Antenatal care: congenital diaphragmatic hernia on anomaly scan: practice question

A OBG 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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OBG · Antenatal care: congenital diaphragmatic hernia on anomaly scan

Sample item

At the 20-week anomaly scan the fetal stomach bubble is seen in the thorax at the level of the four-chamber view, the heart is displaced to the right and the abdominal circumference is small. What is the most likely diagnosis?

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

The answer and the reasoning

B. Left congenital diaphragmatic hernia

Abdominal contents herniating through a diaphragmatic defect, usually on the left, place the stomach in the chest and push the mediastinum away. The small abdominal circumference reflects the loss of abdominal viscera. Pulmonary hypoplasia is the main determinant of outcome, and karyotyping with a detailed anomaly scan is advised.

Option by option

  • A. Gastroschisis

    Gastroschisis is a paraumbilical abdominal wall defect with free-floating bowel, not intrathoracic stomach.

  • B. Left congenital diaphragmatic hernia (correct)

    Correct. Stomach in the thorax with mediastinal shift is characteristic.

  • C. Congenital pulmonary airway malformation without any herniation

    A pulmonary airway malformation is a lung mass, with the stomach remaining in its normal intra-abdominal position.

  • D. Oesophageal atresia

    Oesophageal atresia shows a small or absent stomach bubble with polyhydramnios and the stomach remains below the diaphragm.

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 OBG question

What is the answer to this OBG question?

The best answer is B, Left congenital diaphragmatic hernia. Abdominal contents herniating through a diaphragmatic defect, usually on the left, place the stomach in the chest and push the mediastinum away.

Why is "Gastroschisis" not the answer?

Gastroschisis is a paraumbilical abdominal wall defect with free-floating bowel, not intrathoracic stomach.

Why is "Congenital pulmonary airway malformation without any herniation" not the answer?

A pulmonary airway malformation is a lung mass, with the stomach remaining in its normal intra-abdominal position.

Why is "Oesophageal atresia" not the answer?

Oesophageal atresia shows a small or absent stomach bubble with polyhydramnios and the stomach remains below the diaphragm.

What concept does this question test?

It tests Antenatal care: congenital diaphragmatic hernia on anomaly scan in OBG. The small abdominal circumference reflects the loss of abdominal viscera. Pulmonary hypoplasia is the main determinant of outcome, and karyotyping with a detailed anomaly scan is advised.

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 Antenatal care: congenital diaphragmatic hernia on anomaly scan?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG 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.