xRead - February 2023

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1. A female neonate born at 25 weeks ’ gestational age has undergone patent ductus arteriosus ligation. After extubation, stridor and respiratory distress are noted on physical examination. Vocal cord paralysis is suspected. Which of the following conditions is a well established risk factor for vocal cord paralysis? A. Preterm birth at less than 26 weeks ’ gestational age. B. White or Asian race. C. Prader-Willi syndrome. D. Female sex. E. Birth in the winter months. 2. A male neonate with hypoxic-ischemic encephalopathy has undergone therapeutic hypothermia and is now recovering after rewarming and extubation. He is noted to have stridor and poor ability to feed orally. Which of the following statements regarding vocal cord paralysis and central nervous system injury is correct? A. Central nervous system insults and anomalies are not typically associated with vocal cord paralysis. B. High vagal injury does not affect the recurrent laryngeal nerve. C. In high vagal injuries, the pharyngeal muscles and uvula may be affected, with the uvula deviating toward the contralateral side of the injury. D. In the context of hydrocephalus, compression of the vagus nerve occurs at the level of the frontoparietal cortex. E. Vocal cord paralysis arising from a central nervous system injury or lesion is always bilateral. 3. A term female neonate has undergone cardiac surgery for complex congenital heart disease. During the recovery process, she is weaned off the ventilator and undergoes extubation, but requires reintubation for increased respiratory distress. Evaluation by the pediatric otolaryngologist reveals possible vocal cord paralysis. Which of the following statements regarding vocal cord paralysis in this context is correct? A. The incidence of vocal cord paralysis after congenital heart disease repair is less than 2%. B. Surgery involving the aortic arch or patent ductus arteriosus is associated with injury of the right recurrent laryngeal nerve. C. The Norwood procedure and other aortic arch repairs have an especially high incidence of vocal cord paralysis. D. Vocal cord paralysis after surgery is less common in preterm neonates than in term neonates. E. Vocal cord paralysis after extracorporeal membrane oxygenation occurs not because of the cannulation procedure and direct nerve injury but the compression of the carotid artery. 4. A term neonate is evaluated for stridor and respiratory symptoms. Vocal cord paralysis is diagnosed, but there is no clear underlying etiology. Which of the following statements regarding idiopathic vocal cord paralysis is correct? A. It is always bilateral. B. In general, it is more likely to result in spontaneous recovery compared with identi fi ed causes, such as neurologic or postsurgical cases. C. Tracheostomy is almost always indicated to prevent lung injury. D. With modern genetic testing, idiopathic cases comprise less than 1% of cases. E. It is associated with hearing loss in 90% of cases.

Vol. 21 No. 5

e321

MAY 20 20

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