The statement that vocal cord paralysis is the second most common cause of stridor in the pediatric patient implies it is:

• A. The most common
• B. The second most common behind laryngomalacia
• C. Uncommon
• D. Never causes stridor

Answer: (B)

Understanding frequency rankings is the key here. If vocal cord paralysis is described as the second most common cause of stridor in the pediatric patient, that means there is a more common cause, and vocal cord paralysis sits just after it in frequency. In infants, the most common cause of stridor is laryngomalacia, so the phrase “second most common behind laryngomalacia” places vocal cord paralysis right after that leading cause. It cannot be the most common, and the statement implies it does indeed cause stridor, so it isn’t “uncommon” or “never causes stridor.” In short, this phrasing identifies vocal cord paralysis as a frequent, but not the primary, cause, with laryngomalacia being the top cause.