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ENT · Paediatric airway
Sample itemA 3-week-old thriving infant has inspiratory stridor that worsens on crying and when lying on the back and improves when prone. Feeding is normal. What is the most likely diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Laryngomalacia
Laryngomalacia is the commonest cause of congenital stridor, due to collapse of floppy supraglottic structures such as an omega-shaped epiglottis and short aryepiglottic folds during inspiration. Most cases settle spontaneously by about 18 to 24 months.
Option by option
A. Bilateral vocal cord paralysis
Bilateral vocal cord paralysis typically causes more severe, often biphasic stridor with distress, and the cry is usually preserved.
B. Laryngeal web
A laryngeal web typically gives a weak cry or aphonia from birth.
C. Laryngomalacia (correct)
Inspiratory stridor worse supine or with crying in a well infant is the classic picture.
D. Subglottic stenosis
Subglottic stenosis causes biphasic stridor and is usually persistent or follows intubation.
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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