Paediatric surgery: congenital diaphragmatic hernia: 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.

Try it

General Surgery · Paediatric surgery: congenital diaphragmatic hernia

Sample item

A term newborn has severe respiratory distress at birth, a scaphoid abdomen and heart sounds displaced to the right, and bowel loops are seen in the left chest on radiograph. Which is the correct initial management?

ABag-and-mask ventilationBChest drain insertionCImmediate emergency repair before stabilisationDEndotracheal intubation and nasogastric tube decompression

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

The answer and the reasoning

D. Endotracheal intubation and nasogastric tube decompression

Left posterolateral (Bochdalek) diaphragmatic hernia causes pulmonary hypoplasia and pulmonary hypertension. Bag-mask ventilation distends the herniated bowel and worsens lung compression, so the infant is intubated and a nasogastric tube decompresses the gut. Surgery is delayed until the infant is stable.

Option by option

A. Bag-and-mask ventilation
Mask ventilation fills the intrathoracic bowel with gas and worsens respiratory failure.
B. Chest drain insertion
A chest drain risks perforating herniated bowel.
C. Immediate emergency repair before stabilisation
Emergency repair in an unstable, hypertensive pulmonary circulation raises mortality.
D. Endotracheal intubation and nasogastric tube decompression (correct)
Correct. Intubation avoids gut distension and decompression reduces lung compression.

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, Endotracheal intubation and nasogastric tube decompression. Left posterolateral (Bochdalek) diaphragmatic hernia causes pulmonary hypoplasia and pulmonary hypertension.

Why is "Bag-and-mask ventilation" not the answer?

Mask ventilation fills the intrathoracic bowel with gas and worsens respiratory failure.

Why is "Chest drain insertion" not the answer?

A chest drain risks perforating herniated bowel.

Why is "Immediate emergency repair before stabilisation" not the answer?

Emergency repair in an unstable, hypertensive pulmonary circulation raises mortality.

What concept does this question test?

It tests Paediatric surgery: congenital diaphragmatic hernia in General Surgery. Bag-mask ventilation distends the herniated bowel and worsens lung compression, so the infant is intubated and a nasogastric tube decompresses the gut. Surgery is delayed until the infant is stable.

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 surgery: congenital diaphragmatic hernia?

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.