BAILEY

CHAPTER 4 NO 31-60
SYARAH
◦ 31 . In a dysphagic patient who had previously undergone treatment for advanced
laryngeal
◦ cancer, impaired laryngohyoid elevation would be most readily detected by:
◦ A. Videofluoroscopic swallow study (VFSS)
◦ B . High-resolution manometry
◦ C. Fiberoptic endoscopic evaluation of swallowing (FEES)
◦ D . Clinical bedside swallow evaluation
◦ E. Narrow band imaging
◦ 31 . In a dysphagic patient who had previously undergone treatment for advanced
laryngeal
◦ cancer, impaired laryngohyoid elevation would be most readily detected by:
◦ A. Videofluoroscopic swallow study (VFSS)
◦ B . High-resolution manometry
◦ C. Fiberoptic endoscopic evaluation of swallowing (FEES)
◦ D . Clinical bedside swallow evaluation
◦ E. Narrow band imaging
◦ 32. Which muscle does a singer use to keep the vocal folds approximated when using
a
◦ chest voice mechanism?
◦ A. Thyroarytenoid
◦ B . Interarytenoid
◦ C. Lateral cricoarytenoid
◦ D. Cricothyroid
◦ E. Thyrohyoid
◦ 32. Which muscle does a singer use to keep the vocal folds approximated when using
a
◦ chest voice mechanism?
◦ A. Thyroarytenoid
◦ B . Interarytenoid
◦ C. Lateral cricoarytenoid
◦ D. Cricothyroid
◦ E. Thyrohyoid
◦ 3 3 . Which of the following is most descriptive of the esophageal B ring?
◦ A. A mucosal narrowing at the gastroesophageal junction usually associated with a
hiatal
◦ hernia
◦ B . A thickening of the lower esophageal sphincter ( LES) muscle
◦ C. Esophageal trachealization
◦ D . The narrowing in the lower esophagus associated with the diaphragm
◦ E. A mucosal narrowing located at the upper esophageal sphincter
◦ 3 3 . Which of the following is most descriptive of the esophageal B ring?
◦ A. A mucosal narrowing at the gastroesophageal junction usually associated with a
hiatal
◦ hernia
◦ B . A thickening of the lower esophageal sphincter ( LES) muscle
◦ C. Esophageal trachealization
◦ D . The narrowing in the lower esophagus associated with the diaphragm
◦ E. A mucosal narrowing located at the upper esophageal sphincter
◦ 34. A 67-year-old man with a progressive neuromuscular disorder requires a permanent
◦ tracheostomy. The attending surgeon will use the technique described by Eliachar.
◦ Which of the following statements is true?
◦ A. The technique involves complete laryngotracheal separation by suturing the subcricoid
◦ trachea and exteriorizing the remaining trachea.
◦ B . The technique involves removing the anterior portion of tracheal rings 2, 3 , 4, and 5
◦ in order to create a large opening which is unlikely to close.
◦ C. The technique involves suturing a superiorly based tracheal flap to the superior skin
◦ flap and suturing the inferior and lateral tracheal edges to the inferior skin flap .
◦ D . The technique requires fewer steps than a standard surgical tracheotomy and heals
◦ more rapidly, usually in 5 to 7 days.
◦ E. None of the above.
◦ 34. A 67-year-old man with a progressive neuromuscular disorder requires a permanent
◦ tracheostomy. The attending surgeon will use the technique described by Eliachar.
◦ Which of the following statements is true?
◦ A. The technique involves complete laryngotracheal separation by suturing the subcricoid
◦ trachea and exteriorizing the remaining trachea.
◦ B . The technique involves removing the anterior portion of tracheal rings 2, 3 , 4, and 5
◦ in order to create a large opening which is unlikely to close.
◦ C. The technique involves suturing a superiorly based tracheal flap to the superior skin
◦ flap and suturing the inferior and lateral tracheal edges to the inferior skin flap .
◦ D . The technique requires fewer steps than a standard surgical tracheotomy and heals
◦ more rapidly, usually in 5 to 7 days.
◦ E. None of the above.
◦ 3 5 . A helpful hint to avoid catching the endotracheal tube (ETT) on the arytenoid cartilages
◦ during fiberoptic intubation is to:
◦ A. Place the ETI bevel down on the fiberoptic scope for oral intubations and bevel up for
◦ nasal intubations.
◦ B . Place the ETI bevel up on the fiberoptic scope for oral intubations and bevel down for
◦ nasal intubations.
◦ C. Cut off the bevel on the ETI prior to placement.
◦ D. Rotate the fiberoptic scope prior to advancing the endotracheal tube through the
◦ larynx.
◦ E. Extend the endotracheal tube beyond the tip of the endoscope before entering the
◦ larynx.
◦ 3 5 . A helpful hint to avoid catching the endotracheal tube (ETT) on the arytenoid cartilages
◦ during fiberoptic intubation is to:
◦ A. Place the ETI bevel down on the fiberoptic scope for oral intubations and bevel up for
◦ nasal intubations.
◦ B . Place the ETI bevel up on the fiberoptic scope for oral intubations and bevel down for
◦ nasal intubations.
◦ C. Cut off the bevel on the ETI prior to placement.
◦ D. Rotate the fiberoptic scope prior to advancing the endotracheal tube through the
◦ larynx.
◦ E. Extend the endotracheal tube beyond the tip of the endoscope before entering the
◦ larynx.
◦ 3 6 . On a modified barium swallow study, the epiglottis does not invert during the
pharyngeal
◦ phase of swallowing. Which of the following does this suggest?
◦ A. Paresis of the aryepiglottic folds
◦ B. Pharyngeal delay
◦ C. Preferential filling of only one pyriform sinus
◦ D. Tongue base weakness
◦ E. Esophageal achalasia
◦ 3 6 . On a modified barium swallow study, the epiglottis does not invert during the
pharyngeal
◦ phase of swallowing. Which of the following does this suggest?
◦ A. Paresis of the aryepiglottic folds
◦ B. Pharyngeal delay
◦ C. Preferential filling of only one pyriform sinus
◦ D. Tongue base weakness
◦ E. Esophageal achalasia
◦ 3 7 . A patient demonstrates aspiration after the swallow on a modified barium swallow
◦ study. This could be the result of:
◦ A. Inadequate hyolaryngeal elevation
◦ B. Glottal incompetence
◦ C. Incomplete mastication
◦ D . Reduced labial closure
◦ E. Reduced tongue mobility
◦ 3 7 . A patient demonstrates aspiration after the swallow on a modified barium swallow
◦ study. This could be the result of:
◦ A. Inadequate hyolaryngeal elevation
◦ B. Glottal incompetence
◦ C. Incomplete mastication
◦ D . Reduced labial closure
◦ E. Reduced tongue mobility
◦ 3 8 . Which of the following mechanisms is not used to manipulate the vibratory source
in
◦ voice production?
◦ A. Subglottic pressure
◦ B. Vocal fold approximation
◦ C. Thyrohyoid tension
◦ D . Vocal fold tension
◦ E. Tongue tension
◦ 3 8 . Which of the following mechanisms is not used to manipulate the vibratory source
in
◦ voice production?
◦ A. Subglottic pressure
◦ B. Vocal fold approximation
◦ C. Thyrohyoid tension
◦ D . Vocal fold tension
◦ E. Tongue tension
◦ 3 9 . Sequelae of radiation to the larynx can include:
◦ A. Erythematous, edematous mucosa
◦ B. Decreased mucosal clearance of secretions
◦ C. Decreased vibration of phonatory mucosa
◦ D . Decreased vocal fold range of motion
◦ E. All of the above
◦ 3 9 . Sequelae of radiation to the larynx can include:
◦ A. Erythematous, edematous mucosa
◦ B. Decreased mucosal clearance of secretions
◦ C. Decreased vibration of phonatory mucosa
◦ D . Decreased vocal fold range of motion
◦ E. All of the above
◦ 40. Distal esophageal spasm is characterized by:
◦ A. Nonperistaltic low amplitude contractions
◦ B . Peristaltic low amplitude contractions
◦ C. Nonperistaltic normal or high amplitude contractions
◦ D. Peristaltic normal or high amplitude contractions
◦ E. Aperistalsis with low amplitude contractions
◦ 40. Distal esophageal spasm is characterized by:
◦ A. Nonperistaltic low amplitude contractions
◦ B . Peristaltic low amplitude contractions
◦ C. Nonperistaltic normal or high amplitude contractions
◦ D. Peristaltic normal or high amplitude contractions
◦ E. Aperistalsis with low amplitude contractions
◦ 41 . Our ability to safely swallow different consistencies and volumes of food and liquid
is
◦ based on:
◦ A. Autonomic response
◦ B . Involuntary response
◦ C. Patterned motor response
◦ D. Voluntary response
◦ E. Cognitive processing
◦ 41 . Our ability to safely swallow different consistencies and volumes of food and liquid
is
◦ based on:
◦ A. Autonomic response
◦ B . Involuntary response
◦ C. Patterned motor response
◦ D. Voluntary response
◦ E. Cognitive processing
◦ 42 . A 67-year-old man with terminal lung cancer is unable to eat due to aspiration. He
◦ would like an opportunity to eat. Examination demonstrates left vocal cord paralysis.
◦ Which of the following is probably the most appropriate recommendation?
◦ A. Make patient NPO (nil per os) and place an nasogastric tube
◦ B. Recommend laryngotracheal separation
◦ C. Since it is terminal, no treatment is warranted
◦ D. Vocal fold augmentation
◦ E. Targeted radiotherapy
◦ 42 . A 67-year-old man with terminal lung cancer is unable to eat due to aspiration. He
◦ would like an opportunity to eat. Examination demonstrates left vocal cord paralysis.
◦ Which of the following is probably the most appropriate recommendation?
◦ A. Make patient NPO (nil per os) and place an nasogastric tube
◦ B. Recommend laryngotracheal separation
◦ C. Since it is terminal, no treatment is warranted
◦ D. Vocal fold augmentation
◦ E. Targeted radiotherapy
◦ 43 . The rate of failed emergency department intubations and subsequent surgical
airway
◦ management is approximately between:
◦ A. O% and 0 . 5 %
◦ B . 0 . 5 % and 1 %
◦ c. 1% and 1 . 5 %
◦ D . 1 . 5 % and 2 %
◦ E . 2% and 2 . 5 %
◦ 43 . The rate of failed emergency department intubations and subsequent surgical
airway
◦ management is approximately between:
◦ A. O% and 0 . 5 %
◦ B . 0 . 5 % and 1 %
◦ c. 1% and 1 . 5 %
◦ D . 1 . 5 % and 2 %
◦ E . 2% and 2 . 5 %
◦ 44. A patient with Parkinson disease i s referred t o you for hypophonia. On examination
◦ you see vocal fold bowing. The next appropriate step would include:
◦ A. Referral for placement of a deep brain stimulator
◦ B. Referral for LSVf (Lee Silverman Voice Therapy)
◦ C. A MRl scan
◦ D. Sleep study
◦ E. Audiologic assessment
◦ 44. A patient with Parkinson disease i s referred t o you for hypophonia. On examination
◦ you see vocal fold bowing. The next appropriate step would include:
◦ A. Referral for placement of a deep brain stimulator
◦ B. Referral for LSVf (Lee Silverman Voice Therapy)
◦ C. A MRl scan
◦ D. Sleep study
◦ E. Audiologic assessment
◦ 45 . Which of the following statements is correct regarding keratosis of the vocal folds?
◦ A. Change in size and nature of keratosis should prompt surgical excision.
◦ B . Erythroplakia is a worse prognosis than leukoplakia.
◦ C. Leukoplakia is a worse prognosis than erythroplakia.
◦ D . All keratotic lesions must be completely surgically removed at all times .
◦ E. Observation is appropriate because this is solely a benign process
◦ 45 . Which of the following statements is correct regarding keratosis of the vocal folds?
◦ A. Change in size and nature of keratosis should prompt surgical excision.
◦ B . Erythroplakia is a worse prognosis than leukoplakia.
◦ C. Leukoplakia is a worse prognosis than erythroplakia.
◦ D . All keratotic lesions must be completely surgically removed at all times .
◦ E. Observation is appropriate because this is solely a benign process
◦ 46. Which of the following is not one of the most common causative bacteria for
bacterial
◦ laryngitis?
◦ A. Haemophilus influenzae
◦ B . Staphylococcus species
◦ c. Klebsiella pneumoniae
◦ D . Streptococcus species
◦ E. Enterococcus species
◦ 46. Which of the following is not one of the most common causative bacteria for
bacterial
◦ laryngitis?
◦ A. Haemophilus influenzae
◦ B . Staphylococcus species
◦ c. Klebsiella pneumoniae
◦ D . Streptococcus species
◦ E. Enterococcus species
◦ 47. Voice therapy usually requires:
◦ A. 1 to 2 sessions of indirect voice therapy and 4 to 6 sessions of direct voice therapy
◦ B. 4 to 6 sessions of indirect voice therapy and 1 to 2 sessions of direct voice therapy
◦ C. 1 2 weekly sessions
◦ D. 6 sessions of indirect voice therapy
◦ E. 6 sessions of direct voice therapy
◦ 47. Voice therapy usually requires:
◦ A. 1 to 2 sessions of indirect voice therapy and 4 to 6 sessions of direct voice therapy
◦ B. 4 to 6 sessions of indirect voice therapy and 1 to 2 sessions of direct voice therapy
◦ C. 1 2 weekly sessions
◦ D. 6 sessions of indirect voice therapy
◦ E. 6 sessions of direct voice therapy
◦ 48. Which of the following best describes the use of mitomycin as an adjunct to airway
◦ surgery?
◦ A. Is commonly used only in endoscopic surgery
◦ B. Is dependent on its promotion of fibroblast maturation
◦ C. Has been proven beneficial in a prospective controlled trial
◦ D. Predated its use in ophthalmology
◦ E. Is FDA approved
◦ 48. Which of the following best describes the use of mitomycin as an adjunct to airway
◦ surgery?
◦ A. Is commonly used only in endoscopic surgery
◦ B. Is dependent on its promotion of fibroblast maturation
◦ C. Has been proven beneficial in a prospective controlled trial
◦ D. Predated its use in ophthalmology
◦ E. Is FDA approved
◦ 49. Which of the following is an approach for vocal fold inj ection?
◦ A. Thyrohyoid approach
◦ B. Peroral approach
◦ C. Transthyroid cartilage approach
◦ D. Trans-cricothyroid approach
◦ E. All of the above
◦ 49. Which of the following is an approach for vocal fold inj ection?
◦ A. Thyrohyoid approach
◦ B. Peroral approach
◦ C. Transthyroid cartilage approach
◦ D. Trans-cricothyroid approach
◦ E. All of the above
◦ 50. You are consulted for swallowing difficulties in an 86-year-old man with advanced
◦ dementia. What factors should influence your recommendations?
◦ A. Evidence of outcomes for patients with dementia and dysphagia
◦ B. Care setting and number of episodes of aspiration pneumonia
◦ C. Goals of care as expressed by his family
◦ D . All of the above
◦ 50. You are consulted for swallowing difficulties in an 86-year-old man with advanced
◦ dementia. What factors should influence your recommendations?
◦ A. Evidence of outcomes for patients with dementia and dysphagia
◦ B. Care setting and number of episodes of aspiration pneumonia
◦ C. Goals of care as expressed by his family
◦ D . All of the above
◦ 51 . Sensation of upper airway pressure is primarily mediated through:
◦ A. Superior laryngeal nerve (SLN)
◦ B. Recurrent laryngeal nerve
◦ C. Glossopharyngeal nerve
◦ D. Inferior alveolar nerve
◦ E. Pharyngeal plexus
◦ 51 . Sensation of upper airway pressure is primarily mediated through:
◦ A. Superior laryngeal nerve (SLN)
◦ B. Recurrent laryngeal nerve
◦ C. Glossopharyngeal nerve
◦ D. Inferior alveolar nerve
◦ E. Pharyngeal plexus
◦ 52. Which of the following statements best describes neuromuscular electrical
stimulation?
◦ A. Is proven to always cause laryngeal elevation when delivered to the submental
region
◦ B . Can put a patient at risk for aspiration if surrounding musculature of the neck is
◦ stimulated
◦ C. Can currently improve bolus propulsion by the tongue
◦ D. Can improve swallowing by targeting the mylohyoid and omohyoid muscles
◦ E. Can elevate the pitch of the voice for trans gender patients
◦ 52. Which of the following statements best describes neuromuscular electrical
stimulation?
◦ A. Is proven to always cause laryngeal elevation when delivered to the submental
region
◦ B . Can put a patient at risk for aspiration if surrounding musculature of the neck is
◦ stimulated
◦ C. Can currently improve bolus propulsion by the tongue
◦ D. Can improve swallowing by targeting the mylohyoid and omohyoid muscles
◦ E. Can elevate the pitch of the voice for trans gender patients
◦ 5 3 . Which neurotransmitter is not targeted by drugs that are shown to improve
esophageal
◦ motility?
◦ A. 5 -Hydroxytryptophan
◦ B . Acetylcholine
◦ C. Motilin
◦ D. Norepinephrine
◦ 5 3 . Which neurotransmitter is not targeted by drugs that are shown to improve
esophageal
◦ motility?
◦ A. 5 -Hydroxytryptophan
◦ B . Acetylcholine
◦ C. Motilin
◦ D. Norepinephrine
◦ 54. Recommendation to a patient with dysphonia following a flexible halogen
laryngoscopy
◦ that reveals no lesions should include:
◦ A. No further evaluation is needed
◦ B. Increase hydration to eight glasses of water/ day
◦ C. Physical therapy
◦ D. Stroboscopy
◦ 54. Recommendation to a patient with dysphonia following a flexible halogen
laryngoscopy
◦ that reveals no lesions should include:
◦ A. No further evaluation is needed
◦ B. Increase hydration to eight glasses of water/ day
◦ C. Physical therapy
◦ D. Stroboscopy
◦ 5 5 . The highest concentration of fatigue-resistant slow twitch muscle fibers occurs in:
◦ A. Lateral cricoarytenoid muscle
◦ B. Cricothyroid muscle
◦ C. Vocalis muscle
◦ D. Sternohyoid muscle
◦ E. Thyrohyoid muscle
◦ 5 5 . The highest concentration of fatigue-resistant slow twitch muscle fibers occurs in:
◦ A. Lateral cricoarytenoid muscle
◦ B. Cricothyroid muscle
◦ C. Vocalis muscle
◦ D. Sternohyoid muscle
◦ E. Thyrohyoid muscle
◦ 5 6 . Which one of the following is true?
◦ A. Pepsin can be detected in the maj ority of tissue samples of subglottic scar tissue.
◦ B . Tracheal resection usually requires releasing maneuvers .
◦ C. Balloon dilation is superior to other methods of airway dilation.
◦ D . Endotracheal tube size is not a risk factor for developing intubation stenosis.
◦ E. The Cotton-Myer system was developed for tracheal stenosis cases .
◦ 5 6 . Which one of the following is true?
◦ A. Pepsin can be detected in the maj ority of tissue samples of subglottic scar tissue.
◦ B . Tracheal resection usually requires releasing maneuvers .
◦ C. Balloon dilation is superior to other methods of airway dilation.
◦ D . Endotracheal tube size is not a risk factor for developing intubation stenosis.
◦ E. The Cotton-Myer system was developed for tracheal stenosis cases .
◦ 5 7 . The diagnosis of eosinophilic esophagitis is based on which of the following
histologic
◦ findings?
◦ A. Mast cells in the cervical esophageal mucosa
◦ B . Less than 15 eosinophils per HPF (high-power field) in the esophageal mucosa
◦ C. More than 15 eosinophils per HPF in the esophageal mucosa
◦ D. Chronic ulceration in the esophageal mucosa
◦ E. Presence of Barrett's esophagus
◦ 5 7 . The diagnosis of eosinophilic esophagitis is based on which of the following
histologic
◦ findings?
◦ A. Mast cells in the cervical esophageal mucosa
◦ B . Less than 15 eosinophils per HPF (high-power field) in the esophageal mucosa
◦ C. More than 15 eosinophils per HPF in the esophageal mucosa
◦ D. Chronic ulceration in the esophageal mucosa
◦ E. Presence of Barrett's esophagus
◦ 5 8 . Antoni A and Antoni B areas are classically seen in which of the following laryngeal
◦ pathologies?
◦ A. Chondroma
◦ B . Schwannoma
◦ C. Recurrent respiratory papillomatosis
◦ D. Systemic lupus erythematous
◦ E. Amyloid deposits
◦ 5 8 . Antoni A and Antoni B areas are classically seen in which of the following laryngeal
◦ pathologies?
◦ A. Chondroma
◦ B . Schwannoma
◦ C. Recurrent respiratory papillomatosis
◦ D. Systemic lupus erythematous
◦ E. Amyloid deposits
◦ 5 9 . What is the mixed voice range?
◦ A. The register between head and chest voice
◦ B. The register between falsetto and passagio voice
◦ C. The register between bass and tenor voice
◦ D. The register between alto and soprano voice
◦ E. The register between tenor and baritone voice
◦ 5 9 . What is the mixed voice range?
◦ A. The register between head and chest voice
◦ B. The register between falsetto and passagio voice
◦ C. The register between bass and tenor voice
◦ D. The register between alto and soprano voice
◦ E. The register between tenor and baritone voice
◦ 60. Continuous positive airway pressure (CPAP) is effective for obstructive sleep apnea
◦ (OSA) because it:
◦ A. Supports the soft palate
◦ B. Compresses the tongue base
◦ C. Stimulates activity of dilating muscles
◦ D. Prevents pharyngeal collapse during expiration
◦ E. Forces the pharynx open after obstruction
◦ 60. Continuous positive airway pressure (CPAP) is effective for obstructive sleep apnea
◦ (OSA) because it:
◦ A. Supports the soft palate
◦ B. Compresses the tongue base
◦ C. Stimulates activity of dilating muscles
◦ D. Prevents pharyngeal collapse during expiration
◦ E. Forces the pharynx open after obstruction