MCQS IN LARYNX

ANATOMY AND
PHYSIOLOGY OF LARYNX
Laryngeal cartilage forming
complete circle is;

a. Arytenoid
b. Thyroid
c. Cricoid
d. Hyoid
Narrowest part of infantile
larynx is :

a. Supraglottis
b. Subglottis
c. Glottis
d. None of the above
Narrowest part of adult larynx
is :

a. Subglottis
b. Supraglottis
c. Glottis
d. None of the above
Abductor of vocal cord is :

a. Cricothyroid
b. Post cricoarytenoid
c. Lateral cricoarytenoid
d. Thyroarytenoid (external part)
All of the following are
adductors except:

a. Cricothyroid
b. Post cricoarytenoid
c. Lateral cricoarytenoid
d. Thyroarytenoid (external part)
Which of the following muscle
is adductor of vocal cord:

a. Cricothyroid
b. Lateral cricoarytenoid
c. Thyroarytenoid internal part (vocalis)
d. Post cricoarytenoid
Which of the following is a
secondary elevator of larynx :

a. Stylopharyngeus
b. Geniohyoid
c. Palatopharyngeus
d. Salpingopharyngeus
All are elevators of larynx
except:

a. Thyrohyoid
b. Digastric
c. Stylohyoid
d. Sternohyoid
All are depressors of larynx
except :

a. Sternohyoid
b. Stylopharyngeus
c. Sternothyroid
d. Omohyoid
Which of the following is a
primary elevator of larynx :

a. Diagastric
b. Myelohyoid
c. Thyrohyoid
d. Stylohyoid
Sensory nerve supply of
larynx below the level of vocal
cord is:
a. External branch of superior laryngeal
nerve
b. Internal branch of superior laryngeal
nerve
c. Recurrent laryngeal nerve
d. Inferior pharyngeal nerve
Water can in the larynx is
present in:

a. Paraglottic space
b. Pyriform fossa
c. Reinke’s space
d. Laryngeal saccule
Laryngocele arises from:

a. Anterior commissure
b. Saccule of ventricle
c. False cords
d. True cords
Anteroposterior size of glottis in
males is :
a. 16 mm
b. 20 mm
c. 24 mm
d. 28 mm
Sensory nerve supply above the
vocal cord is :
a. Glossopharyngeal nerve
b. Superior laryngeal nerve
c. Recurrent laryngeal nerve
d. Pharyngeal branch of vagus
Which of the following muscle
is not supplied by recurrent
laryngeal nerve:
a. Posterior cricoarytenoid
b. Lateral cricoarytenoid
c. Cricothyroid
d. Vocalis
Vocal cord is lined by:
a. Columnar epithelium
b. Ciliated columnar epithelium
c. Stratified squamous epithelium
d. Cuboidal epithelium
All of the following laryngeal
cartilages undergo calcification
except :
a. Thyroid
b. Cricoid
c. Epiglottis
d. Arytenoids
Cricothyroid muscle is supplied
by:

a. Superior laryngeal nerve

b. External laryngeal nerve
c. Recurrent laryngeal nerve
d. Glossopharyngeal nerve
Thyroid angle in males is :

a. 60 degree
b. 90 degree
c. 100 degree
d. 120 degree
A neonate while suckling milk
can respire without difficulty
due to:
a. Short soft palate
b. Small tongue
c. High larynx
d. Small pharynx
CONGENITAL DISORDERS
AND STRIDOR
Most common congenital
anomaly of larynx is:
a. Laryngeal web
b. Laryngomalacia
c. Subglottic stenosis
d. Vocal cord palsy
Most common cause of stridor in
a 10 days old child is :
a. Vocal nodule
b. Foreign body
c. Laryngomalacia
d. Juvenile papillomatosis
Diagnosis of congenital subglottic
stenosis in a premature neonate is
made when tip of bronchoscope of
following diameter can not be
passed through subglottis :
a. 3 mm
b. 3.5 mm
c. 4 mm
d. 4.5 mm
Laryngeal web most commonly
involves the region of :
a. Glottis
b. Supraglottis
c. Subglottis
d. Both b & c
Best way to diagnose
laryngomalacia is :
a. Symptoms and signs of disease only
b. Soft tissue lateral view neck
c. Direct laryngoscopy under GA
d. Flexible fibreoptic laryngoscopy
Most common mode of
treatment for laryngomalacia is :
a. Reassurance
b. Medical
c. Surgery
d. Tracheostomy
Stridor is caused by all except:

a. Hypocalcemia
b. Asthma
c. Epiglottitis
d. Laryngeal tumour
A neonate after birth is noticed
to have stridor and hoarse cry.
All of the following diagnosis is
possible except :
a. Laryngeal web
b. Laryngeal paralysis
c. Laryngomalacia
d. Laryngeal cyst
All of the following are true about
laryngomalacia except :
a. Most common cause of laryngeal stridor
b. Stridor is relieved when child is put in
prone position
c. Epiglottis appears omega shaped
d. 50% of pts require surgery
In a child of suspected acute
epiglottitis, indicate your first line
of management :

a. Order an X-ray of soft tissue lateral view

neck to establish diagnosis
b. Throat swab culture and start I/V fluids
c. Secure an airway by intubation
d. Perform a laryngoscopy
Most common cause of stridor in
a 60 yrs old male is :
a. Nasopharyngeal carcinoma
b. Thyroid carcinoma
c. FB aspiration
d. Carcinoma larynx
Acute epiglottitis in children is
mostly caused by :
a. Parainfluenzae type I & II
b. Respiratory syncytial virus
c. Hemophilus influenzae type B
d. Streptococcus pneumoniae
Antibiotic of choice in acute
epiglottitis is :
a. Tetracycline
b. Chlorumphenicol
c. Cephalosporin
d. Penicillin
Thumb sign in lateral X-ray neck
is seen in :
a. Saccular cyst
b. Epiglottitis
c. Vallecular cyst
d. Carcinoma epiglottis
Acute laryngotracheal
bronchitis is caused by which
organism :
a. Rota virus
b. Haemophilus influenzae
c. Para influenza virus
d. Rhinovirus
Church Steeple sign is seen in :
@
 Acute laryngotracheobronchitis (croup)
 Laryngomalacia
 Acute epiglottitis
 Quinsy
Tripod sign is seen in : @

 Acute laryngotracheobronchitis (croup)

 Laryngomalacia
 Acute epiglottitis
 Quinsy
In dysphonia plica ventricularis,
sound is produced by :
a. True vocal cords
b. Ventricle of larynx
c. Aryepiglottic folds
d. False vocal cords or ventricular bands
LARYNGEAL PALSY
Right vocal cord palsy may occur
in:
a. Aortic aneurysm
b. Carcinoma larynx
c. Hilar lymphadenopathy
d. Bronchogenic carcinoma
Vocal cord palsy is not
associated with:
a. Left atrial enlargement
b. Bronchogenic carcinoma
c. Secondaries in mediastinum
d. Vertebral secondaries
Cause of bilateral recurrent
laryngeal palsy is:

a. Aneurysm of arch of aorta

b. Thyroid surgery
c. Hilar lymphadenopathy
d. Bronchogenic carcinoma
Which of the following type of
laryngeal palsy may be
dangerous to life:
a. Left recurrent laryngeal paralysis
b. Bilateral abductor paralysis
c. Left superior laryngeal paralysis
d. Right recurrent laryngeal paralysis
Which of the following is a
feature of bilateral recurrent
laryngeal nerve palsy:
a. Complete loss of speech with stridor &
dyspnoea
b. Complete loss of speech without stridor &
dyspnoea
c. No loss of speech with severe stridor &
dyspnoea
d. No loss of speech & no difficulty in
breathing
In bilateral abductor palsy which
of the following is not a mode of
treatment:

a. Transeverse Cordotomy
b. Teflon paste injection
c. Nerve muscle transplant
d. Arytenoidectomy
Injury to superior laryngeal nerve
causes:
a. Hoarseness
b. Paralysis of vocal cords
c. No effect
d. Loss of timbre of voice
Which of the following is
treatment of unilateral vocal
cord palsy:

a. Isshiki type I thyroplasty

b. Arytenoidectomy
c. Isshiki type II thyroplasty
d. Woodman’s operation
A 10 yrs old boy developed
hoarseness of voice following an
attack of diphtheria. On exam, his Rt
vocal cord is paralyzed. Treatment of
choice for paralyzed vocal cord will
be:
a. Gel foam injection of Rt vocal cord
b. Fat injection of Rt vocal cord
c. Thyroplasty type I
d. Wait for spontaneous recovery
A Pt presented with stridor &
dyspnoea which he developed after
an attack of URTI. IDL revealed a
3mm glottic opening. Which of the
following is not used in management:
a. Tracheostomy
b. Arytenoidectomy
c. Teflon injection
d. Transverse cordotomy ( Kashima
operation)
Type I thyroplasty is for:

a. Vocal cord medialization

b. Vocal cord lateralization
c. Vocal cord shortening
d. Vocal cord lengthening
In thyroplasty type 2 vocal cord
is:

a. Medialized
b. Lateralized
c. Lengthened
d. Shortened
Paralysis of superior
laryngeal nerve causes all
except :
a. Inability to raise pitch
b. Lengthening of vocal cord
c. Shortening of vocal cord
d. Occasional aspiration
Paralysis of recurrent laryngeal
nerve does not affect the
function of :

a. Thyroarytenoid
b. Lateral cricoarytenoid
c. Vocalis
d. Cricothyroid
Which of the following muscle is
tensor of vocal cord ?
a. Post cricoarytenoid
b. Transverse arytenoid
c. Lateral cricoarytenoid
d. Cricothyroid
In unilateral vocal cord
paralysis treatment is : *

a. Isshiki type I thyroplasty

b. Isshiki type II thyroplasty
c. Woodman’s operation
d. Laser arytenoidectomy
MISC. TOPICS
Which of the following is a
precancerous lesion:
a. Pachydermia of larynx
b. Scleroma larynx
c. Keratosis of larynx
d. Contact ulcer
Tracheostomy cuts down dead
space by :
a. 10 –15 %
b. 20 – 25%
c. 30 – 50%
d. 60 – 70%
On an average respiratory dead
space is :
a. 100ml
b. 150ml
c. 200ml
d. 250ml
In which of the following
laryngeal crepitus will be absent:
a. Post cricoid carcinoma
b. Subglottic carcinoma
c. Carcinoma vocal cord
d. Supraglottic carcinoma
Reinke’s oedema is responsible
for :
a. Vocal nodule
b. Vocal polyp
c. Diffuse polypoidal degeneration of vocal
cords
d. Laryngeal cyst
Which of the following usually
affects the anterior part of
larynx?

a. Contact ulcer
b. Pachydermia laryngitis
c. Intubation granuloma
d. Lupus
Treatment of choice for stage I
carcinoma larynx is :
a. Radical surgery
b. Chemotherapy
c. Radiotherapy
d. Surgery followed by radiotherapy
Virus responsible for Juvenile
papillomatosis is :
a. Cytomegalovirus
b. Epstein-Barr virus
c. Adenovirus
d. Human papilloma virus
HPV do not cause which type
of cancer :

a. Carcinoma base of tongue

b. Tonsillar carcinoma
c. Nasopharyngeal carcinoma
d. Cervical carcinoma
Regarding multiple laryngeal
papillomatosis of larynx all are
true except :

a. Caused by a virus
b. Recurrent in nature
c. Premalignant
d. Laser excision is best treatment
Hoarseness is earliest symptom
of carcinoma of :
a. Glottis
b. Subglottis
c. Supraglottis
d. Pyriform fossa
All are true of supraglottic
cancer except :

a. Most aggressive of laryngeal cancers

b. High incidence of nodal metastasis
c. Earliest symptom is hoarseness
d. Commonest site is supraglottic region in
epiglottis
Chances of cervical nodal
metastasis is highest in
carcinoma of :

a. Glottis
b. Subglottis
c. Supraglottis
d. Ant commissure
The prognosis of carcinoma
of glottis is good because : @

a. It presents with early symptoms

b. It has no lymphatic spread
c. It is radiosensitive
d. It has late neck node involvement
In carcinoma of pyriform fossa,
pain is referred to ipsilateral ear
via:
a. CN IX
b. CN IX
c. CN X
d. CN XII
Phonation in oesophageal
speech in a case of
laryngectomy is produced by :

a. Buccal cavity
b. Pharynx
c. Pharyngo-oesophageal segment
d. Trachea
Treatment of Verrucous
carcinoma (Ackermans tumour)
of larynx is :
a. Radiotherapy
b. Chemotherapy
c. Surgery
d. Surgery followed by radiotherapy
Ventricle of Morgagni is situated
in:
a. Larynx between false and true cords
b. Between base of skull and upper border of
superior constrictor
c. Nasopharynx representing epithelial
diverticulum which forms ant lobe of pituitary
d. Nose above the vestibule and ant to
middle turbinate
A 3 yrs old male child presents with
multiple laryngeal papilloma with
hoarse voice and slight airway
distress. Papilloma are involving the
glottis. The best treatment is:
a. Tracheostomy and observation
b. Steroids
c. Interferon therapy
d. Microlaryngoscopy and excision
The best laser for multiple
laryngeal papillomatosis is:
a. Argon
b. Nd YAG
c. KTP-532
d. CO2 Laser
All are true about external
laryngocele except :
a. Produces a swelling in neck on valsalva
b. Communicates with laryngeal ventricle
c. Can be seen on CT
d. Herniates through cricothyroid
membrane
Which of the following statement
is not true in functional aphonia:
a. Always affects both cords
b. Vocal cords fail to adduct on phonation
c. Vocal cords adduct on coughing
d. Vocal cords abduct on cough but adduct on
phonation
Which of the following is
incorrect ? A bronchial
foreign body :
a. Lodges more in Rt bronchus
b. Can be expelled spontaneously with
cough
c. Causes emphysema or collapse of
lung
d. If vegetable, is less dangerous than
metallic one
Hypothyroidism can cause all
except:
a. Hoarseness
b. Dryness of mouth
c. Nasal stuffiness
d. Hearing loss and vertigo
A Blom-Singer prosthesis is
used :

a. As a ventilation tube in OME

b. To close a perforation in nasal septum
c. To divert tracheal air into oesophagus
for voice production in laryngectomy pt
d. In stapedectomy to conduct sound
from incus to oval window
Which of the following is
usually associated with
smoking :
a. Vocal nodule
b. Contact ulcer
c. Vocal cord polyp
d. Reinke’s oedema
Androphonia is corrected by
doing:
a. Type I thyroplasty
b. Type II thyroplasty
c. Type III thyroplasty
d. Type IV thyroplaty
Microlaryngoscopy was first
started by :

a. Bruce Benzamin
b. Kleinsasser
c. Chevalier Jackson
d. Negus
Palpatory thud or audible
slap is seen in :

a. Bronchial FB
b. Laryngeal FB
c. Tracheal FB
d. Oesophageal FB
Mouse nibbled appearance of
vocal cord is seen in :

a. Tuberculosis
b. Syphilis
c. Carcinoma
d. Papilloma
In a young man whose voice
is not broken, it is called :

a. Androphonia
b. Puberphonia
c. Phonaesthenia
d. Functional aphonia
Key-hole appearance of
glottis is seen in :

a. Functional aphonia
b. Puberphonia
c. Phonaesthenia
d. Vocal cord paralysis
Gutzmann’s pressure test is
used in :

a. Functional aphonia
b. Puberphonia
c. Phonaesthenia
d. Androphonia
All of the following about
Zenker’s diverticulum are
correct except :
a. Arises from post part of pharynx
b. Is a traction diverticulum
c. Causes regurgitation of undigested
food
d. Treated by diverticulectomy and
cricopharyngeal myotomy
Most common benign tumour
of oesophagus is :

a. Leiomyoma
b. Lipoma
c. Fibroma
d. Papilloma
Most common type of
oesophageal cancer is :

a. Adenocarcinoma
b. Squamous cell carcinoma
c. Adenoidcystic carcinoma
d. Mucoepidermoid carcinoma
Radiographic findings of
Achalasia cardia include all
except :
a. Oesophageal dilatation
b. Rat tail appearance
c. Failure of lower oesophageal
sphincter to relax
d. Diffuse oesophageal spasm
A 50 yrs old man has drinks
followed by heavy dinner. He had
severe vomiting , chest pain and
collapsed. X-ray chest shows
hydropneumothorax. The likely
diagnosis is
a. Mallory-Weiss syndrome
b. Boer heave syndrome
c. Ruptured duodenal ulcer
d. Acute myocardial infarction
Turban epiglottis is seen in :
a. Diphtheria
b. Syphilis
c. Tuberculosis
d. Acute epiglottitis
Which of the following focal
length lens is used in
operative microscope in ear
surgery?
a. 100 mm
b. 250 mm
c. 450 mm
d. 950 mm
Cricoid cartilage is a derivative of
which branchial arch?
a. IIIrd arch
b. IVth arch
c. VIth arch
d. IInd arch
Laryngeal crepitus is seen in :
a. Normal persons
b. Fracture of thyroid cartilage
c. Post cricoid carcinoma
d. Prevertebral abscess
Virus responsible for Juvenile
papillomatosis is :
a. Cytomegalovirus
b. Epstein-Barr virus
c. Adenovirus
d. Papova virus
Recurrent respiratory
papillomatosis is treated by
topical application of :
a. Zinc
b. Acyclovir
c. Cidofovir
d. Cisplatin
A tracheostomised pt with
tracheostomy tube in the ward
developed sudden complete
blockage of the tube. Which of
the following is the best next step
in management?
a. Immediate removal of tube
b. Suction of tube with sodium
bicarbonate
c. Suction of tube with saline
d. Jet ventilation
Gold standard surgical
procedure for prevention of
aspiration is:
a. Thyroplasty
b. Tracheostomy
c. Tracheal division and permanent
tracheostome
d. Feeding gastrostomy / Jejunostomy
All of the following conditions
are associated with snoring
except :
a. Angiofibroma
b. Laryngeal papillomatosis
c. Tonsillar enlargement
d. Adenoids
Bryce’s sign is seen in : @
a. Laryngomalacia
b. Laryngotracheobronchitis
c. Infected laryngocele
d. Acute epiglottitis
The commonest cause of
hoarseness of voice in Nepal
is : @
a. Common cold
b. Laryngopharyngeal reflux due to
hyperacidity
c. Infection
d. Abuse of voice
All of the following are true
about pachydermia laryngitis
except : *
a. Hoarseness of voice
b. Biopsy shows acanthosis and
hyperkeratosis
c. Premalignant
d. Involves posterior part of larynx
Muscle responsible for
mutational falsetto voice
(puberphonia) is : *
a. Vocalis
b. Cricothyroid
c. Thyroarytenoid
d. Posterior cricoarytenoid
Pseudosulcus larynx is seen
secondary to : *

a. Vocal abuse
b. Laryngopharyngeal reflux
c. Tuberculosis
d. Corticosteroid use
Patient following peanut
consumption presented with
laryngeal oedema, stridor,
hoarseness and swelling of
tongue. Most likely diagnosis is :
a. Pharyngeal abscess
b. Angioneurotic oedema
c. FB larynx
d. FB bronchus
All of the following
statements ere true about
recurrent laryngeal
papillomatosis except :
a. Caused by human papilloma virus
b. HPV 6 & 11 are most commonly
implicated
c. HPV 6 is more virulent than HPV 11
d. Transmission to neonate occurs
through contact with mother during
vaginal delivery