Pharynx and tonsils: Down syndrome and cervical instability: 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 · Pharynx and tonsils: Down syndrome and cervical instability

Sample item

A 6-year-old with Down syndrome is scheduled for adenotonsillectomy for obstructive sleep apnoea. Which positioning precaution is most important?

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

The answer and the reasoning

C. Keep the neck neutral and avoid extreme extension or flexion

Children with Down syndrome have ligamentous laxity and may have atlantoaxial instability, so extreme neck extension or flexion during airway management or surgery risks cord injury. The usual extended tonsillectomy position is modified to a gentle, near-neutral one.

Option by option

  • A. Apply gentle cervical traction throughout surgery

    Traction applies a distracting force across an unstable joint and is not a protective measure.

  • B. Use full neck extension over a shoulder roll to expose the tonsils

    Full extension over a shoulder roll is the usual tonsillectomy position but risks atlantoaxial subluxation here.

  • C. Keep the neck neutral and avoid extreme extension or flexion (correct)

    Correct. Ligamentous laxity makes extreme neck movement dangerous in Down syndrome, so the neck is kept near neutral.

  • D. Place the head in full flexion to reach the adenoids

    Full flexion also stresses the lax transverse ligament and is not required for adenoid access.

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 C, Keep the neck neutral and avoid extreme extension or flexion. Children with Down syndrome have ligamentous laxity and may have atlantoaxial instability, so extreme neck extension or flexion during airway management or surgery risks cord injury.

Why is "Apply gentle cervical traction throughout surgery" not the answer?

Traction applies a distracting force across an unstable joint and is not a protective measure.

Why is "Use full neck extension over a shoulder roll to expose the tonsils" not the answer?

Full extension over a shoulder roll is the usual tonsillectomy position but risks atlantoaxial subluxation here.

Why is "Place the head in full flexion to reach the adenoids" not the answer?

Full flexion also stresses the lax transverse ligament and is not required for adenoid access.

What concept does this question test?

It tests Pharynx and tonsils: Down syndrome and cervical instability in ENT. The usual extended tonsillectomy position is modified to a gentle, near-neutral one.

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 Pharynx and tonsils: Down syndrome and cervical instability?

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.