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Inducible laryngeal obstruction — SCE Respiratory MCQ

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HardRespiratory physiologyInducible laryngeal obstructionSCE Respiratory

A singer develops episodic inspiratory stridor only during performance. Methacholine is negative; resting laryngoscopy is normal. Which investigation provides the highest diagnostic yield?

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Correct answer: A — Provoked laryngoscopy during performance

Explanation lettering: C = shown as A · A = shown as B · B = shown as C

C is correct. Inducible laryngeal obstruction is intermittent, so visualization during the trigger is the diagnostic standard; normal resting laryngoscopy does not exclude it. Repeat bronchodilator spirometry is low yield after negative challenge and an inspiratory phenotype. Static CT may detect structural stenosis but not dynamic closure. BAL and right-heart catheterisation address different mechanisms. Speech-therapy-led breathing retraining follows confirmation.

Reference: ERS/ATS interpretive strategies for lung-function tests: https://publications.ersnet.org/content/erj/60/1/2101499