This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'True about branchial anomaly : \nSelect and explain. \nA. Cysts are more common than sinuses, B. For sinuses surgery is not always indicated, C. Cysts present with dysphagia and hoarseness of voice, D. Most commonly due to 2nd branchial remnant', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Branchiogenic Anomalies \n\nBranchial anomalies are remnants of the branchial apparatus present during the embryonic life.\nEmbryologically the structures of head and neck are derived from 5 pairs of branchial arches, their intervening clefts externally and pouches internally.\nA tract of branchial origin may form a complete fistula, or one end may be obliterated to form an external or internal sinus, or both ends may resorb forming a cyst.\n2nd branchial remnant are the most common\nIst branchial remnants are typically located in front or back of the ear or in the upper neck in the region of the mandible. Fistulas typically commence through the parotid gland and end in the external auditory canal.\n2nd branchial cleft remnants cause fistulas/sinuses with an external opening along the anterior border of the sternocleidomastoid muscle and internal opening at the tonsillar fossa (The fistulous track passes in b/w internal & external carotid arteries)\n3rd branchial cleft remnants usually do not have associated sinuses or fistulas and are located in the suprasternal notch or clavicular region. These most often contain cartilage and present clinically as a firm mass or as a subcutaneous abscess. Rarely sinus may occur which open internally into the pyriform sinus.\nBranchiogenic anomalies occur with equal frequency on each side of the neck and 15% are bilateral.\n\nClinical presentation\n\nBy definition, all branchial remnants are present at the time of birth although they may not become clinically evident until later in life.\nFistulas and sinus present at birth whereas cysts usually appear in late childhood and adults.\nFistulas and sinuses usually discharge a mucoid or purulent material\nThe cysts are characteristically found anterior and deep to the upper third of the sternocleidomastoid (interior to the angle of mandible)\nSinuses and cysts are prone to become repeatedly infected producing cellulitis and abscess formation.\n\nTreatment\n\nAlmost all branchial abnormalities should be excised early in life since repeated infection is common making resection more difficult.\nComplete removal of the cyst and tract is necessary for a cure and preventing recurrence.\nA series of two or sometimes three small transverse incisions in a "stepladder\' fashion is preferred to a long oblique incision in the neck, which is cosmetically undesirable.', 'role': 'assistant'}]