Systemic paediatrics: transposition of great arteries: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Systemic paediatrics: transposition of great arteries

Sample item

A term baby, born to a diabetic mother, is deeply cyanosed from the first day. An echocardiogram shows the aorta arising from the right ventricle with an intact ventricular septum and a restrictive atrial septum despite prostaglandin infusion. Which procedure improves mixing?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Balloon atrial septostomy

In transposition of the great arteries the circulations run in parallel, so survival needs mixing at atrial, ductal or ventricular level. Balloon atrial septostomy (Rashkind) enlarges the foramen ovale as a bridge to the arterial switch operation. Closing the ductus would remove mixing.

Option by option

  • A. Closure of the ductus with indomethacin

    Indomethacin would close the ductus and worsen cyanosis.

  • B. Balloon atrial septostomy (correct)

    Correct. Septostomy creates an interatrial communication for mixing.

  • C. Pulmonary artery banding

    Pulmonary banding reduces pulmonary flow in high-flow lesions and does not help mixing.

  • D. Blalock-Taussig shunt

    A Blalock-Taussig shunt increases pulmonary flow in obstructed lesions such as tetralogy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is B, Balloon atrial septostomy. In transposition of the great arteries the circulations run in parallel, so survival needs mixing at atrial, ductal or ventricular level.

Why is "Closure of the ductus with indomethacin" not the answer?

Indomethacin would close the ductus and worsen cyanosis.

Why is "Pulmonary artery banding" not the answer?

Pulmonary banding reduces pulmonary flow in high-flow lesions and does not help mixing.

Why is "Blalock-Taussig shunt" not the answer?

A Blalock-Taussig shunt increases pulmonary flow in obstructed lesions such as tetralogy.

What concept does this question test?

It tests Systemic paediatrics: transposition of great arteries in Pediatrics. Balloon atrial septostomy (Rashkind) enlarges the foramen ovale as a bridge to the arterial switch operation. Closing the ductus would remove mixing.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic paediatrics: transposition of great arteries?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.