Congenital Diaphragmatic Hernia — MCQs
In Congenital Diaphragmatic Hernia (CDH), the most commonly associated anomaly affects the
Which of the following are correct for herniation via foramen of Morgagni? 1. It occurs posteriorly in chest. 2. Transverse colon is the commonest content. 3. Defect is between sternal and costal attachments. 4. It is a type of congenital hernia. Select the answer using the code given below.
In the intraoperative image of congenital hernia repair, the structure marked by the red arrow is identified as which of the following?
Which one of the following is the treatment of choice in a child with inguinal hernia ?
True about congenital diaphragmatic hernia (CDH) except:
A young child presented with mild intermittent upper abdominal pain. X-ray is given below. What is the diagnosis?
Not an absolute contraindication of laparoscopy is
Most common congenital diaphragmatic hernia is:
Congenital hydrocele is best treated by which of the following?
The treatment of choice for congenital hypertrophic pyloric stenosis is :
Congenital Diaphragmatic Hernia Indian Medical PG Practice Questions and MCQs
Question 1: In Congenital Diaphragmatic Hernia (CDH), the most commonly associated anomaly affects the
- A. Congenital heart defects (Correct Answer)
- B. Anomalies of the urinary tract
- C. Anomalies of the skull
- D. Craniofacial anomalies
Explanation: ***Congenital heart defects*** - **Congenital diaphragmatic hernia (CDH)** is frequently associated with other congenital anomalies. - **Cardiac malformations** are the most common co-occurring defects, affecting a significant proportion of CDH patients. *Anomalies of the urinary tract* - While **urogenital anomalies** can occur with CDH, they are less prevalent than congenital heart defects. - These typically include conditions like **renal agenesis** or **hydronephrosis**. *Anomalies of the skull* - **Skull anomalies** are not a primary or common association with congenital diaphragmatic hernia. - Genetic syndromes associated with both CDH and skull anomalies are relatively rare. *Craniofacial anomalies* - **Craniofacial anomalies**, such as **cleft lip/palate**, can occur with CDH but are less common than cardiac anomalies. - These are often seen within the context of specific genetic syndromes.
Question 2: Which of the following are correct for herniation via foramen of Morgagni? 1. It occurs posteriorly in chest. 2. Transverse colon is the commonest content. 3. Defect is between sternal and costal attachments. 4. It is a type of congenital hernia. Select the answer using the code given below.
- A. 1, 3 and 4
- B. 1, 2 and 4
- C. 1, 2 and 3
- D. 2, 3 and 4 (Correct Answer)
Explanation: ***2, 3 and 4*** - The **foramen of Morgagni** hernia (also known as a parasternal or retrosternal hernia) is a type of **congenital diaphragmatic hernia (CDH)** - statement 4 is **correct**. - The defect is located in the **anterior diaphragm**, specifically between the **sternal and costal attachments** - statement 3 is **correct**. - The **transverse colon** is indeed a common content (most common visceral organ), though omentum is actually the most frequent overall content - statement 2 is considered **correct** in clinical practice. - Statement 1 is **incorrect** as Morgagni hernias occur **anteriorly**, not posteriorly. *1, 3 and 4* - This option incorrectly includes statement 1, which claims the herniation occurs **posteriorly** in the chest. - **Morgagni hernias** are **anterior** diaphragmatic defects (parasternal location). - Posterior diaphragmatic hernias are **Bochdalek hernias**, not Morgagni hernias. *1, 2 and 4* - This option is incorrect because statement 1 states the hernia occurs **posteriorly**, which is wrong. - **Morgagni hernias** are located in the **anterior diaphragm** between sternal and costal attachments. - While statements 2 and 4 are correct, the inclusion of statement 1 makes this option incorrect. *1, 2 and 3* - This option is incorrect because statement 1 claims the hernia occurs **posteriorly**, which is inaccurate. - **Morgagni hernias** are **anterior** defects, representing only 2-3% of congenital diaphragmatic hernias. - The key distinguishing feature is the anterior parasternal location, not posterior.
Question 3: In the intraoperative image of congenital hernia repair, the structure marked by the red arrow is identified as which of the following?
- A. Femoral vein
- B. Obturator vein
- C. Testicular vein (Correct Answer)
- D. Inferior epigastric vein
Explanation: ***Testicular vein*** - The **testicular vein** is clearly visible within the **spermatic cord** structures, which are typically identified and often dissected during congenital hernia repair. - Its position coursing with the testicular artery and vas deferens is consistent with its anatomical location within the inguinal canal. *Femoral vein* - The **femoral vein** lies more inferiorly and medially within the femoral canal, distinct from the inguinal canal contents visualized in this image. - Identification of the femoral vein would be in the context of a femoral hernia repair, not typically a congenital (indirect inguinal) hernia. *Obturator vein* - The **obturator vein** is located deep within the pelvis, accompanying the obturator nerve and artery through the obturator foramen. - It is not typically encountered or visible during a standard open or laparoscopic inguinal hernia repair. *Inferior epigastric vein* - The **inferior epigastric vein** runs superiorly and medially, forming the medial border of the **inguinal triangle (Hesselbach's triangle)**. - While it's an important landmark in hernia repair (differentiating direct vs. indirect hernias), its anatomical position and trajectory are distinct from the structure indicated by the arrow, which is part of the spermatic cord.
Question 4: Which one of the following is the treatment of choice in a child with inguinal hernia ?
- A. Shouldice operation
- B. Lichtenstein repair
- C. Herniotomy alone (Correct Answer)
- D. Bassini's repair
Explanation: ***Herniotomy alone*** - In children, an **inguinal hernia** is typically an **indirect hernia** resulting from a persistent **patent processus vaginalis**. - **Herniotomy alone** (ligation and excision of the hernia sac) is sufficient because the posterior wall of the inguinal canal is usually strong and does not require reinforcement. *Shouldice operation* - The **Shouldice operation** is a **fascial repair** technique involving multiple layers of the posterior inguinal wall. - It is primarily used in **adults** for direct inguinal hernias or recurrent hernias, where the posterior wall is weakened. *Lichtenstein repair* - The **Lichtenstein repair** is a **tension-free mesh repair** method commonly performed in adults. - It involves placing a prosthetic mesh to reinforce the posterior wall of the inguinal canal, which is unnecessary and potentially problematic in growing children. *Bassini's repair* - **Bassini's repair** is a **tissue-based repair** that involves approximating the conjoined tendon to the inguinal ligament. - Like other adult repair techniques, it is associated with higher tension and risks of recurrence in adults due to underlying tissue weakness, and is not suitable for the physiological anatomy of a pediatric inguinal hernia.
Question 5: True about congenital diaphragmatic hernia (CDH) except:
- A. Causes pulmonary hypoplasia
- B. Occurs mostly on the left side
- C. Occurs anteriorly in the diaphragm (Correct Answer)
- D. Leads to cyanosis at birth
Explanation: ***Occurs anteriorly in the diaphragm*** - This statement is incorrect. Most CDHs, specifically **Bochdalek hernias**, occur in the **posterolateral** aspect of the diaphragm. **Morgagni hernias** are anterior but are much less common. - The question asks for the statement that is *not* true about CDH, making this the correct answer. *Causes pulmonary hypoplasia* - This is true because the herniated abdominal contents in the chest cavity compress the developing lungs, preventing them from growing to their normal size. - **Pulmonary hypoplasia** is the primary cause of morbidity and mortality in infants with CDH due to insufficient lung tissue and underdeveloped pulmonary vasculature. *Occurs mostly on the left side* - This is true, as approximately 85% of CDH cases involve a defect in the **left hemidiaphragm**. - The exact reason for the left-sided predominance is not fully understood but may relate to the faster closure of the right pleuroperitoneal canal during development. *Leads to cyanosis at birth* - This is true due to severe **respiratory distress** and **pulmonary hypertension** resulting from pulmonary hypoplasia and abnormal pulmonary vascular development. - The newborn's inability to adequately oxygenate blood causes a bluish discoloration of the skin and mucous membranes.
Question 6: A young child presented with mild intermittent upper abdominal pain. X-ray is given below. What is the diagnosis?
- A. Morgagni hernia (Correct Answer)
- B. Bochdalek hernia
- C. Gastric volvulus
- D. Eventration of diaphragm
Explanation: ***Morgagni hernia*** - The X-ray shows a **gas-filled lesion** in the **right cardiophrenic angle**, which is characteristic of a Morgagni hernia, where abdominal contents (often colon or omentum) herniate through the foramen of Morgagni. - The mild intermittent **upper abdominal pain** in a child is consistent with the infrequent or non-specific symptoms these hernias can present, as they are often discovered incidentally. *Bochdalek hernia* - **Bochdalek hernias** typically occur posteriorly and laterally, predominately on the **left side**, and are usually identified in the **neonatal period** with severe respiratory distress. - The radiographic appearance would be of abdominal contents (bowel loops, liver, spleen) largely filling the ipsilateral hemithorax, causing significant mediastinal shift, which is not seen here. *Gastric volvulus* - **Gastric volvulus** involves abnormal rotation of the stomach, often presenting with acute symptoms like **epigastric pain, vomiting, and inability to pass a nasogastric tube (Borchardt's triad)**. - Radiographically, it would show a **distended stomach** with an abnormal position, often high in the chest, but without the distinct localized air-filled mass in the cardiophrenic angle. *Eventration of diaphragm* - **Diaphragmatic eventration** is an abnormal elevation of part or all of an intact hemidiaphragm, usually due to muscular hypoplasia. - The X-ray would show a **uniformly elevated hemidiaphragm** with normal continuity, and there would be no discrete air-filled structures above the diaphragm to suggest herniated bowel.
Question 7: Not an absolute contraindication of laparoscopy is
- A. Patient on anticoagulant therapy
- B. Diaphragmatic hernia
- C. Generalized peritonitis
- D. Previous incomplete laparoscopy (Correct Answer)
Explanation: ***Previous incomplete laparoscopy*** - This is a **relative contraindication**, not an absolute one, making it the correct answer. - Prior incomplete laparoscopy may result in **adhesion formation**, but this doesn't absolutely prevent future laparoscopic procedures. - Each case must be evaluated individually based on the **extent of adhesions**, surgical expertise, and risk-benefit analysis. - With proper technique and experience, repeat laparoscopy is often feasible and safe. *Patient on anticoagulant therapy* - While anticoagulation increases **bleeding risk** during laparoscopy, this is primarily a **relative contraindication** in modern practice. - Anticoagulants can typically be **held, reversed, or bridged** perioperatively based on thromboembolic risk. - Only **severe uncorrected coagulopathy** (not simply being on anticoagulants) would be considered absolute. - This represents a more significant concern than previous incomplete laparoscopy but is still manageable. *Diaphragmatic hernia* - This is generally a **relative contraindication**, though large hernias pose significant risks. - **Pneumoperitoneum** can potentially worsen herniation and cause **respiratory or cardiac compromise**. - Small diaphragmatic hernias may not preclude laparoscopy, while large ones require careful assessment. - The decision depends on hernia size, cardiopulmonary reserve, and surgical urgency. *Generalized peritonitis* - While traditionally controversial, severe generalized peritonitis is often considered a **strong relative** or practical contraindication. - **Bowel distension** and inflammation make trocar insertion technically challenging and increase **perforation risk**. - However, with experience and proper patient selection, laparoscopy may be performed in selected cases. - The presence of **septic shock** or hemodynamic instability would shift this toward absolute contraindication.
Question 8: Most common congenital diaphragmatic hernia is:
- A. Bochdalek hernia (Correct Answer)
- B. Morgagni hernia
- C. None of the options
- D. Paraesophageal hernia
Explanation: ***Bochdalek hernia*** - This is the most common type of **congenital diaphragmatic hernia (CDH)**, accounting for approximately **95% of all CDH cases**. - It occurs due to a defect in the **posterolateral diaphragm** (pleuroperitoneal membrane), typically on the **left side**. - Presents in neonates with respiratory distress due to herniation of abdominal contents into the thorax. *Morgagni hernia* - This is a rare type of **congenital diaphragmatic hernia**, occurring through the **anterior retrosternal diaphragm** (foramen of Morgagni). - Accounts for only **2-5% of all CDH cases**, usually on the right side. - Often asymptomatic and diagnosed incidentally in adults. *Paraesophageal hernia* - This is an **acquired hiatal hernia** where part of the stomach herniates alongside the esophagus through the esophageal hiatus. - While **hiatal hernias are the most common diaphragmatic hernias overall**, they are **not congenital** and therefore not the answer to this question. - Seen commonly in older adults. *None of the options* - Incorrect, as **Bochdalek hernia** is definitively the most common congenital diaphragmatic hernia.
Question 9: Congenital hydrocele is best treated by which of the following?
- A. Eversion of sac
- B. Lords procedure
- C. Excision of sac
- D. Herniotomy (Correct Answer)
Explanation: ***Herniotomy*** - A **congenital hydrocele** results from a **patent processus vaginalis**, which allows peritoneal fluid to accumulate around the testis. - **Herniotomy** involves ligating and dividing the patent processus vaginalis, thereby closing the communication between the peritoneal cavity and the scrotum, preventing further fluid accumulation. *Eversion of sac* - This technique is typically used for **adult hydroceles**, where the processus vaginalis is usually obliterated. - It involves everting the hydrocele sac and stitching it behind the testis, which allows the sac lining to absorb the fluid. *Excision of sac* - This procedure is also generally reserved for **adult hydroceles**, particularly large ones or those that have recurrently failed other treatments. - It involves removing the entire hydrocele sac, which can be associated with higher morbidity such as hematoma or infection compared to other techniques for congenital hydroceles. *Lords procedure* - The **Lord's procedure** is a plication technique primarily used for **adult hydroceles** of moderate size. - It involves plicating (folding and stitching) the tunica vaginalis, rather than everting or excising it, to reduce its volume and promote fluid reabsorption.
Question 10: The treatment of choice for congenital hypertrophic pyloric stenosis is :
- A. Duodenojejunostomy
- B. Heller's operation
- C. Ramstedt's operation (Correct Answer)
- D. Gastrojejunostomy
Explanation: ***Ramsted's operation*** - **Ramstedt pyloromyotomy** is the definitive surgical treatment for **congenital hypertrophic pyloric stenosis**. - This procedure involves a longitudinal incision through the serosa and muscular layers of the hypertrophied pylorus, stopping short of the mucosa, to relieve the obstruction. *Duodenojejunostomy* - This procedure involves connecting the **duodenum to the jejunum**, typically performed to bypass an obstruction or resection in the distal duodenum or pancreas. - It is not indicated for **pyloric stenosis**, which is an obstruction at the gastric outlet. *Heller's operation* - Also known as **Heller myotomy**, this procedure is used to treat **achalasia**, a disorder affecting the esophagus. - It involves cutting the muscle fibers of the lower esophageal sphincter to facilitate food passage into the stomach, which is unrelated to **pyloric hypertrophy**. *Gastrojejunostomy* - This surgical procedure creates a connection between the **stomach and the jejunum**, bypassing the duodenum. - It is typically performed for conditions like **duodenal obstruction** or distal gastric tumors, not for primary pyloric muscle hypertrophy.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free