Thyroid surgery complications: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Thyroid surgery complications

Sample item

Six hours after a total thyroidectomy, a woman has increasing neck swelling and tightness, noisy breathing and a falling oxygen saturation. What is the most appropriate immediate step?

AOrder a CT scan of the neckBOpen the wound at the bedside by removing the skin sutures and strap muscle layer to evacuate the haematomaCGive intravenous calcium gluconateDGive intravenous dexamethasone and observe

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Open the wound at the bedside by removing the skin sutures and strap muscle layer to evacuate the haematoma

Rapidly expanding neck haematoma after thyroidectomy causes venous and lymphatic obstruction with laryngeal oedema and airway compromise. Immediate bedside release of the wound closure layers decompresses the neck and is life-saving, with intubation and return to theatre afterwards.

Option by option

A. Order a CT scan of the neck
Imaging wastes time in an airway emergency.
B. Open the wound at the bedside by removing the skin sutures and strap muscle layer to evacuate the haematoma (correct)
Correct. Decompression is the priority and should not wait for imaging or transfer.
C. Give intravenous calcium gluconate
Hypocalcaemia causes perioral tingling and tetany and does not cause neck swelling.
D. Give intravenous dexamethasone and observe
Steroids will not relieve compression by a haematoma.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is B, Open the wound at the bedside by removing the skin sutures and strap muscle layer to evacuate the haematoma. Rapidly expanding neck haematoma after thyroidectomy causes venous and lymphatic obstruction with laryngeal oedema and airway compromise.

Why is "Order a CT scan of the neck" not the answer?

Imaging wastes time in an airway emergency.

Why is "Give intravenous calcium gluconate" not the answer?

Hypocalcaemia causes perioral tingling and tetany and does not cause neck swelling.

Why is "Give intravenous dexamethasone and observe" not the answer?

Steroids will not relieve compression by a haematoma.

What concept does this question test?

It tests Thyroid surgery complications in ENT. Immediate bedside release of the wound closure layers decompresses the neck and is life-saving, with intubation and return to theatre afterwards.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Thyroid surgery complications?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.