Head and neck tumours: carotid blowout: 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 tumours: carotid blowout

Sample item

A man irradiated for hypopharyngeal cancer develops a pharyngocutaneous fistula after salvage laryngectomy. On day 12 there is a small self-limiting bleed from the neck wound, followed hours later by a heavy bleed. Which complication was heralded?

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

The answer and the reasoning

A. Carotid artery blowout

In irradiated necks with salivary leakage, the carotid wall is exposed and weakened and can rupture. A small warning (herald) bleed often precedes a catastrophic haemorrhage and demands urgent airway and haemorrhage control, direct pressure, resuscitation and angiography with a covered stent or surgical management.

Option by option

  • A. Carotid artery blowout (correct)

    Correct. A herald bleed in an irradiated neck with a fistula warns of carotid rupture.

  • B. Chyle leak

    A chyle leak gives milky drainage rather than bright bleeding.

  • C. Internal jugular vein thrombosis

    Venous thrombosis causes swelling and not arterial haemorrhage.

  • D. Tracheo-innominate artery fistula

    A tracheo-innominate fistula follows tracheostomy tube erosion, not a neck wound fistula.

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 A, Carotid artery blowout. In irradiated necks with salivary leakage, the carotid wall is exposed and weakened and can rupture.

Why is "Chyle leak" not the answer?

A chyle leak gives milky drainage rather than bright bleeding.

Why is "Internal jugular vein thrombosis" not the answer?

Venous thrombosis causes swelling and not arterial haemorrhage.

Why is "Tracheo-innominate artery fistula" not the answer?

A tracheo-innominate fistula follows tracheostomy tube erosion, not a neck wound fistula.

What concept does this question test?

It tests Head and neck tumours: carotid blowout in ENT. A small warning (herald) bleed often precedes a catastrophic haemorrhage and demands urgent airway and haemorrhage control, direct pressure, resuscitation and angiography with a covered stent or surgical management.

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 Head and neck tumours: carotid blowout?

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.