Thyroid: bilateral nerve palsy: practice question

A General Surgery 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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General Surgery · Thyroid: bilateral nerve palsy

Sample item

Immediately after extubation following total thyroidectomy, a woman develops inspiratory stridor and respiratory distress. Laryngoscopy shows both cords fixed near the midline. What is the most appropriate management?

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

The answer and the reasoning

B. Re-intubation, with tracheostomy if recovery does not follow

Bilateral recurrent laryngeal nerve palsy leaves both cords in the paramedian position, so the glottic chink is narrow and the airway is obstructed. The airway is secured by intubation, and if the palsy persists, a tracheostomy is made while waiting for recovery. Voice is relatively preserved, which is why stridor is the main feature.

Option by option

  • A. Observation and humidified oxygen

    Observation is unsafe because the narrowed glottis causes fatigue and respiratory arrest.

  • B. Re-intubation, with tracheostomy if recovery does not follow (correct)

    Correct. A secure airway is the priority, with tracheostomy if the palsy persists.

  • C. Re-exploration to release a haematoma only

    Haematoma release is for compression, which is not shown by fixed cords on laryngoscopy.

  • D. Intravenous calcium gluconate

    Calcium treats hypocalcaemic laryngospasm, but the cords here are fixed, not in spasm.

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.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Re-intubation, with tracheostomy if recovery does not follow. Bilateral recurrent laryngeal nerve palsy leaves both cords in the paramedian position, so the glottic chink is narrow and the airway is obstructed.

Why is "Observation and humidified oxygen" not the answer?

Observation is unsafe because the narrowed glottis causes fatigue and respiratory arrest.

Why is "Re-exploration to release a haematoma only" not the answer?

Haematoma release is for compression, which is not shown by fixed cords on laryngoscopy.

Why is "Intravenous calcium gluconate" not the answer?

Calcium treats hypocalcaemic laryngospasm, but the cords here are fixed, not in spasm.

What concept does this question test?

It tests Thyroid: bilateral nerve palsy in General Surgery. The airway is secured by intubation, and if the palsy persists, a tracheostomy is made while waiting for recovery. Voice is relatively preserved, which is why stridor is the main feature.

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: bilateral nerve palsy?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.