Airway: tracheo-innominate fistula: 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 · Airway: tracheo-innominate fistula

Sample item

Ten days after tracheostomy a patient has a small bright red bleed from the tube followed hours later by torrential bleeding. What is the likely cause and first action?

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

The answer and the reasoning

A. Tracheo-innominate fistula; hyperinflate the cuff and apply pressure before going to theatre

A sentinel bleed signals erosion of the innominate artery by the tube tip or cuff, often from a low tracheostomy. The cuff is overinflated or a finger is placed through the stoma to compress the artery against the sternum while arranging surgical repair.

Option by option

  • A. Tracheo-innominate fistula; hyperinflate the cuff and apply pressure before going to theatre (correct)

    Correct. A sentinel bleed suggests tracheo-innominate fistula and needs urgent control.

  • B. Gastric ulcer; insert nasogastric tube

    A gastric ulcer is not related to the tube.

  • C. Pulmonary embolism; anticoagulate

    Pulmonary embolism does not present like this.

  • D. Thyroid bleed; observe

    Observation is dangerous because massive bleeding follows.

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, Tracheo-innominate fistula; hyperinflate the cuff and apply pressure before going to theatre. A sentinel bleed signals erosion of the innominate artery by the tube tip or cuff, often from a low tracheostomy.

Why is "Gastric ulcer; insert nasogastric tube" not the answer?

A gastric ulcer is not related to the tube.

Why is "Pulmonary embolism; anticoagulate" not the answer?

Pulmonary embolism does not present like this.

Why is "Thyroid bleed; observe" not the answer?

Observation is dangerous because massive bleeding follows.

What concept does this question test?

It tests Airway: tracheo-innominate fistula in ENT. The cuff is overinflated or a finger is placed through the stoma to compress the artery against the sternum while arranging surgical repair.

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 Airway: tracheo-innominate fistula?

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.