All of the following are included in the major criteria. Nade's criteria to diagnose congenital heart disease EXCEPT:

Appeared in: DSSSB 6 September 2024

Explanation

An abnormal second heart sound is classified as a minor criterion under Nadas' criteria for diagnosing congenital heart disease.
The question requires identifying the option that is NOT a major criterion.
According to the criteria, a diagnosis of CHD is suggested by one major criterion or two minor criteria.
Since an abnormal second heart sound is a minor finding, it is the correct exception among the given options, which are all major criteria.

Option A: A systolic murmur of grade 3 or more is a major criterion for diagnosing congenital heart disease, indicating significant pathology.
Option B: Both central cyanosis and any diastolic murmur are considered major criteria. Diastolic murmurs, in particular, are almost always pathological.
Option C: Congestive heart failure is a major criterion, reflecting the heart's inability to meet the body's metabolic demands due to a significant structural defect.

Clinical Relevance

Nursing practice connection: Knowing Nadas' criteria for the diagnosis of congenital heart disease helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses in pediatric and neonatal units play a vital role in the initial screening and assessment of infants. Recognizing the signs listed in Nadas' criteria is crucial for early detection and prompt referral to a pediatric cardiologist.
Accurate auscultation of heart sounds to identify murmur grade, diastolic murmurs, and abnormalities in the second heart sound (like a fixed split or loud P2) is a critical nursing skill.
What if? If a child presented with only an abnormal second heart sound and an abnormal ECG, this would meet the diagnostic threshold (two minor criteria), prompting further investigation like an echocardiogram, even without any major criteria present.

How to Approach the Question

First, identify the core concept being tested, which is Nadas' criteria for congenital heart disease.
Recognize the negative framing of the question due to the keyword 'EXCEPT'. This means you are looking for the option that does not belong to the specified category ('major criteria').
Mentally recall or list the major criteria for Nadas' framework: loud systolic murmur (grade 3+), any diastolic murmur, central cyanosis, and congestive heart failure.
Evaluate each option against this list.
Options A, B, and C (Systolic murmur > grade 3, Cyanosis/diastolic murmur, CHF) are all established major criteria.
Option D (Abnormal second heart sound) is not on the list of major criteria; it is a minor criterion.

Concept Tested & Keywords

QAtbs5XBvVh4nFhkqUcR10

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 432-434

Practise the full DSSSB 6 September 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.