Complications and emergencies: neck haematoma after thyroidectomy: practice question

A Anaesthesia 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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Anaesthesia · Complications and emergencies: neck haematoma after thyroidectomy

Sample item

Forty minutes after total thyroidectomy, a patient in the recovery room has a tense swelling of the neck, noisy breathing and an SpO2 falling to 88 percent. What is the most urgent step?

ATracheostomy under local anaesthetic on the wardBNebulised adrenaline with dexamethasone, then observe the airwayCUrgent CT of the neck to locate the bleeding pointDOpen the wound at the bedside to evacuate the clot

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

The answer and the reasoning

D. Open the wound at the bedside to evacuate the clot

A rapidly expanding neck haematoma compresses the trachea and obstructs venous and lymphatic drainage, producing laryngeal oedema. Immediate release of skin sutures and strap muscles at the bedside relieves the compression, followed by oxygen, airway support and return to theatre. Delay for imaging or drugs risks asphyxia.

Option by option

A. Tracheostomy under local anaesthetic on the ward
A tracheostomy is difficult through a swollen, distorted neck and is not the first move when the cause can be released.
B. Nebulised adrenaline with dexamethasone, then observe the airway
Adrenaline and steroids do not relieve compression from a haematoma and waste vital time.
C. Urgent CT of the neck to locate the bleeding point
Imaging delays treatment of an airway threat, and the diagnosis is clinical.
D. Open the wound at the bedside to evacuate the clot (correct)
Correct. Decompressing the neck at once removes the pressure on the airway and is a life-saving first step.

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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Open the wound at the bedside to evacuate the clot. A rapidly expanding neck haematoma compresses the trachea and obstructs venous and lymphatic drainage, producing laryngeal oedema.

Why is "Tracheostomy under local anaesthetic on the ward" not the answer?

A tracheostomy is difficult through a swollen, distorted neck and is not the first move when the cause can be released.

Why is "Nebulised adrenaline with dexamethasone, then observe the airway" not the answer?

Adrenaline and steroids do not relieve compression from a haematoma and waste vital time.

Why is "Urgent CT of the neck to locate the bleeding point" not the answer?

Imaging delays treatment of an airway threat, and the diagnosis is clinical.

What concept does this question test?

It tests Complications and emergencies: neck haematoma after thyroidectomy in Anaesthesia. Immediate release of skin sutures and strap muscles at the bedside relieves the compression, followed by oxygen, airway support and return to theatre. Delay for imaging or drugs risks asphyxia.

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 Complications and emergencies: neck haematoma after thyroidectomy?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia 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.