7/2/2013

Answers:

A patient presents to your clinic with complaints of a change in her voice over the past three months. She appears to have a weak voice, which gets worse with use. She does not smoke, denies hemoptysis, dyspnea or cough. She states that she recently underwent surgery and points to a scar on her neck. When performing laryngoscopy what would you expect to see?

A) A vocal cord nodule 

B) A vocal cord polyp 

C) A single vocal cord in the intermediate position 

D) A single vocal cord in the cadaveric position 

E) A single vocal cord in the paramedian position

With regards to recurrent laryngeal nerve paralysis, which is more commonly injured. LRLN or RRLN? Why?

LRLN is more commonly injured due to its longer course.

MC Question:

Pt presents with dysphonia and a hx of aspiration pneumonia. On laryngoscopy the left vocal cord is found to remain lateral even during phonation. Where is the most likely area for the lesions causing this paralysis?

A) At the site of the false vocal cord 

B) At the site of the true vocal cord 

C) Below the origin of the superior laryngeal nerve 

D) Above the origin of the superior laryngeal nerve

Free Response Questions:
What are two procedures used to medialize paralyzed vocal folds?

Quick Facts:
Bilateral Recurrent Laryngeal Nerve Paralysis
-often recent hx of thyroid surgery (usually total)
-presentation is often in the ED w/ stridor as minimal swelling can occlude airway.
-tracheotomy is often only viable option emergently.
-some nerve recovery is expected in 50% of patients.

7/1/2013

Answers:

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

What muscle is the sole abductor of the vocal cords?

The Posterior Cricoarytenoid

MC Question:
A patient presents to your clinic with complaints of a change in her voice over the past three months. She appears to have a weak voice, which gets worse with use. She does not smoke, denies hemoptysis, dyspnea or cough. She states that she recently underwent surgery and points to a scar on her neck. When performing laryngoscopy what would you expect to see?

A) A vocal cord nodule 

B) A vocal cord polyp 

C) A single vocal cord in the intermediate position 

D) A single vocal cord in the cadaveric position 

E) A single vocal cord in the paramedian position

Free Response Questions:
With regards to recurrent laryngeal nerve paralysis, which is more commonly injured. LRLN or RRLN? Why?

Quick Facts:
Surgical Treatment for Vocal Fold Paralysis
-Dynamic = reinnervation/laryngeal pacing.
-Static = medialize cord.
-Injection laryngoplasty = often collagen/vox/hydroxyapatite/fat
-Laryngeal framework=place silastic implant via thyroid window.