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NBME 17 Answers

nbme17/Block 3/Question#33 (6.4 difficulty score)
A female newborn delivered at 36 weeks' ...
Incomplete formation of pleuroperitoneal membrane🔍

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submitted by cassdawg(548),

This is a Congenital Diaphragmatic Hernia (FA2020p370).

Conginital diaphragmatic hernias are caused by a congenital defect of the pleuroperitoneal membrane which allows contents of the abdominal cavity to herniate upward, and displace the contents of the thorax (hence why our baby has displacement of the mediastinal contents to the right). This also leads to lung malformation and respiratory distress (hence the low apgar scores). Because the stomach is likely herniates upward, a nasogastric tube placed would appear in the left mediastinum (because that is where the stomach is). Further, there is an absence of bowel gas in the abdomen likely because the bowels are herniated into the thorax.

cheesetouch  FA2018 P364 CDH +