A neonate within 4 hours of bih presented with severe respiratory distress. He appears to be dyspneic, tachypneic, and cyanotic with severe retractions of the chest. On examination, grunting is present along with use of the accessory muscles. Neonate also appears to have scaphoid abdomen and increased chest wall diameter. There is evidence of shift of the point of maximal cardiac impulse from its original location to the right side. Chest x ray of the neonate Defect in development of which pa of the responsible structure is causing this condition of the baby?
A neonate within 4 hours of bih presented with severe respiratory distress. He appears to be dyspneic, tachypneic, and cyanotic with severe retractions of the chest. On examination, grunting is present along with use of the accessory muscles. Neonate also appears to have scaphoid abdomen and increased chest wall diameter. There is evidence of shift of the point of maximal cardiac impulse from its original location to the right side. Chest x ray of the neonate Defect in development of which pa of the responsible structure is causing this condition of the baby?
π‘ Explanation
**Core Concept**
The neonate's presentation is consistent with congenital diaphragmatic hernia (CDH), a condition characterized by a developmental defect in the diaphragm, allowing abdominal organs to herniate into the thoracic cavity, compromising lung development and function.
**Why the Correct Answer is Right**
The correct answer is related to the development of the pleuroperitoneal membranes (PPMs). The pleuroperitoneal membranes are a pair of membranes that form during embryonic development to separate the pleural and peritoneal cavities. Failure of proper closure of these membranes results in a diaphragmatic hernia. The pleuroperitoneal membranes are derived from the somatic mesoderm, specifically from the pleuroperitoneal folds (PPFs). The correct answer, PA D, refers to the dorsal pleuroperitoneal membrane, which is the part of the diaphragm that is primarily affected in congenital diaphragmatic hernia.
**Why Each Wrong Option is Incorrect**
**Option A:** The anterior part of the diaphragm is not primarily involved in congenital diaphragmatic hernia.
**Option B:** The arch of the aorta is not directly related to the development of the diaphragm.
**Option C:** The correct answer, PA D, is the dorsal pleuroperitoneal membrane, which is the part of the diaphragm primarily affected in congenital diaphragmatic hernia.
**Option D:** The bochdalek hernia is a type of congenital diaphragmatic hernia that occurs in the posterior part of the diaphragm, but this option does not specify the dorsal pleuroperitoneal membrane.
**Clinical Pearl / High-Yield Fact**
Classic congenital diaphragmatic hernia occurs on the left side, but bilateral or right-sided hernias can also occur. The presence of a scaphoid abdomen and increased chest wall diameter is highly suggestive of a diaphragmatic hernia.
**β Correct Answer: C. PA D. Dorsal pleuroperitoneal membrane.**
β Correct Answer: C. PA D
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