Larynx: infant bilateral cord palsy and Chiari malformation: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Larynx: infant bilateral cord palsy and Chiari malformation

Sample item

A newborn with a lumbar myelomeningocele has progressive inspiratory stridor, a weak cry and feeding difficulty. Laryngoscopy shows bilateral vocal fold immobility. What is the likely underlying cause?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Arnold-Chiari malformation with brainstem traction or compression affecting the vagus nuclei

Congenital bilateral vocal fold paralysis is often central, and the commonest association is Arnold-Chiari malformation with hydrocephalus. Shunting of the hydrocephalus or posterior fossa decompression may restore movement, and an airway intervention is needed if stridor is severe.

Option by option

  • A. Subglottic haemangioma

    A haemangioma is visible as a subglottic mass.

  • B. Arnold-Chiari malformation with brainstem traction or compression affecting the vagus nuclei (correct)

    Correct. Brainstem involvement in Chiari malformation causes vagal dysfunction.

  • C. Laryngomalacia

    Laryngomalacia has mobile cords with supraglottic collapse.

  • D. Laryngeal web

    A web is a fixed membrane with normal cord movement behind it.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is B, Arnold-Chiari malformation with brainstem traction or compression affecting the vagus nuclei. Congenital bilateral vocal fold paralysis is often central, and the commonest association is Arnold-Chiari malformation with hydrocephalus.

Why is "Subglottic haemangioma" not the answer?

A haemangioma is visible as a subglottic mass.

Why is "Laryngomalacia" not the answer?

Laryngomalacia has mobile cords with supraglottic collapse.

Why is "Laryngeal web" not the answer?

A web is a fixed membrane with normal cord movement behind it.

What concept does this question test?

It tests Larynx: infant bilateral cord palsy and Chiari malformation in ENT. Shunting of the hydrocephalus or posterior fossa decompression may restore movement, and an airway intervention is needed if stridor is severe.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Larynx: infant bilateral cord palsy and Chiari malformation?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.