DSSSB October 2024
Medical & Surgical Nursing
Easy
All of the following are heart diseases due to left to right shunt, EXCEPT?
Appeared in: DSSSB October 2024
Explanation
- Truncus arteriosus is a cyanotic congenital heart defect, which distinguishes it from the other options.
- It involves a single great artery (truncus) arising from both ventricles, supplying the systemic, pulmonary, and coronary circulations.
- This anatomy leads to a complete mixing of deoxygenated (venous) and oxygenated (arterial) blood, which is then distributed to the body, resulting in a mixed or right-to-left shunt and systemic cyanosis.
Why Other Options Were Wrong
- Option A: Atrial septal defect (ASD) is a classic example of a left-to-right shunt. It is an opening in the septum between the atria.
- Option B: Ventricular septal defect (VSD) is the most common congenital heart defect and is characterized by a left-to-right shunt through a hole in the interventricular septum.
- Option D: Patent ductus arteriosus (PDA) is the failure of the fetal ductus arteriosus to close, resulting in a persistent connection between the aorta and pulmonary artery, causing a left-to-right shunt.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification of congenital heart defects by shunt direction (acyanotic vs. cyanotic) as background academic context rather than a clinical decision trigger.
- Nurses must differentiate between acyanotic (left-to-right shunt) and cyanotic (right-to-left shunt) defects. Acyanotic defects often present with signs of heart failure and pulmonary congestion (e.g., tachypnea, poor feeding, crackles), while cyanotic defects present with visible cyanosis and hypoxia.
- What if? If a large left-to-right shunt (like a VSD) is left untreated, chronic pulmonary overcirculation can lead to irreversible pulmonary hypertension. This can cause the shunt to reverse (Eisenmenger syndrome), becoming a right-to-left shunt and causing late-onset cyanosis.
How to Approach the Question
- This is an 'EXCEPT' question, which requires you to find the outlier among the options.
- First, identify the common characteristic of the group mentioned in the stem: 'heart diseases due to left to right shunt'.
- Recall the classification of congenital heart defects into acyanotic (left-to-right shunts) and cyanotic (right-to-left shunts).
- Evaluate each option: Atrial septal defect, Ventricular septal defect, and Patent ductus arteriosus are all classic examples of left-to-right shunts.
- Identify the option that does not fit this category. Truncus arteriosus is a cyanotic defect with a mixed/right-to-left shunt, making it the correct exception.
Concept Tested & Keywords
- Concept Tested: Classification of congenital heart defects by shunt direction (acyanotic vs. cyanotic).
- Stem keywords: heart diseases, left to right shunt
- Lead-in keywords: EXCEPT
- Negative lead-in flag: The question asks for the EXCEPTION, meaning the condition that is NOT a left-to-right shunt.
Question ID
QsIuu9munUxF1dYp1ZuJpc
Reference Book
E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 2 (215-514) p. 1
E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 430-432
E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 539-541
Practise the full DSSSB October 2024
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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