Neonatal surgery: oesophageal atresia: practice question

A Pediatrics 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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Pediatrics · Neonatal surgery: oesophageal atresia

Sample item

A newborn has excessive frothing at the mouth, and chokes and turns blue at the first feed. A feeding tube cannot be passed beyond about 10 cm and coils in the upper chest on radiograph, which also shows gas in the stomach. What is the most likely anatomy?

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

The answer and the reasoning

D. Oesophageal atresia with a distal tracheo-oesophageal fistula

The commonest form (about 85%) is a blind upper oesophageal pouch with a fistula between the trachea and the lower oesophageal segment, which lets air into the stomach. Features are drooling, choking and cyanosis with feeds, and a nasogastric tube that cannot be passed. The baby is kept nil by mouth with the upper pouch on suction, and associated VACTERL anomalies are sought before surgical repair.

Option by option

  • A. Isolated oesophageal atresia without a fistula

    Without a fistula the abdomen is gasless (scaphoid), because no air reaches the stomach.

  • B. Congenital diaphragmatic hernia

    A diaphragmatic hernia gives respiratory distress with bowel in the chest, and a tube passes into the stomach.

  • C. H-type tracheo-oesophageal fistula

    An H-type fistula has a patent oesophagus, so a tube passes and symptoms appear later with choking and recurrent pneumonia.

  • D. Oesophageal atresia with a distal tracheo-oesophageal fistula (correct)

    Correct. Gas in the stomach with a blind upper pouch indicates a distal fistula.

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 Pediatrics question

What is the answer to this Pediatrics question?

The best answer is D, Oesophageal atresia with a distal tracheo-oesophageal fistula. The commonest form (about 85%) is a blind upper oesophageal pouch with a fistula between the trachea and the lower oesophageal segment, which lets air into the stomach.

Why is "Isolated oesophageal atresia without a fistula" not the answer?

Without a fistula the abdomen is gasless (scaphoid), because no air reaches the stomach.

Why is "Congenital diaphragmatic hernia" not the answer?

A diaphragmatic hernia gives respiratory distress with bowel in the chest, and a tube passes into the stomach.

Why is "H-type tracheo-oesophageal fistula" not the answer?

An H-type fistula has a patent oesophagus, so a tube passes and symptoms appear later with choking and recurrent pneumonia.

What concept does this question test?

It tests Neonatal surgery: oesophageal atresia in Pediatrics. Features are drooling, choking and cyanosis with feeds, and a nasogastric tube that cannot be passed. The baby is kept nil by mouth with the upper pouch on suction, and associated VACTERL anomalies are sought before surgical repair.

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 Neonatal surgery: oesophageal atresia?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.