperative nursing care of tracheostomy patient?
Ans:
POST OP NURSING
1.
Constant supervision. After tracheostomy,
constant supervision of the patient for bleeding, displacement or
blocking of tube and removal of secretions is essential. A nurse or
patient's relative should be in attendance. Patient is given a bell or
a paper pad and a pencil to communicate.
2.
Suction. Depending on the amount of secretion,
suction may be required every half an hour or so; use sterile
catheters with a Y-connector to break suction force. Suction injuries
to tracheal mucosa should be avoided. This is done by applying
suction to the catheter only when withdrawing it.
3.
Prevention of crusting and tracheitis. This is
achieved by:
(a) Proper humidification, by use of humidifier, steam tent, ultrasonic
nebulizer or keeping a boiling kettle in the room.
(b) If crusting occurs, a few drops of normal or hypotonic saline or Ringer's
lactate are instilled into the trachea every 2-3 hours to loosen crusts. A
mucolytic agent such as acetylcysteine solution can be instilled to liquefy
tenacious secretions or to loosen the crusts.
4.
Care of tracheostomy tube. Inner cannula should
be removed and cleaned as and when indicated for the first 3 days.
Outer tube, unless blocked or displaced, should not be removed for
3-4 days to allow a track to be formed when tube placement will
become easy. After 3-4 days, outer tube can be removed and
cleaned every day.
Page 318 dhingra.
Annual 2012
Q.NO.21
a) Enumerate 4 Causes of stridor in a 4 year
old child who is not febrile?
b) What are clinical features of
LARYNGOMALACIA?
ANS
Causes:
Papillomatosis
Injury
Foreign body
Laryngeal edema
Adenotonsillar hypertrophy
Laryngomalacia:
It is characterized by excessive flaccidity of supraglottic
larynx which is sucked in during inspiration producing stridor and

sometimes cyanosis. Stridor is increased on crying but subsides

on placing the child in prone position; cry is normal. The
condition manifests at birth or soon after and usually disappears
by 2 years of age.
Page 295-296 Dhingra

a)
b)
c)
a)

i.
ii.

iii.
iv.

b)
c)

Q.NO.22
A 70 years old male patient complaints of hoarseness for last 3
years. He does not cooperate for indirect laryngoscopy. His chest Xray is normal.
What are available methods for examination of his larynx?
What is treatment for T1N0M0 glottic carcinoma?
List 3 side effects of radiotherapy?
Ans:
Methods For Examination:
Radiography
X-ray chest is essential for co-existent lung disease (e.g. tuberculosis),
pulmonary metastasis or mediastinal nodes.
Soft tissue lateral view neck. Extent of lesions of epiglottis, aryepiglottic
folds, arytenoids and involvement of pre-epiglottic space may be seen.
Destruction of thyroid cartilage may be seen. This is now superceded by CT
scan and MRI.
Contrast laryngograms. Radio-opaque dye, dionosil, is instilled into the
larynx. Laryngograms outline the surface extent of tumours. This
investigation has now been replaced by CT scan.
CT scan. It is a very useful investigation to find the extent of tumor, invasion
of pre-epiglottic or paraepiglottic space, destruction of cartilage and lymph
node involvement
Direct laryngoscopy
Microlaryngoscopy
Supravital staining and biopsy
See Q.NO.6
Side Effects

Early
Radiation sickness
Mucositis
Dryness of mucus membranes
Skin reactions
Hematopoietic suppression

LATE
Permanent xerostomia
Decaying of teeth
Osteoradionecrosis
Endocrinal defects
Trismus
Page 310-311 Dhingra
2013

Annual
Q.No.24
A young teacher presented with hoarseness of voice for the last six
months and she is engaged in teaching for last 5 years. Her voice is
persistently hoarse and is not being relieved by the medication of
the primary health care physician?

a) What do you suspect in this case and what are different

possibilities?
b) How do you investigate this case?
c) How will you manage this case? (Annual 2013)
Ans:
A) This is a case of voice strain also known as Phonasthenia.
Other possibilities are
1) Inflammation like acute or chronic laryngitis, influenza, laryngo-tracheobronchitis, atrophic laryngitis
2) Any kind of benign or malignant tumor
3) Trauma
4) Paralysis of vocal cords
B)
Investigations:
1) CBC+ESR
2) X-RAY
3) CT Scan
4) Indirect laryngoscopy
5) Direct laryngscopy
C)
Management:
1) Vocal rest for 1 to 2 week
2) Periods of voice rest after excessive use
3) Vocal hygiene
4) Consult to speech therapist for further evaluation
ALSO See Q.NO.9 and Q.NO.19
Page 290 Dhingra and page 155 Logan and turner
Q.NO.25
An old patient visited the E.N.T OPD and could not speak due to
insertion of tracheostomy tube.
a) What is purpose of the tracheostomy tube?
b) Describe important indications for this operation?
c) What are major complications of this operation?
Ans:
a) Tracheostomy is making an opening in the anterior wall of trachea and
converting it into a stoma on the skin surface. Te purpose of tracheostomy
tube is to maintain secure airway passage to the lungs if there is any
obstruction in upper airway passage.
b) Indications:
To relieve upper airway obstruction
To facilitate bronchial toilet
To decrease dead space
To assist ventilation
As an elective procedure in head and neck surgery
c) Complications:
A) Immediate (at the time of operation)
1) Hemorrhage.

2) Apnoea. This follows opening of trachea in a patient

who had prolonged respiratory obstruction. This is due to
sudden washing out of CO2 which was acting as a
respiratory stimulus. Treatment is to administer 5% CO2 in
oxygen or assisted ventilation.
3) Pneumothorax due to injury to apical pleura.
4) Injury to recurrent laryngeal nerves.
5) Aspiration of blood. 6. Injury to oesophagus. This can
occur with tip of knife while incising the trachea and may
result in tracheo-oesophageal fistula.
B) Intermediate (during first few hours or days):
1) Bleeding, reactionary or secondary.
2) Displacement of tube.
3) Blocking of tube.
4) Subcutaneous emphysema.
5) Tracheitis and tracheobronchitis with crusting in trachea.
6) Atelectasis and lung abscess.
7) Local wound infection and granulations.
C) Late (with prolonged use of tube for weeks and
months):
1) Haemorrhage, due to erosion of major vessel.
2) Laryngeal stenosis, due to perichondritis of cricoid
cartilage.
3) Tracheal stenosis, due to tracheal ulceration and
infection.
4) Tracheo-oesophageal fistula, due to prolonged use of
cuffed tube or erosion of trachea by the tip of
tracheostomy tube.
5) Problems of decannulation. Seen commonly in infants
and children.
6) Persistent tracheocutaneous fistula.
7) Problems of tracheostomy scar. Keloid or unsightly scar.
8) Corrosion of tracheostomy tube and aspiration of its
fragments into the tracheobronchial tree
Reference chapter 62 Dhingra 4th edition and chapter 35 Logan and
turner
Supplementary 2013
Q.NO.26
A young child from a village, learning the holy QURAN by heart for
the last one year, is brought to the E.N.T OPD for having hoarse
voice for last 6 months. Since then he is not getting better by the
treatment of local primary health care person.
a) What pathology or cause you expect in this case?
b) What definitive procedure is required to develop this pathology?
c) How would you manage this child?

a)
b)

c)

a)
b)
c)
a)
b)
c)

Ans:
Vocal nodule See Q.NO.9 And Q.NO.19
Pathology:
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. In early stages, the nodules
appear soft, reddish and edematous swellings but later become grayish
or white in color.
See Q.NO.9 and Q.NO.19
Annual 2014
Q.NO.27
A 70 years old male with carcinoma of larynx and stridor for last 2
months is brought to emergency department. An urgent
Tracheostomy is carried out and when trachea is opened and
tracheostomy tube is placed in the trachea it is observed that
patient is not breathing.
What has happened to the patient?
What is cause of this condition?
How will you manage this patient?
Ans:
Apnoea
This follows opening of trachea in a patient who had prolonged respiratory
obstruction. This is due to sudden washing out of CO2 which was acting as a
respiratory stimulus.
. Treatment is to administer 5% CO2 in oxygen or assisted ventilation.
Reference Q.NO.25(c)
Q.NO.28
A 2 year old boy while playing with his toys developed sudden
choking. He is cyanosed and has intense Inspiratory stridor when
brought to emergency room. How will you manage him?
Ans:
Management:
Laryngeal foreign body:
A large bolus of food obstructed above the cords may make the patient
totally aphonic, unable to cry for help. He may die of asphyxia unless
immediate first aid measures are taken. The measures consist of pounding
on the back, turning the patient upside down and following Heimlich
maneuver. These measures should not be done if patient is only partially
obstructed, for fear of causing total obstruction.
Heimlich's maneuver. Stand behind the person, and place your arms
around his lower chest and give four abdominal thrusts. The residual air in
the lungs may dislodge the foreign body providing some airway.
Cricothyrotomy or emergency tracheostomy should be done if
Heimlich's maneuver fails. Once acute respiratory emergency is over, foreign

body can be removed by direct laryngoscopy or by laryngofissure, if found

impacted.
Tracheal and bronchial foreign bodies:
These can be removed by bronchoscopy with full preparation and
under general anesthesia. Emergency removal of these foreign bodies is not
indicated unless there is airway obstruction or they are of the vegetable
nature (e.g. seeds) and likely to swell up.

a)
b)
c)

a)
b)
c)

Methods to remove tracheobronchial foreign body:

Conventional rigid bronchoscopy.
Rigid bronchoscopy with telescopic aid.
Bronchoscopy with C-arm fluoroscopy.
Use of Dormia basket or Fogarty's balloon for rounded objects.
Tracheostomy first and then bronchoscopy through the tracheostome.
Thoracotomy and bronchotomy for peripheral foreign bodies.
Flexible fibre optic bronchoscopy in selected adult patients.
Page 323 Dhingra 6th Edition.
Q.No.29
A 6 year old child presents with high grade fever, dysphagia and
stridor. On examination he is sitting and leaning forward with
dribbling of saliva. He is looking toxic. He has had history of flu
three days ago.
What is most probable diagnosis?
Give its differential diagnosis?
How will you manage it? Enumerate four steps of management?
ANS
See Q.NO.10, 12 and 20
Supplementary 2014
Q.NO.30
A male 50 years of age presents with hoarseness of voice for two
months which is progressive. Patient is smoker for 30 years. Indirect
laryngoscopy shows a mass on the right vocal cord which is mobile.
There is no significant extension of the mass. There are no neck
nodes.
What is most probable diagnosis?
How will you prove your diagnosis?
What are the treatment options?
Ans:
See Q.NO.3 and Q.NO.6