WBR0522

Author	PageAuthor::Vendhan Ramanujam
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Head and Neck
Prompt	[[Prompt::A 35 year old man presents to a physicians office with a complaint of hoarseness in his voice for the 6 past months. He denies any other symptoms or complaints. He has no such past medical history, takes no medications. He has been smoking occasionally, one or two cigarettes every month for the past one year. He does not drink alcohol. He uses no illicit drugs. He has been working as a telephone operator for the past 8 months. Which of the following is the most likely diagnosis?]]
Answer A	AnswerA::Cancer of the larynx
Answer A Explanation	[[AnswerAExp::Incorrect-Laryngeal carcinoma may be considered only in patients with a history of heavy tobacco use.]]
Answer B	AnswerB::Postnasal drip syndrome
Answer B Explanation	AnswerBExp::'''Incorrect'''-Postnasal drip syndrome leads to chronic throat clearing, and physical examination will reveal “cobblestoning” of the posterior pharynx.
Answer C	AnswerC::Reflux esophagitis
Answer C Explanation	[[AnswerCExp::Incorrect-Reflux disease may cause hoarseness, but the patient would complain of heartburn, nocturnal cough, chronic sore throat, and excess phlegm production.]]
Answer D	AnswerD::Chronic laryngitis
Answer D Explanation	[[AnswerDExp::Correct-Hoarseness may be due to edema or swelling of the larynx or vocal cords, or to external compression of the larynx or the recurrent laryngeal nerve. Certain occupations, such as being a singer or telephone operator, also place people at risk for voice strain (chronic laryngitis) due to overuse. Medications, such as inhaled corticosteroids, may contribute to the problem.]]
Answer E	AnswerE::Viral laryngitis
Answer E Explanation	[[AnswerEExp::Incorrect-Viral laryngitis is the common cause of hoarseness, but this patient does not exhibit any symptoms or signs of a viral syndrome.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Hoarseness may be due to edema or swelling of the larynx or vocal cords, or to external compression of the larynx or the recurrent laryngeal nerve. Certain occupations, such as being a singer or telephone operator, place people at risk for voice strain (chronic laryngitis) due to overuse. Medications, such as inhaled corticosteroids, may contribute to the problem. Educational Objective: Hoarseness may be due to edema or swelling of the larynx or vocal cords, or to external compression of the larynx or the recurrent laryngeal nerve. Certain occupations, such as being a singer or telephone operator, also place people at risk for voice strain (chronic laryngitis) due to overuse. Medications, such as inhaled corticosteroids, may contribute to the problem. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Chronic laryngitis, WBRKeyword::hoarsness, WBRKeyword::viral laryngitis, WBRKeyword::laryngeal carcinoma, WBRKeyword::reflux esophagitis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::