Airway management: level of tracheostomy: 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 · Airway management: level of tracheostomy

Sample item

A surgeon places a tracheostomy through the first tracheal ring, immediately below the cricoid cartilage. Which late complication is the main concern?

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

The answer and the reasoning

D. Subglottic stenosis

A tube placed too high can injure the cricoid, the only complete ring of the airway, and healing there causes subglottic stenosis. The tracheostomy is therefore usually made at the second or third ring. Placing it too low risks innominate artery erosion.

Option by option

  • A. Oesophageal perforation

    Perforation of the oesophagus follows posterior wall injury, not high placement.

  • B. Tracheomalacia of the lower trachea

    Tracheomalacia affects the segment under a long-standing cuff, not the upper ring.

  • C. Recurrent laryngeal nerve palsy

    The nerves lie in the tracheo-oesophageal groove, away from an anterior incision.

  • D. Subglottic stenosis (correct)

    Correct. High placement damages the cricoid and scarring narrows the subglottis.

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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Subglottic stenosis. A tube placed too high can injure the cricoid, the only complete ring of the airway, and healing there causes subglottic stenosis.

Why is "Oesophageal perforation" not the answer?

Perforation of the oesophagus follows posterior wall injury, not high placement.

Why is "Tracheomalacia of the lower trachea" not the answer?

Tracheomalacia affects the segment under a long-standing cuff, not the upper ring.

Why is "Recurrent laryngeal nerve palsy" not the answer?

The nerves lie in the tracheo-oesophageal groove, away from an anterior incision.

What concept does this question test?

It tests Airway management: level of tracheostomy in Anaesthesia. The tracheostomy is therefore usually made at the second or third ring. Placing it too low risks innominate artery erosion.

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 Airway management: level of tracheostomy?

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.