NORCET-7 Mains-2024: Which symptom indicates that a child may have a tracheoesophageal fistula, EXCEPT?

NORCET-7 Mains-2024

Child Health Nursing (Pediatrics)

Medium

Appeared in: NORCET-7 Mains-2024

Explanation

Hoarseness of voice is not a primary symptom of a congenital tracheoesophageal fistula (TEF).
The classic signs of TEF are respiratory and related to the inability to swallow properly.
Hoarseness is typically associated with laryngeal problems (voice box) or can be a postoperative complication, but it is not a presenting sign of the defect itself.

Option A: This is a common symptom. The abnormal connection allows saliva, food, and gastric contents to enter the lungs, leading to aspiration pneumonia and recurrent respiratory infections.
Option B: This is a hallmark sign. In the most common form of TEF with esophageal atresia, the upper esophagus is a blind pouch, preventing saliva from reaching the stomach. It pools and results in excessive drooling and frothy bubbles from the mouth and nose.
Option C: This is a classic triad of symptoms known as the '3 Cs' (Coughing, Choking, Cyanosis) that occur during feeding attempts. Fluid fills the esophageal pouch and spills into the trachea, triggering these protective reflexes.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of Tracheoesophageal Fistula (TEF) to guide bedside assessment, documentation, and the next nursing action.
Early recognition of TEF symptoms is critical to prevent life-threatening aspiration pneumonia. The '3 Cs' (Coughing, Choking, Cyanosis) during feeding are a red flag requiring immediate cessation of feeding and medical evaluation.
The priority nursing action for a suspected TEF is to make the infant NPO (nothing by mouth), position them with the head elevated, and provide continuous suctioning of the oral pouch to prevent aspiration.
TEF is often associated with other congenital anomalies as part of the VACTERL association (Vertebral defects, Anal atresia, Cardiac defects, Tracheo-esophageal fistula, Renal anomalies, and Limb abnormalities). A thorough newborn assessment is crucial.

How to Approach the Question

First, identify that the question uses the word 'EXCEPT'. This means you are looking for the option that is NOT a true symptom of the condition.
Read the condition in the stem: 'tracheoesophageal fistula'. Recall the pathophysiology: an abnormal connection between the trachea and esophagus.
Evaluate each option to see if it is a known symptom of TEF.
Option A (recurrent infection), B (drooling), and C (coughing/choking) are all classic signs resulting from aspiration and inability to swallow. These are true.
Option D (hoarseness) is not directly caused by the fistula itself. It relates to the larynx.
Since three options are true symptoms, the remaining option, 'Hoarseness of voice', must be the correct answer to the 'EXCEPT' question.

Concept Tested & Keywords

Concept Tested: Clinical manifestations of Tracheoesophageal Fistula (TEF)
Stem keywords: tracheoesophageal fistula, symptom, child
Lead-in keywords: EXCEPT
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: Question asks for the symptom that is NOT present.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 37-39

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 173-175