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Inducible laryngeal obstruction — SCE Respiratory MCQ

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HardAirways diseaseInducible laryngeal obstructionSCE Respiratory

A 34-year-old woman has recurrent episodes of inspiratory noise and throat tightness during exercise. Salbutamol is ineffective. Spirometry is normal and FeNO is 12 ppb; exercise laryngoscopy demonstrates paradoxical vocal fold adduction at peak symptoms. What is the most likely diagnosis?

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Correct answer: B — Inducible laryngeal obstruction

The best answer is “Inducible laryngeal obstruction”. The clinical pattern, physiology and imaging described are most consistent with Inducible laryngeal obstruction. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Exercise-induced bronchoconstriction, within a respiratory pathway”, “Severe eosinophilic asthma, after safety review”, “Tracheobronchomalacia, after specialist assessment”, “Panic disorder with hyperventilation”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: BTS/NICE/SIGN asthma guideline NG245: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations