LARYNGOSCOPY

LARYNGOSCOPY

Q. 1

Acute laryngeal spasm during indirect laryngoscopy is seen in?

 A Acute epiglottitis

 B

Acute laryngo tracheo bronchitis

 C Acute tonsillitis

 D

Acute laryngitis

Q. 1

Acute laryngeal spasm during indirect laryngoscopy is seen in?

 A

Acute epiglottitis

 B

Acute laryngo tracheo bronchitis

 C

Acute tonsillitis

 D

Acute laryngitis

Ans. A

Explanation:

Q. 2

During laryngoscopy and endo-tracheal intubation which of the maneuver is not performed:

 A

Flexion of the neck

 B

Extension of Head at the atlanto-occipital joint.

 C

The laryngoscope is lifted upwards levering over the upper incisors.

 D

In a straight blade laryngoscope, the epiglottis is lifted by the tip.

Ans. C

Explanation:

Ans:C i.e. The laryngoscope is lifted upward levering over the upper incisiors.

Procedure of Endotracheal Intubation:

  • The correct position is with the lower part of the cervical spine flexed (by placing a pillow or other suitable pad under the patient’s occiput), and the atlanto-occipital joint extended(by tilting the head back) – the so-called “sniffing position”. This position aligns the axes of the mouth, pharynx and trachea, and will give the best visualization of the cords during laryngoscopy.
  • In a Straight Blade Laryngoscope,lift the epiglottis with the tip of the blade.

Q. 3 Anaesthesia used in micro laryngoscopy is 

 A

Pollarad tube of 10 mm diameter with heavy sedation

 B

Pollarad tube of 15 mm diameter with topical xylocaine

 C

Pollarad tube with infiltration block

 D

Heavy sedation on and Endotracheal intubation

Ans. C

Explanation:

Ci.e. Pollarad tube with infiltration block

– Microlaryngoscopy tubes are long, have a small internal and external diameter, and are designed specifically for endoscopic procedures (but not suitable for laser surgery). Typically 4 to 5 mm internal diameter tubes with high volume, low-pressure cuffs are used in nasal or oral versions. The most popular anaesthetic technique uses a Coplan’s micro laryngoscopy tube (5mm ID, 31cm long, 10mm cuff volume and constructed from soft plastic). It is designed for micro laryngeal surgery or for the patient whose airway has been narrowed to such an extent that a normal-sized tracheal tube cannot be inserted. The small tube diameter provides better visibility and access to the surgical field but may lit incomplete exhalation and occlusion.

– Most commonly the patients are intubated with small diameter (4 – 6 mm) tracheal tubes; – Standandard tracheal tubes of this size, however, are designed for pediatric patients. They tend to be too short for adult trachea (in length) with a low volume cuff that will exert high pressure against it

– A 4 – 6 mm micro laryngeal tracheal (MLT) tubes (Mallinckrodt critical Care) is the same length as the adult tube, has disproportionately large high volume low-pressure cuff, and is stiffer and less prone to compression than a regular tracheal tube.


Q. 4

In a direct laryngoscopy,which of the following can be visualized?

 A

Cricothyroid

 B

Lingual surface of epiglottis

 C

Arytenoids

 D

All

Ans. D

Explanation:

Larynx: Epiglottis, aryepiglottic folds, arytenoids, cuneiform and corniculate cartilage, ventricular ands, ventricles, true cords, anterior commissure, posterior commissure, subglottis and rings of trachea.

Hypopharynx: Both pyriform fossae, post-cricoid region, posterior wall of laryngopharynx.

Oropharynx: Base of tongue, lingual tonsils, valleculae, media and lateral glosso-epiglottic folds.


Q. 5

Which of the following is difficult to visualize or examine on indirect laryngoscopy?

 A

True vocal cord

 B

Anterior commissure

 C

Epiglottis

 D

False vocal cord

Ans. B

Explanation:

 

Hidden areas of larynx viz. infrahyoid epiglottis, anterior commissure, ventricles and subglottic region and apex of pyriform fossa are difficult to visualize by indirect laryngoscopy.



Q. 6

Microlaryngoscopy was started by:

 A

Bruce Benjamin

 B

Kleinsasser

 C

Chevalier Jackson

 D

None

Ans. B

Explanation:

The present day microsurgical techniques of the larynx are a credit to Kleinsasser.


Q. 7

The procedure that should precede microlaryngoscopy is:

 A

Pharyngoscopy

 B

Esophagoscopy

 C

Rhinoscopy

 D

Laryngoendoscopy

Ans. D

Explanation:

 

Microlaryngoscopy concentrates mainly on the glottic area in cases where the diagnosis is already established and unlike direct laryngoscopy, is not primarily concerned with other areas of larynx which should have been assessed preoperatively.



Q. 8 A girl, 4 yrs of age presented in emergency with mild re­spiratory distress. On laryngoscopy, she was diagnosed to have multiple juvenile papillo-matosis of the larynx . Next line of management is:

 A

Tracheostomy

 B

Microlaryngoscopy

 C

Steroid

 D

Antibiotics

Ans. B

Explanation:

 

The management is microlarygoscopic surgery using CO, laser to ablate the lesion.

Steroids and antibiotics have no role.

Tracheostomy is reserved for those patients who have severe respiratory distress.



Q. 9

A patient is examined by an ENT Specialist doctor by the following test as shown in the image.Which are the other tests,that can also be used for the assessment of the same region which is being tested by the doctor? 

 A

Nasopharyngoscopy

 B

Examination under anaesthesia after palatal retraction.

 C

Digital palpation

 D

Laryngoscopy

Ans. A

Explanation:

Answer- Nasopharyngoscopy

The image represents Posterior rhinoscopy test

Posterior Rhinoscopy:

  • It is method of examination of the Nasopharynx.
  • Structures seen on posterior rhinoscopy:

– Both choanae

– Posterior end of nasal septum

– Opening of Eustachian

– Posterior end of superior/tube middle and inferior turbinates

– Fossa of Rosenmuller

– Torus Tubarius

– Adenoids

– Roof and posterior wall and nasopharynx.


Different methods of examining the Nasopharynx 

i. Posterior Rhinoscopy

ii. Nasopharyngoscopy.

iii. Examination under anaesthesia after palatal retraction.

iv. Digital palpation.

v. Radiological examination.

 


Q. 10

lntra ocular pressure rises in ‑

 A

 Intubation & laryngoscopy

 B

 LMA

 C

 Infusion of IV propofol

 D

 Bag and mask ventilation

Ans. A

Explanation:

Ans. is ‘a i.e., I ntubation & laryngoscopy 



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