Paediatric anaesthesia: tracheo-oesophageal fistula: 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 · Paediatric anaesthesia: tracheo-oesophageal fistula

Sample item

In a neonate with oesophageal atresia and a distal tracheo-oesophageal fistula, how is the tracheal tube best positioned?

AAbove the vocal cordsBWith the tip beyond the fistula but above the carinaCIn the right main bronchusDAnywhere, since the position does not matter

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

The answer and the reasoning

B. With the tip beyond the fistula but above the carina

Positive pressure ventilation can pass through the distal fistula into the stomach, causing gastric distension, diaphragmatic splinting and poor ventilation. Placing the tube tip beyond the fistula and above the carina, confirmed by bronchoscopy or auscultation, prevents this. Gastric distension is also avoided by gentle ventilation pressures.

Option by option

A. Above the vocal cords
A tube above the cords would not provide a secure airway.
B. With the tip beyond the fistula but above the carina (correct)
Correct. The tube tip lies distal to the fistula opening.
C. In the right main bronchus
A right main bronchial tube would cause one-lung ventilation.
D. Anywhere, since the position does not matter
Position is critical in preventing gastric distension.

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.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, With the tip beyond the fistula but above the carina. Positive pressure ventilation can pass through the distal fistula into the stomach, causing gastric distension, diaphragmatic splinting and poor ventilation.

Why is "Above the vocal cords" not the answer?

A tube above the cords would not provide a secure airway.

Why is "In the right main bronchus" not the answer?

A right main bronchial tube would cause one-lung ventilation.

Why is "Anywhere, since the position does not matter" not the answer?

Position is critical in preventing gastric distension.

What concept does this question test?

It tests Paediatric anaesthesia: tracheo-oesophageal fistula in Anaesthesia. Placing the tube tip beyond the fistula and above the carina, confirmed by bronchoscopy or auscultation, prevents this. Gastric distension is also avoided by gentle ventilation pressures.

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 Paediatric anaesthesia: tracheo-oesophageal fistula?

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.