Embryology: tracheoesophageal fistula: practice question

A Anatomy 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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Anatomy · Embryology: tracheoesophageal fistula

Sample item

A newborn with maternal polyhydramnios chokes, coughs and turns cyanotic on the first feed, and a nasogastric tube coils in the upper chest while the abdomen shows gas. What is the most common anomaly?

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

The answer and the reasoning

D. Blind upper oesophageal pouch with a fistula between the trachea and lower oesophagus

Failure of the tracheoesophageal septum to separate the foregut gives oesophageal atresia, and about 85% of cases have a proximal blind pouch with a distal tracheo-oesophageal fistula. Gas enters the stomach through the fistula, which is why the abdomen contains air. Polyhydramnios occurs because the fetus cannot swallow amniotic fluid.

Option by option

  • A. H-type fistula without atresia

    An H-type fistula presents later with recurrent aspiration, not inability to pass the tube.

  • B. Fistula between the trachea and upper oesophageal pouch alone

    A fistula only to the upper pouch is rare and does not give gastric air.

  • C. Isolated oesophageal atresia without fistula

    Pure atresia without a fistula gives a gasless abdomen.

  • D. Blind upper oesophageal pouch with a fistula between the trachea and lower oesophagus (correct)

    Correct. This is the commonest pattern and explains gas in the stomach.

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 Anatomy question

What is the answer to this Anatomy question?

The best answer is D, Blind upper oesophageal pouch with a fistula between the trachea and lower oesophagus. Failure of the tracheoesophageal septum to separate the foregut gives oesophageal atresia, and about 85% of cases have a proximal blind pouch with a distal tracheo-oesophageal fistula.

Why is "H-type fistula without atresia" not the answer?

An H-type fistula presents later with recurrent aspiration, not inability to pass the tube.

Why is "Fistula between the trachea and upper oesophageal pouch alone" not the answer?

A fistula only to the upper pouch is rare and does not give gastric air.

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

Pure atresia without a fistula gives a gasless abdomen.

What concept does this question test?

It tests Embryology: tracheoesophageal fistula in Anatomy. Gas enters the stomach through the fistula, which is why the abdomen contains air. Polyhydramnios occurs because the fetus cannot swallow amniotic fluid.

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 Embryology: tracheoesophageal fistula?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy 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.