Throat Conditions

Question 1

Pharyngeal pouch, also referred to as Zenker’s diverticulum, is a sac or pocket which can develop between the lower part of the throat (cricopharyngeus) and the upper part of the gullet or food pipe (oesophagus/thyropharyngeus). What is the incidence of this?

1 - 1 : 100/000
2 - 10 : 100/000
3 - 100 : 100/000
4 - 1000 : 100/000

Answer 1

1 - 1 : 100/000

Killian’s dehiscence is a triangular area in the wall of the pharynx between the thyropharyngeus and cricopharyngeus muscles.

Question 2

Pharyngeal pouch is a sac or pocket which can develop between the lower part of the throat (cricopharyngeus) and the upper part of the gullet or food pipe (oesophagus/thyropharyngeus). Is this more common in elderly or younger populations?

Answer 2

• elderly

5:1 more common in men

Occurs due to a weakness in the muscles of the throat

Question 3

Which of the following is NOT a typical symptom a patient with a pharyngeal pouch?

1 - dysphagia
2 - regurgitation
3 - sialorrhea
4 - aspiration/recurrent chest infections
5 - neck swelling which gurgles on palpation
6 - halitosis (bad breathe)

Answer 3

3 - sialorrhea

Medical term for drooling

Question 4

What is the gold standard for diagnosing a patient with a suspected pharyngeal pouch?

1 - endoscopy
2 - chest X-ray
3 - MRI
4 - barium swallow test

Answer 4

4 - barium swallow test

Water soluble contrast swallow

Question 5

Which of the following is NOT a suitable treatment for a patient with suspected pharyngeal pouch?

1 - SALT input (assess swallow and diet)
2 - tracheotomy
3 - antibiotics for infections
4 - endoscopic stapling/excision of pouch)

Answer 5

2 - tracheotomy

Question 7

Laryngopharyngeal reflux (LPR) is a condition caused by gastro-oesophageal acid reflux resulting in inflammatory changes to the larynx/hypopharynx mucosa. What % of ENT referrals is this observed in?

1 - 0.1%
2 - 1%
3 - 10%
4 - 40%

Answer 7

3 - 10%

Question 8

Laryngopharyngeal reflux (LPR) is a condition caused by gastro-oesophageal acid reflux resulting in inflammatory changes to the larynx/hypopharynx mucosa. This can cause all of the following symptoms, EXCEPT which one?

1 - catarrh (mucus build up in throat)
2 - dysphagia
3 - repetitive throat clearing
4 - voice changes
5 - globus pharyngeus
6 - chronic cough.

Answer 8

2 - dysphagia

All of these symptoms are vague and non-specific

Question 9

Laryngopharyngeal reflux (LPR) is a condition caused by gastro-oesophageal acid reflux resulting in inflammatory changes to the larynx/hypopharynx mucosa. Erythema and oedema can be seen when scoping the patient. Which of the following is the gold standard for diagnosis?

1 - endoscopy
2 - pH manometry
3 - MRI
4 - water soluble contrast swallow

Answer 9

2 - pH manometry

Question 10

Which of the following is NOT a conservative management approach for Laryngopharyngeal reflux (LPR)?

1 - dietary/lifestyle change
2 - quit smoking/alcohol reduction
3 - SALT input
4 - steroids

Answer 10

Laryngopharyngeal reflux (LPR)

Question 11

Which 2 medications can be used as a treatment for Laryngopharyngeal reflux (LPR)?

1 - ondansetron
2 - omeprazole
3 - cyclizine
4 - gaviscon

Answer 11

2 - omeprazole
Proton pump inhibitor

4 - gaviscon

Question 13

Which of the following can the vocal cords be found?

1 - epiglottis
2 - glottis
3 - subglottis
4 - supraglottis

Answer 13

2 - glottis

Question 14

The vocal cords can be found at the level of the glottis. What level of vertebrae is this?

1 - C1-C4
2 - C2-C8
3 - C4-C6
4 - C5-T2

Answer 14

3 - C4-C6

This changes as we grow from a child to an adult

Question 15

What is dysphonia?

1 - abnormal voice
2 - difficulty swallowing
3 - drooling
4 - difficulty in generating speech

Answer 15

1 - abnormal voice

Question 16

Does vocal cord paralysis cause just an abnormal voice?

Answer 16

• No

Can affect breathing as well as below this is the trachea

If adducted during paralysis, then this is a medical emergency

Question 17

Match what the vocal cord does in relation to the activity:

• breathing and speaking
• adduction and abduction

Answer 17

• breathing = abduction
• speaking = adduction
  Vocal cords adduct to help with vibrations and thus make sound

Question 18

The recurrent laryngeal nerves innervate the vocal cords. Which cranial nerve are the recurrent laryngeal nerves a branch of?

1 - facial nerve (CN7)
2 - hypoglossal nerve (CN12)
3 - vagus nerve (CN10)
4 - glossopharyngeal nerve (CN8)

Answer 18

3 - vagus nerve (CN10)

Left is more likely to be damaged due to its course going under the arch of the aorta

Question 19

Stridor is a high pitched noice causes by restriction of air flow. A lesion at which of the following would cause an inspiratory stridor?

1 - Oropharynx
2 - Glottis/supraglottis
3 - Subglottic
4 - Tracheal

Answer 19

2 - Glottis/supraglottis

Question 20

Stridor is a high pitched noice causes by restriction of air flow. A lesion at which of the following would cause an expiratory stridor?

1 - Oropharynx
2 - Glottis/supraglottis
3 - Subglottic
4 - Tracheal

Answer 20

4 - Tracheal

Often described as a wheeze

Question 21

Stridor is a high pitched noice causes by restriction of air flow. A lesion at which of the following would cause a biphasic stridor?

1 - Oropharynx
2 - Glottis/supraglottis
3 - Subglottic
4 - Tracheal

Answer 21

3 - Subglottic

Question 22

If a patient presents with stridor, it is important to do which of the following 1st?

1 - bloods
2 - call ENT and anaesthetics
3 - ABCDE assessment
4 - airway assessment

Answer 22

3 - ABCDE assessment

Include history if not distressing the patient

All others would also be done

Question 23

If a patient presents with stridor, it is important to perform an ABCDE approach and seek help. We can also do all of the following, except which one?

1 - Intubate
2 - High flow oxygen 15L
3 - adrenaline nebuliser
4 - dexamethasone
5 - heliox (B2 agonist nebuliser)
6 - IV Antibiotics (if infective)

Answer 23

1 - Intubate

MUST only be performed by ENT or anaesthetist

Question 24

Which of the following is NOT a red flag for suspected throat malignancy?

1 - horse voice for months
2 - dysphagia with solids for weeks
3 - dysphagia for liquid and solids since dysphagia began
4 - neck lumps present for weeks
5 - unintensional weight loss for months

Answer 24

3 - dysphagia for liquid and solids since dysphagia began

Malignancy would start with solids, before progressing to liquids