NORCET 2 -2021 (Shift-2)
Medical & Surgical Nursing
Easy
After thyroidectomy the patient complains for hoarseness of voice that occurs due to injury in?
Appeared in: NORCET 2 -2021 (Shift-2)
Explanation
- The recurrent laryngeal nerve (RLN) is at a high risk of injury during thyroidectomy due to its close anatomical proximity to the thyroid gland.
- The RLN innervates most of the intrinsic muscles of the larynx that are responsible for vocal cord movement and voice production.
- Damage to this nerve can cause vocal cord paralysis, leading to the characteristic symptom of a hoarse, weak, or breathy voice.
- All three provided sources confirm that RLN injury is a known complication of thyroidectomy leading to hoarseness.
Why Other Options Were Wrong
- Option A: Injury to the superior laryngeal nerve primarily affects the cricothyroid muscle.
- Option B: The 'anterior laryngeal nerve' is not a standard anatomical term used in the context of laryngeal innervation.
- Option D: The inferior laryngeal nerve is the terminal branch of the recurrent laryngeal nerve after it enters the larynx. While injury here causes hoarseness, the term 'recurrent laryngeal nerve' is the more precise and standard term for the entire nerve trunk at risk during a thyroidectomy.
Related Visual
- Visual 1: Diagram: Anatomical course of the recurrent laryngeal nerve and superior laryngeal nerve in relation to the thyroid gland and trachea. This helps visualize why these nerves are at risk during thyroidectomy.
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing Postoperative complications of thyroidectomy, specifically laryngeal nerve injury in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- Nurses must perform a baseline voice assessment pre-operatively and continue to monitor for voice changes (hoarseness, weakness) post-operatively as a key indicator of RLN injury.
- Bilateral RLN injury is a medical emergency that can cause acute airway obstruction. Therefore, a tracheostomy set must be kept at the bedside of all post-thyroidectomy patients.
- What if? If the patient had a normal speaking voice but complained of voice fatigue and inability to sing high notes, the injury would more likely be to the external branch of the superior laryngeal nerve.
How to Approach the Question
- First, identify the key elements of the question: the procedure is a thyroidectomy, and the resulting symptom is hoarseness of voice.
- Next, recall the anatomy of the neck, specifically the nerves located near the thyroid gland.
- Connect the symptom (voice change) to the function of the nerves in that area. Hoarseness directly relates to the function of the vocal cords.
- Differentiate between the functions of the major laryngeal nerves. The recurrent laryngeal nerve controls most muscles for voice production, while the superior laryngeal nerve primarily controls pitch.
- Based on this differentiation, conclude that injury to the nerve responsible for general voice production (recurrent laryngeal nerve) is the cause of hoarseness.
Concept Tested & Keywords
- Concept Tested: Postoperative complications of thyroidectomy, specifically laryngeal nerve injury.
- Stem keywords: thyroidectomy, hoarseness of voice, injury
- Lead-in keywords: due to injury in
- Negative lead-in flag: false
Question ID
QsJ5ccO9vMpM-rjGu5NgKT
Practise the full NORCET 2 -2021 (Shift-2)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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