Paediatric surgery: tracheomalacia after oesophageal atresia repair: 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: tracheomalacia after oesophageal atresia repair

Sample item

A 6-month-old who had repair of oesophageal atresia with a distal tracheo-oesophageal fistula has a barking cough and episodes of cyanosis, especially with feeds. Which complication is most likely?

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

The answer and the reasoning

D. Tracheomalacia at the site of the former fistula

Weakness of the tracheal wall at the level of the fistula leads to expiratory collapse of the trachea, producing a barking cough, stridor and cyanotic spells. Stricture presents with dysphagia and food bolus impaction, and reflux with vomiting and aspiration. Aortopexy is considered for severe attacks.

Option by option

  • A. Gastro-oesophageal reflux

    Reflux is common after repair but produces vomiting and aspiration, not a barking cough and cyanosis.

  • B. Anastomotic stricture

    An anastomotic stricture causes dysphagia and choking on solids rather than a barking cough.

  • C. Recurrent tracheo-oesophageal fistula

    A recurrent fistula gives choking and coughing with every feed and recurrent pneumonia.

  • D. Tracheomalacia at the site of the former fistula (correct)

    Correct. Tracheal collapse during expiration explains the barking cough and cyanotic spells.

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 General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Tracheomalacia at the site of the former fistula. Weakness of the tracheal wall at the level of the fistula leads to expiratory collapse of the trachea, producing a barking cough, stridor and cyanotic spells.

Why is "Gastro-oesophageal reflux" not the answer?

Reflux is common after repair but produces vomiting and aspiration, not a barking cough and cyanosis.

Why is "Anastomotic stricture" not the answer?

An anastomotic stricture causes dysphagia and choking on solids rather than a barking cough.

Why is "Recurrent tracheo-oesophageal fistula" not the answer?

A recurrent fistula gives choking and coughing with every feed and recurrent pneumonia.

What concept does this question test?

It tests Paediatric surgery: tracheomalacia after oesophageal atresia repair in General Surgery. Stricture presents with dysphagia and food bolus impaction, and reflux with vomiting and aspiration. Aortopexy is considered for severe attacks.

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: tracheomalacia after oesophageal atresia repair?

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.