[END OF ROUND] LARYNGOLOGY REVISION

Question 1

C/P: Hoarseness of voice, biphasic stridor, cough & expectoration, fibrosis & formation of a web between the VF, bilateral nasal obstruction & mucoid discharge. When examined via indirect laryngoscope, bilateral symmetrical granulations & crustations were observed in the subglottic region. Upon obtaining a biopsy, fibroblasts, Russel bodies & mikluiczcells were seen.

1.DIAGNOSIS?
2.TTT?

Answer 1

1. (larygno) Scleroma
   2- severe stridor—> tracheostomy
   -thin web–>MLS
   -thick web–>Laryngofissure + apply free skin graft

Question 2

C/P: history of smoking, hoarseness of voice, slightly raised white patches above mucosa of the VF, VF are freely mobile however.

1.DIAGNOSIS?
2.TTT?

Answer 2

1.Leukoplakia
2. -Avoid/control PDFs
-MLS
-Careful follow up

Question 3

C/P: history of under going surgery under anesthesia, followed up change of voice & discomfort in the throat.

a pink granular mass is seen on the vocal processes of the arytenoids

1.DIAGNOSIS?
2.TTT?

Answer 3

1. Intubation granuloma
2. MLS

Question 4

C/P: child 5-8y, fever, biphasic stridor, hoarse cry, croupy cough + thick viscid sputum & dyspnea.

mucosa of the larynx is congested & edematous. Steeple sign is seen on x-ray

1.DIAGNOSIS?
2.TTT?

Answer 4

1. Croup (acute laryngo-tracheo-bronchitis)
2. secure the airway (tracheostomy is preferred), oxygen, ABs & Mucolytic, Steroids, steam inhalation & humidification

Question 5

C/P: hoarse voice, dry congested throat, dry irritative cough.

diffuse symmetrical bilateral congestion+ thickening of mucosa of VF, localized hyperkeratosis/nodules/polyps

1.DIAGNOSIS?
2.TTT?

Answer 5

1. Chronic nonspecific laryngitis
2. Control PDFs, steam inhalation, ABs+ Mucolytic, voice therapy, MLS

Question 6

C/P: child, episode of common cold followed by fever (38-39) hoarseness of voice, croupy metallic cough, dyspnea that rapidly progresses into stridor

VF are bilaterally symmetrically congested with viscid secretions in between & a narrowed larynx

1.DIAGNOSIS?
2.TTT?

Answer 6

1. Acute nonspecific laryngitis in children.
2. secure airway (endotracheal tube/tracheostomy), oxygen, ABs+ Mucolytics, steroids, steam inhalation + humidification

Question 7

C/P: adult, history of smoking & common cold followed by hoarseness of voice, dry cough that progresses into wet cough with viscid sputum.

VF are symmetrically bilaterally congested with viscid secretions in between.

1.DIAGNOSIS?
2.TTT?

Answer 7

1. Acute nonspecific laryngitis in adults.
2. Voice rest, ABs+ Mucolytics, steam inhalation

Question 8

C/P: adult, complaining of dysphonia.

unilateral single whitish warty-like mamillated swellings on VF, no recurrence when removed

1.DIAGNOSIS?
2.TTT?

Answer 8

1. Single papilloma
2. MLS

Question 9

C/P: child 5-15y, history of HPV infection, dysphonia & stridor

multiple sessile warty-like pinkish granulations on larynx

1.DIAGNOSIS?
2.TTT?

Answer 9

1.Multiple papillomatosis
2. Repeated MLS, Tracheostomy (LOW), estrogen/interferon,tetracyclines

Question 10

C/P: adult complaining of dysphonia
unilateral single whitish warty like mamillated swelling on VF

1.DIAGNOSIS?
2.TTT?

Answer 10

1. Single papillomatosis
2. MLS

Question 11

C/P: adult male >40y, with history of smoking & alcoholism complaining of hoarseness of voice, stridor, throat discomfort, dysphagia, referred otalgia, foeter oris, cough & expectoration that is sometimes blood stained.
broadened larynx, tenderness, absent laryngeal click.

cauliflower mass is seen growing on VF.

1.DIAGNOSIS?
2.INVESTIGATIONS?

Answer 11

1. Cancer larynx
2. -General exam (CBC, ESR,
   ECG…)
   -Radiological= CT scan,
   Barium swallow, Plain X-ray
   -Endoscopy
   -*Biopsy to confirm diagnosis

Question 12

Glottic tumors TTT (2)

Answer 12

1. Cordectomy (Laser MLS/ Conventional laryngectomy)
2. Partial VERTICAL laryngofissure

Question 13

Supraglottic tumors TTT (4)

Answer 13

1. Partial HORIZONTAL laryngectomy
   2.Total laryngectomy (late cases)
2. Radical neck dissection
3. Elective neck dissection

Question 14

Subglottic tumors TTT

Answer 14

Total laryngectomy & radiotherapy

Question 15

Indications of Irradiation in cases of cancer larynx (4)

Answer 15

1. T1 glottic or supraglottic tumors
2. Surgery is CI
3. Inoperable cases
   4.Non resectable LNs

Question 16

Voice rehabilitation after total laryngectomy in cases of cancer larynx is done by (3)

Answer 16

1. Esophageal speech
2. Artificial larynx
   3.Tracheo-esophageal valve

Question 17

Palliative TTT in cases of cancer larynx is done by (5)

Answer 17

1-Tracheostomy (laryngeal obstruction)
2.Gastrostomy (dysphagia)
3. Palliative excision (of fungating tumors)
4. Chemotherapy (MTX)
5.Antibiotics + Analgesics

Question 18

C/P: mild dysphonia that improves with time, dyspnea only on exertion.
with indirect laryngoscopy, VC is seen in paramedian position, one VC is shorter and thinner than the other, the arytenoids have fallen forward

1.DIAGNOSIS?
2.TTT?

Answer 18

1. Unilateral RLN paralysis
2. -wait 6-12 months for spontaneous recovery
   -Vocal fold augmentation
   -Thyroplasty

Question 19

C/P: marked dysphonia that improves with time, dyspnea only on exertion, aspiration that improves with time with indirect laryngoscopy, VC is seen in cadaveric position

1.DIAGNOSIS?
2.TTT?

Answer 19

1. Unilateral RLN & SLN paralysis
2. wait 6-12 months for spontaneous recovery
   -Vocal fold augmentation
   -Thyroplasty

Question 20

Investigations of unilateral VF paralysis (4)

Answer 20

1. Radiological= Chest X-ray, CT, MRI, Thyroid scans
2. Laboratory (ESR, Syphilis, TB, virology)
3. Direct laryngoscopy
4. other Endoscopy=
   -Nasopharyngoscopy,
   -Esophagoscopy
   -Biopsy

Question 21

C/P: history of thyroidectomy operation followed by sudden onset stridor, voice is not bad, no aspiration

VF in paramedian position

1.DIAGNOSIS?
2.TTT?

Answer 21

1. Bilateral RLN (Abductor) paralysis
2. TTT of cause
3. Follow up 6-12 months for spontaneous recover
4. Tracheostomy (severe obstruction)
5. Surgery for VF lateralization (improves respiration at the expense of phonation)
   -Laser cordectomy
   -Laser cordotomy
   -Arytenoidectomy

Question 22

C/P: Aphonia, severe aspiration, no stridor

1.DIAGNOSIS?
2.TTT?

Answer 22

1. Bilateral RLN & SLN (adductor) paralysis
2. Glottic closure & permanent tracheostomy with speaking valve
   (NO SPONTANEOUS RECOVERY)

Question 23

C/P: child, sudden attack of coughing, choking, dyspnea & cyanosis, burning feeling in chest.

dullness heard on chest. percussion.

with chest x-ray, narrow intercostal spaces, low copula, lung collapse & mediastinum shift towards collapsed lung is seen.

1.DIAGNOSIS?
2.TTT?

Answer 23

1. FB inhalation with complete obstruction
2. Removal via bronchoscopy
   ⤷if failed: open thoracic surgery
   & bronchotomy
3. Antibiotics, bronchodilators, expectorants

Question 24

C/P: child, sudden attack of coughing, choking, dyspnea & cyanosis, burning feeling in chest.

hyper-resonance is heard on chest percussion

with chest x-ray, widened intercostal spaces, high copula, inflated lung with mediastinum shift away from inflated lung is seen

1.DIAGNOSIS?
2.TTT?

Answer 24

1. FB inhalation with incomplete obstruction
2. Removal via bronchoscopy
   ⤷if failed: open thoracic surgery
   + bronchotomy
3. Antibiotics, bronchodilators, expectorants

Question 25

Investigations of FB inhalation

Answer 25

1- Bronchoscopy (GOLD STD) 2. Chest X-ray; AP & lateral view

Question 26

C/P: 3-8y , repeated attacks URTI, BILATERAL nasal obstruction, mouth breather, snoring, sleep apnea, lack of concentration in class, diminished hearing, postnasal discharge, Pigeon chest 1.DIAGNOSIS? 2.TTT? 3.INVESTIGATIONS?

Answer 26

1. Adenoid hypertrophy 2. Adenoidectomy (+/- tonsillectomy) 3. Nasopharyngeal X-ray -Pure tone audiometry & tympanometry

Question 27

C/P: Fever (39-40), headache, malaise, sore throat, dysphagia, otalgia, foeter oris, rapid full pulse (proportionate), enlarged tender LNs, on examination: edematous enlarged congested tonsils with pus in crypts 1.DIAGNOSIS? 2.TTT? 3.INVESTIGATIONS?

Answer 27

1. Acute tonsillitis 2. Medical TTT= Penicillin for 10d (Erythromycin if penicillin allergy), Analgesics, Antipyretics, bed rest 3. C&S, CBC= leukocytosis+ Neutrophils

Question 28

C/P: FAHM, insomnia, repeated attack of sore throat & dysphagia, change of voice , fetor oris, expelling of fetid debris, neck swelling, cervical lymphadenitis, enlarged jugulodigastric LNs, congested anterior pillar, irregular surface of tonsils, tonsils unequal in size 1.DIAGNOSIS? 2.TTT?

Answer 28

1. Chronic tonsillitis 2. Tonsillectomy

Question 29

C/P: child 2-5y, FAHM, severe sore throat, dysphagia, UNILATERAL neck swelling, BULLNECK APPEARANCE weak v rapid pulse (disproportionate), albuminuria, grayish white pseudomembrane on tonsils that is adherent and leads to bleeding on removal 1.DIAGNOSIS?

Answer 29

1. Diphtheria

Question 30

C/P: hoarse croupy cough, inspiratory stridor, pyrexia, weak rapid pulse, grayish white pseudomembrane that bleeds when separated 1.DIAGNOSIS?

Answer 30

1. Laryngeal diphtheria

Question 31

C/P: Severe pain, referred otalgia, fetor oris, unilateral tender cervical LNs, unilateral membrane in pharynx when removed leaves behind a deep irregular crater like inlaid ulcer 1.DIAGNOSIS? 2.TTT?

Answer 31

1. Vincent's Angina 2. H2O2 -Penicillin or Erythromycin + Metronidazole

Question 32

C/P: child, symptoms of acute tonsilitis+ red rash all over trunk & limbs, circumoral pallor & red smooth tongue 1.DIAGNOSIS? 2.TTT? 3.INVESTIGATIONS?

Answer 32

1. Scarlet fever 2. Antibiotics= Penicillin for 10d (erythromycin if allergic) -Antipyretics -Analgesics -Bed rest, fluids, etc 3. CBC= Leukocytosis -Dick's test -Chultz-Chartton test

Question 33

C/P: diabetic patient, severe dysphagia, sore throat, fever, white milky patches on tongue, palate, tonsils, pharynx 1.DIAGNOSIS? 2.TTT? 3.INVESTIGATIONS

Answer 33

1. Moniliasis 2. -Stop Abs -Antifungal drops= Mycostatin, Daktarin gel -Alkaline stringent gargle -good diet & vitamins 3.Throat swab & film examination

Question 34

C/P: 50y woman, difficulty in swallowing solid food for the last 3 years, non-tender swelling in the right upper neck, koilonychia, glossitis, angular stomatitis, splenomegaly, anemia, achlorhydria 1.DIAGNOSIS? 2.TTT? 3.INVESTIGATIONS?

Answer 34

1. Plummer Vinson $ 2. nutrition for anemia & vit deficiency -repeated dilatation of stricture -follow up for malignancy 3. Endoscopy (DIAGNOSTIC) -biopsy to exclude malignancy

Question 35

C/P: dysphagia for years, double swallowing, regurgitation of undigested food, nocturnal cough, repeated chest infections, swelling in *LEFT* side of neck following meals 1.DIAGNOSIS? 2.TTT? 3.INVESTIGATIONS?

Answer 35

1. Pharyngeal pouch (zinker's diverticulum) 2. mild=> cricopharyngeal myotomy -well formed pouch=> diverticulotomy + cricopharyngeal myotomy 3. Barium swallow & endoscopy

Question 36

C/P: severe FAHM, severe pain below mandible, dysphagia, trismus, dysphonia, early respiratory obstruction external neck swelling in below the jaw, protruded tongue, trismus 1.DIAGNOSIS? 2.TTT? 3.INVESTIGATIONS?

Answer 36

1. Ludwig's angina 2. Abscess drainage, EXTERNAL incision (midline/horse shoe incision) -Abs, Antipyretics, Analgesics -Tracheostomy (done early due to rapid progression)

Question 37

C/P: adult, frequent attack of acute tonsilitis, pain, dysphagia, drooling of saliva, referred otalgia, hot potato voice, trismus, torticollis, fetor oris fever (40-41) w/ proportionate rapid pulse, tonsils pushed downwards & medially, displaced uvula, enlarged jugulodigastric LNs 1.DIAGNOSIS? 2.TTT? 3.INVESTIGATIONS?

Answer 37

1. Quinzy 2.Abs + drainage, INTERNAL +Tracheostomy 3.Syringe aspiration

Question 38

C/P: recurrent severe epistaxis, anemia, bilateral nasal obstruction (started off as unilateral), nose broadening, mass in nasal cavity & nasopharynx, proptosis, swollen cheek, bilateral OME & CHL, soft palate pushed downward

Answer 38

1. Angiofibroma 2. surgical excision after preoperative embolization 3.CT nose, angiography, MRI & MRA, pure tone audiometry & tympanometry