Acyanotic Congenital Heart Diseases MCQs

Answer- C. Tender hepatomegaly Heart failure in infants & children results some degree of hepatemegaly which is usually tender & sometimes splenomegaly. Peripheral edema is age dependent : In infants, edema usually eye & over flank. Older childern & adolescent shows both periorbital edema & pedal edema and occurs late.

PDA is associated with a collapsing pulse Patent ductus arteriosus Overview Acyanotic congenital heart defect Connection between the pulmonary trunk and descending aorta More common in premature babies, born at high altitude or maternal rubella infection in the first trimester Features Left subclavicular thrill Continuous 'machinery' murmur Large volume, bounding, collapsing pulse Wide pulse pressure Heaving apex beat Management Indomethacin closes the connection in the majority of cases If associated with another congenital heart defect amenable to surgery then prostaglandin E1 isuseful to keep the duct open until after surgical repair. Reference: Braunwald's heart disease 12 th edition, page no.1559

Contraindications for medical closure of PDA Platelet count 3 AKI or Sr. creatinine >1. 8mg/dl. NEC/Feed in tolerance Unexplained bleeding. Reference: Nelson 21 st Edition, Chapter 122.5

Administration of palivizumab (15 mg/kg IM once a month), a neutralizing humanized murine monoclonal antibody against F-protein of RSV, is recommended for protecting high-risk children against serious complications from RSV disease. Immunoprophylaxis reduces the frequency and total days of hospitalization for RSV infections in high-risk infants in about half of cases. Ribavirin is therapeutic, not prophylactic. Reference: Nelson 21 st Ed/Chapter 418

Children with PDA have pulmonary congestion due to increased pulmonary blood flow, which results in CO2 Retention, not CO2 Washout. Regarding other options Option A is True. Bounding pulses are seen in PDA due to wide pulse pressure found in most patients. In PDA, there is diastolic run-off of blood due to L -> R shunt. This causes a fall in Diastolic BP, producing a wide pulse pressure. Option B is True. Pulmonary hemorrhage has been described in some patients due to pulmonary congestion and increased pulmonary pressures. Option C is True. Necrotizing Enterocolitis can occur in preterm babies with NEC, since a large L -> R shunt reduces descending aorta blood flow. This produces vasoconstriction in the gut circulation and predisposes to NEC. Reference: Nelson 21 st Edition, Chapter 122.5

Sepsis, Crigler Najar syndrome and Gilbert syndrome can all present with unconjugated hyperbilirubinemia in neonates and even in first 24 hr of life (the so-called congenital jaundice). Rotor syndrome produces conjugated jaundice and usually does not manifest in the neonatal period, hence the answer. Reference: OP Ghai 10 th Edition, Page 171

Common presentations in an infant of diabetic mother are Hypoglycemia (selection A) Hypocalcemia (Selection C) Neural tube defects Macrosomia Other manifestations Respiratory distress syndrome Cardiomegaly Cardiac malformations (VSD, TGA, Truncus arteriosus, Double outlet right ventricle, tricuspid atresia, COA) (Selection D) Lumbosacral agenesis Neural tube defect (Selection E) Renal agenesis, hydronephrosis Anorectal atresia Small left colon syndrome Tags : Topic : INFANT OF DIABETIC MOTHER Difficulty level : MUST KNOW PYQ : FMGE DEC 2022 Reference : Nelson textbook of pediatrics, 21 st ed., pg. 983

Affected individuals with Down Syndrome are more prone to congenital heart defects (50%) such as atrioventricular septal defects, ventricular septal defects, isolated secundum atrial septal defects, patent ductus arteriosus, and tetralogy of Fallot. MC congenital heart disease in down syndrome is endocardial cushion defect, also called as complete AV septal defect or atrioventricular canal defect. Reference: Nelson 21 st Edition, Chapter 98.2 And Chapter 453.5