Paediatric surgery: oesophageal atresia anatomy: practice question

A General Surgery 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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General Surgery · Paediatric surgery: oesophageal atresia anatomy

Sample item

A newborn has frothing at the mouth and chokes with the first feed. A nasogastric tube coils in the upper chest, and the abdominal radiograph shows gas in the stomach. Which anatomy is most likely?

AH-type fistula without atresiaBProximal fistula with a blind distal pouchCIsolated oesophageal atresia without fistulaDBlind upper pouch with a distal tracheo-oesophageal fistula

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

The answer and the reasoning

D. Blind upper pouch with a distal tracheo-oesophageal fistula

About 85% of oesophageal atresia cases are Gross type C: a blind proximal pouch with a distal tracheo-oesophageal fistula. Gas enters the stomach through the fistula from the airway, so the abdomen is not gasless. Pure atresia has a gasless abdomen, and associated VACTERL anomalies should be sought.

Option by option

A. H-type fistula without atresia
An H-type fistula allows a patent oesophagus, so the tube passes and feeding problems appear later.
B. Proximal fistula with a blind distal pouch
A proximal fistula with a blind distal segment has a gasless abdomen.
C. Isolated oesophageal atresia without fistula
Pure atresia gives a scaphoid, gasless abdomen.
D. Blind upper pouch with a distal tracheo-oesophageal fistula (correct)
Correct. Gastric gas implies a distal fistula connecting the airway to 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.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Blind upper pouch with a distal tracheo-oesophageal fistula. About 85% of oesophageal atresia cases are Gross type C: a blind proximal pouch with a distal tracheo-oesophageal fistula.

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

An H-type fistula allows a patent oesophagus, so the tube passes and feeding problems appear later.

Why is "Proximal fistula with a blind distal pouch" not the answer?

A proximal fistula with a blind distal segment has a gasless abdomen.

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

Pure atresia gives a scaphoid, gasless abdomen.

What concept does this question test?

It tests Paediatric surgery: oesophageal atresia anatomy in General Surgery. Gas enters the stomach through the fistula from the airway, so the abdomen is not gasless. Pure atresia has a gasless abdomen, and associated VACTERL anomalies should be sought.

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 Paediatric surgery: oesophageal atresia anatomy?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.