This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'Diagnosis of traumatic rupture of diaphragma) Laparoscopyb) Chest X rayc) Diagnostic peritoneal lavaged) IPPV \nSelect and explain. \nA. ab, B. a, C. ad, D. bc', 'role': 'user'}, {'content': 'Answer: A \nExplanation: • Diaphragmatic injuries are often caused by penetrating injuries.\n• Patients sustaining penetrating injuries below the nipples and above the costal margins should be investigated to rule out diaphragmatic injury.\nEtiology\n• Penetrating trauma (knife, bullet, repair of hiatus hernia)\n• Blunt trauma (motor vehicle accident, fall from height, bout of hyperemesis):\n−− Caused by compressive force applied to the pelvis and abdomen.\n−− Rupture is usually large, with herniation of abdominal content into chest\nClinical Features\n• Most diaphragmatic injuries are silent and the presenting features are those of injury to the surrounding organs.\n• Late complication: Herniation of abdominal contents in to the chest.\n• Herniation of organ: Stomach\xa0>Colon >Small intestine >Omentum >Spleen >Kidney and pancreas.\nDiagnosis\n• There is no single standard investigation to diagnose diaphragmatic injuries.\n• Chest X-ray after placement of a nasogastric tube may be helpful (as this may show the stomach herniated into the chest)\n• Contrast study of upper or lower GIT, CT scan and diagnostic peritoneal lavage all lack positive or negative predictive value.\n• Most accurate evaluation is by video assisted thracoscopy (VATS) or laparoscopy, offering the advantage of allowing the surgeon to proceed to repair and additional evaluation of the abdominal organs.\nTreatment\n• Operative repair\xa0is recommended in all cases.\n• All penetrating diaphragmatic injury must be repaired via the abdomen and not the chest, to rule out penetrating hollow viscus injury.\nBergvist Triad: Rib fracture + Fracture of spine /pelvis + Traumatic rupture of diaphragm', 'role': 'assistant'}]