Larynx and airway: paediatric tracheostomy pneumothorax: 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 · Larynx and airway: paediatric tracheostomy pneumothorax

Sample item

Immediately after emergency tracheostomy in a 2-year-old, oxygen saturation falls, breath sounds are absent on the right and the percussion note is hyperresonant. What is the most likely cause?

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

The answer and the reasoning

D. Injury to the cervical dome of the pleura

In young children the dome of the pleura rises high into the neck, so low dissection can injure it and cause pneumothorax. Tracheostomy in a child therefore needs careful dissection and a postoperative chest radiograph.

Option by option

  • A. Division of the thyroid isthmus

    Isthmus division gives bleeding and does not cause lung collapse.

  • B. Tube lying within the oesophagus

    An oesophageal tube would give no ventilation, not unilateral signs.

  • C. Injury to the recurrent laryngeal nerve

    Nerve injury changes the voice and does not produce hyperresonance.

  • D. Injury to the cervical dome of the pleura (correct)

    Correct. A high pleural dome is easily breached and produces a pneumothorax.

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, Injury to the cervical dome of the pleura. In young children the dome of the pleura rises high into the neck, so low dissection can injure it and cause pneumothorax.

Why is "Division of the thyroid isthmus" not the answer?

Isthmus division gives bleeding and does not cause lung collapse.

Why is "Tube lying within the oesophagus" not the answer?

An oesophageal tube would give no ventilation, not unilateral signs.

Why is "Injury to the recurrent laryngeal nerve" not the answer?

Nerve injury changes the voice and does not produce hyperresonance.

What concept does this question test?

It tests Larynx and airway: paediatric tracheostomy pneumothorax in ENT. Tracheostomy in a child therefore needs careful dissection and a postoperative chest radiograph.

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 Larynx and airway: paediatric tracheostomy pneumothorax?

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.