TRICKY QUIZ 2 - DR. VYSHNAVI ENT

A 53-year-old woman undergoes a thyroidectomy for papillary thyroid carcinoma. The surgery is uneventful, but the following day, she notices her voice is weaker, and she struggles to project it clearly. Despite this, she experiences no swallowing difficulty, and there are no signs of postsurgical complications such as hematoma formation. Which of the following muscles is likely affected due to a nerve injury, and what is its primary function?

• Posterior cricoarytenoid—responsible for vocal cord abduction

• Thyroarytenoid—tightens and relaxes vocal cords for sound modulation

• Cricothyroid—adjusts tension of vocal cords to change pitch

• Lateral cricoarytenoid—mediates vocal cord adduction for sound production

A 15 year old boy with proptosis of eyes and bleeding from nose presented to the clinician. Which of the following is NOT a commonly used classification system for staging the diagnosis?

• Radkowski classification

• Sessions classification

• Fisch classification

• TNM classification

A 34-year-old man presents with rapidly progressive submandibular swelling, trismus, dysphagia, and drooling following a week of worsening dental pain. He is leaning forward with his arms on his knees, struggling to breathe. His voice is muffled, and examination reveals tongue elevation and induration of the floor of the mouth. Despite oxygen supplementation, his oxygen saturation drops to 88%, and he becomes increasingly agitated. Which of the following airway management strategies is LEAST appropriate for this patient?

• Awake fiberoptic intubation with topical anesthesia

• Surgical tracheostomy under local anesthesia

• Rapid sequence intubation with neuromuscular blockade

• Cricothyrotomy as a last resort in complete airway obstruction

A 31-year-old pregnant woman presents with progressive bilateral hearing loss, worse in the right ear, and difficulty hearing whispers. Her mother had similar symptoms and underwent surgery for hearing restoration. Rinne test shows bone conduction > air conduction in the right ear, and audiometry reveals a 20 dB air-bone gap. Which of the following findings or tests is LEAST likely to be associated with the suspected diagnosis?

• Carhart’s notch at 2000 Hz on audiometry

• Type As tympanogram on impedance audiometry

• Schwartze sign on otoscopic examination

• Positive fistula test indicating perilymph leakage

A child presents with bilateral conductive hearing loss accompanied by abnormal external ear morphology. The Rinne test confirms bone conduction exceeding air conduction in both ears, and the Weber test lateralizes to the right ear. Which of the following embryological structures plays the least significant role in the development of this condition?

• First pharyngeal arch

• Second pharyngeal arch

• Oticplacode

• First pharyngeal pouch

A 3-year-old boy is brought to the emergency department with a 1-day history of sore throat, fever, and difficulty breathing. He has no past medical issues and is fully vaccinated, including Hib. On examination, he is anxious, sitting upright with his neck extended, mouth open, drooling, and refusing to lie down. He makes high-pitched noises during breathing, especially on expiration. Attempts to examine his throat worsen his distress. What is the most appropriate next step in management?

• Lay the child flat and establish intravenous access immediately.

• Attach monitors and induce anesthesia with oxygen and inhalational agent in the emergency department, keeping the child seated.

• Perform direct laryngoscopy in the emergency department to assess airway patency.

• Transfer to the operating room, monitor the child, and induce anesthesia while seated using oxygen and inhalational agent.

A 2-month-old infant has noisy breathing that worsens with feeding, crying, or lying supine. He has no surgical history, is gaining weight well, and shows clear nasal passages without craniofacial abnormalities. Chest examination is normal, but inspiratory stridor is heard on auscultation. Which test is the gold standard for diagnosing this condition?

• Airway fluoroscopy

• Bronchoscopy and direct laryngoscopy

• Flexible fiberoptic laryngoscopy

• Radiologic imaging studies

A 2-year-old boy is brought to the hospital due to a weak cry. Flexible laryngoscopy reveals a lesion in the anterior two-thirds of the left vocal fold, and the patient undergoes surgical removal. Histopathology shows hyperplastic stratified squamous epithelium with a central fibrovascular core. Which of the following viral strains is most commonly associated with this condition?

• HPV 16 and HPV 18

• HPV 11 and HPV 18

• HPV 11 and HPV 16

• HPV 6 and HPV 11

A 3-month-old infant is brought to the clinic due to weak cry, stridor, and feeding difficulties. The parents report persistent hoarseness since birth. On examination, the infant has inspiratory stridor without retractions, and nasal regurgitation during feeding. Flexible laryngoscopy reveals bilateral vocal cord immobility. Further neurological assessment shows hypotonia and poor head control. Which of the following is the most likely underlying cause of this infant’s symptoms?

• Congenital laryngomalacia

• Arnold-Chiari malformation type II

• Neonatal myasthenia gravis

• Congenital subglottic stenosis

A 4-year-old child suddenly develops respiratory distress and high-pitched stridor while playing. His parents report that he was eating small pieces of food just before symptoms began. The child is gasping for air but is still able to cough. Physical examination shows suprasternal retractions and wheezing localized to the neck region. Which of the following is the most appropriate initial management?

• Encourage the child to continue coughing

• Perform the Heimlich maneuver immediately

• Blindly sweep the airway with a finger

• Attempt direct laryngoscopy for immediate foreign body removal