The nurse caring for a 5-year-old with a history of teratology of Fallot notes that the child has clubbed fingers. This finding is indicative of which associated condition?

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This question was previously asked in

SGPGI Staff Nurse Official Paper (Held On: 28 Feb, 2024 Shift 1)

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Answer 1

Correct Answer: Tissue hypoxia

Rationale:

Clubbed fingers, also known as digital clubbing, are a physical manifestation commonly associated with chronic tissue hypoxia. Tissue hypoxia occurs when there is an inadequate oxygen supply to body tissues, leading to compensatory changes in the fingers and nails.
In the context of tetralogy of Fallot, a congenital heart defect, tissue hypoxia arises due to a right-to-left shunting of blood through the ventricular septal defect. This allows deoxygenated blood to bypass the lungs and enter systemic circulation, causing a lower oxygen level in the blood.
The body attempts to compensate for chronic hypoxia by increasing blood flow to the extremities, resulting in the characteristic thickening or "clubbing" of the fingertips and nails.
Clubbed fingers are a long-term adaptation to chronic hypoxemia and are often observed in children with cyanotic congenital heart diseases like tetralogy of Fallot.

Additional Information:

Digital clubbing may also be seen in other conditions causing chronic hypoxia, such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, or certain gastrointestinal and liver disorders. However, in this case, the underlying cause is related to cyanotic heart disease.
Management of clubbing in tetralogy of Fallot usually involves addressing the underlying hypoxia, often through surgical correction of the heart defect.

Explanation of Other Options:

Chronic hypertension

Rationale: Chronic hypertension refers to persistently high blood pressure. It is not directly associated with clubbed fingers. While hypertension can cause other complications like left ventricular hypertrophy or vascular damage, it does not result in the physical changes seen in clubbing.

Delayed physical growth

Rationale: Delayed physical growth can occur in children with congenital heart defects due to poor oxygenation and inadequate nutrient delivery. However, it is not the specific cause of clubbed fingers. Clubbing results from long-term tissue hypoxia rather than growth delays.

Destruction of bone marrow

Rationale: Bone marrow destruction can lead to anemia or pancytopenia but is not associated with clubbed fingers. The clubbing is due to chronic hypoxia rather than hematologic conditions caused by bone marrow issues.

Conclusion:

Clubbed fingers are a hallmark of chronic tissue hypoxia, which is a common complication of cyanotic congenital heart defects like tetralogy of Fallot. Understanding the underlying cause is essential for targeted treatment and management of the condition.