Head and neck: branchial cyst: 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 · Head and neck: branchial cyst

Sample item

A 22-year-old has a painless, smooth, fluctuant swelling at the anterior border of the sternocleidomastoid at the junction of its upper and middle thirds. Aspiration yields turbid fluid with cholesterol crystals. What is the diagnosis?

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

The answer and the reasoning

D. Branchial cyst arising from the second branchial cleft

A branchial cyst is a remnant of the second branchial cleft and presents in early adulthood as a soft, non-tender swelling along the anterior border of the upper sternocleidomastoid. The fluid contains cholesterol crystals and the cyst is lined by squamous or respiratory epithelium with lymphoid tissue. Treatment is complete surgical excision, with care to avoid the accessory, hypoglossal and glossopharyngeal nerves.

Option by option

  • A. Dermoid cyst

    A dermoid cyst lies in the midline or at the lateral end of the eyebrow and contains keratin and skin appendages.

  • B. Cystic hygroma

    A cystic hygroma is a multiloculated, transilluminant swelling of the posterior triangle, mostly in infants.

  • C. Thyroglossal duct cyst

    A thyroglossal cyst is midline and moves with swallowing and tongue protrusion.

  • D. Branchial cyst arising from the second branchial cleft (correct)

    Correct. The site and cholesterol crystals are typical of a second cleft cyst.

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.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is D, Branchial cyst arising from the second branchial cleft. A branchial cyst is a remnant of the second branchial cleft and presents in early adulthood as a soft, non-tender swelling along the anterior border of the upper sternocleidomastoid.

Why is "Dermoid cyst" not the answer?

A dermoid cyst lies in the midline or at the lateral end of the eyebrow and contains keratin and skin appendages.

Why is "Cystic hygroma" not the answer?

A cystic hygroma is a multiloculated, transilluminant swelling of the posterior triangle, mostly in infants.

Why is "Thyroglossal duct cyst" not the answer?

A thyroglossal cyst is midline and moves with swallowing and tongue protrusion.

What concept does this question test?

It tests Head and neck: branchial cyst in ENT. The fluid contains cholesterol crystals and the cyst is lined by squamous or respiratory epithelium with lymphoid tissue. Treatment is complete surgical excision, with care to avoid the accessory, hypoglossal and glossopharyngeal nerves.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Head and neck: branchial cyst?

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.