6/28/2013

Answers:

Which of the following is not a presenting symptom of laryngeal cancer?

A) Hemoptysis 

B) Ear pain 

C) Dysphagia 

D) Odynophagia 

E) Neck mass

F) All of the above are presenting symptoms

With regards to laryngeal cancer, a "breathy" voice indicates----whereas a "muffled" voice indicates----?

"Breathy" = vocal cord paralysis 
"Muffled" = supraglottic lesion

MC Question:
The left recurrent laryngeal loops around----, the right recurrent laryngeal loops around----, after which both run in----.
A) Ligamentum arteriosum, subclavian artery, the tracheoesophageal groove 
B) Aorta, subclavian artery, the tracheoesophageal groove 
C) Subclavian artery, Ligamentum arteriosum, the tracheoesophageal groove 
D) Ligamentum arteriosum, subclavian artery, posterior to the esophagus 
E) Subclavian artery, ligamentum arteriosum, posterior to the esophagus

Free Response Questions:
What muscle is the sole abductor of the vocal cords?

Quick Facts:
Unilateral recurrent laryngeal paralysis
-lesion is below superior laryngeal nerve origin
-vocal cord is in paramedian position due to unopposed cricothyroid activity.
-LRLN damage is more common than RRLN damage due to longer course.
-Usually iatrogenic, can also be caused by tumors, aortic aneurysms, Ortner syndrome and trauma.
-presents with dysphonia, weakening with use.

6/27/2013

Answers:

Indications for total larygnectomy for laryngeal cancer include all of the following except:

A) All T4 tumors 

B) Tongue base involved past circumvallate 

C) Cricoid cartilage involved 

D) as salvage therapy after prior failed treatment 

E) direct invasion fo surrounding neck tissue


When should a patient with laryngeal cancer and without clinically apparent nodal mets undergo a neck dissection?

When the risk of nodal mets is greater than 15%. This includes all supraglottic and T3 or higher glottic cancers.

MC Question:
Which of the following is not a presenting symptom of laryngeal cancer?
A) Hemoptysis 
B) Ear pain 
C) Dysphagia 
D) Odynophagia 
E) Neck mass
F) All of the above

Free Response Questions:
With regards to laryngeal cancer, a "breathy" voice indicates----whereas a "muffled" voice indicates----?

Quick Facts:
-All intrinsic muscles of larynx are innervated by recurrent laryngeal nerve except cricothyroid (ext. sup. laryngeal).
-Sole abductor of vocal cords is posterior cricoarytenoid.
-Path of Vagus:
-nuclei in upper medulla give rise to rootlets.
-motor fibers come from nucleus ambiguus and join at cervical ganglion below jugular foramen.
-vagus exits jugular foramen w/ CNIX and XII. It descends in carotid sheath.
-R RLN curls under subclavian artery and runs superiorly to tracheoesophageal groove, passes into larynx under inf. constrictor.
-L RLN leaves vagus at arch, loops under ligamentum arteriosum before entering groove.

Tuesday, June 26, 2013

Answers:
----cancers have less----and therefore have less tendency for bilateral regional spread relative to----cancer.
A) Glottic; lymphatics; supraglottic 
B) Glottic; vasculature; supraglottic 
C) Supraglottic; lymphatics; glottic 
D) Supraglottic; vasculature; glottic

Most reccurence of laryngeal cancer occurs within what time period post treatment?

2 years

MC Question:
Indications for total larygnectomy for laryngeal cancer include all of the following except:

A) All T4 tumors 

B) Tongue base involved past circumvallate 

C) Cricoid cartilage involved 

D) as salvage therapy after prior failed treatment 

E) direct invasion fo surrounding neck tissue

Free Response Questions:
When should a patient with laryngeal cancer and without clinically apparent nodal mets undergo a neck dissection?

Quick Facts:
Signs/Symptoms of Laryngeal cancer include:

-hoarseness, dysphagia, hemoptysis, neck mass, throat pain, ear pain and airway compromise.
-glottic cancer presents earlier due to sensitivity of vocal folds
-supraglottic cancers present later as tumors must be larger to cause symptoms.

Answers:

What HPV subtype is associated with laryngeal cancer? How does HPV affect prognosis for laryngeal cancer?
A) 8, better prognosis 
B)21, better prognosis 
C)16, better prognosis 
D) 8, worse prognosis 
E) 21, worse prognosis 
F) 16, worse prognosis

Arrange subglottic, glottic and suprglottic laryngeal cancer from most to least prevalent in the US.

Glottic>Supraglottic>Subglottic

MC Question:

----cancers have less----and therefore have less tendency for bilateral regional spread relative to----cancer.
A) Glottic; lymphatics; supraglottic 
B) Glottic; vasculature; supraglottic 
C) Supraglottic; lymphatics; glottic 
D) Supraglottic; vasculature; glottic

Free Response Questions:

Most reccurence of laryngeal cancer occurs within what time period post treatment?

Quick Facts:

Hemilaryngectomy: removal of one vertical half of larynx. 
Indicated for:
-subglottic extension no more than 1 cm below true cords
-a mobile affected cord
-unilateral involvement
-no cartilage invasion
-no extralaryngeal soft tissue involvement

Supraglottic Laryngectomy: removal of supraglottis.  
Indicated for:
-T1/2/3 w/ preepiglottic space involvement only
-vocal cords are mobile
-cartilage not involved
-ant. commissure not involved
-pt has good pulm status
-base of tongue not involved past circumvallate papillae
-apex of pyriform sinus not involved
-FEV1 is >50%

Total Laryngectomy: Complete removal of larynx
-anastomosis proximal stump to opening @ root of neck for permanent stoma.
-Indications are:
-T3/4 not amenable to partial laryngectomy or chemo.
-thyroid/cricoid involvement
-direct invasion of surrounding tissues
-tongue base involved past circumvallate
-salvage therapy failures of chemo/radiation.

Answers:

All of the intrinsic muscles of the larynx are innervated by ---- except for the ---- which is innervated by the external branch of the superior laryngeal.
A) Recurrent Laryngeal branch of CNX; Posterior Cricoarytenoid 
B) Recurrent Laryngeal branch of CNX; Cricothyroid Muscle 
C)Internal Branch of Superior Laryngeal; Posterior Cricoarytenoid 
D) Internal BRanch of Superior Laryngeal; Cricothyroid Muscle

What are the borders of the supraglottis, glottis and subglottis?

Supraglottis: tip of epiglottis to ventricle 
Glottis: true vocal cords to .5 cm below free edge of true cords 
Subglottis: inferior glottis to inf edge of cricoid cartilage

MC Question:

What HPV subtype is associated with laryngeal cancer? How does HPV affect prognosis for laryngeal cancer?
A) 8, better prognosis 
B)21, better prognosis 
C)16, better prognosis 
D) 8, worse prognosis 
E) 21, worse prognosis 
F) 16, worse prognosis

Free Response Questions:

Arrange subglottic, glottic and suprglottic laryngeal cancer from most to least prevalent in the US.

Quick Facts

Head and Neck Cancer Followup:
-Schedule f/u every 4-6 wks x 1 yr
-2nd yr every 2 months
-3rd yr every 3 months
-considered cured after 5 yrs.
-Most recurrence occurs in the first 2 yrs.

6/21/2013

MC Questions:

All of the intrinsic muscles of the larynx are innervated by ---- except for the ---- which is innervated by the external branch of the superior laryngeal.
A) Recurrent Laryngeal branch of CNX; Posterior Cricoarytenoid 
B) Recurrent Laryngeal branch of CNX; Cricothyroid Muscle 
C)Internal Branch of Superior Laryngeal; Posterior Cricoarytenoid 
D) Internal BRanch of Superior Laryngeal; Cricothyroid Muscle

Free Response:

What are the borders of the supraglottis, glottis and subglottis?

Quick Facts:

Malignant Laryngeal Lesions:
-glottic>supraglottic in US but not worldwide
-malignant disorders of subglottis are rare.
-HPV associated subtypes include HPV16.
-GERD suspected in pathogenesis but this is not definitive.
-Genes linked to laryngeal cancer include: p53, Bcl-2, RB