Down Syndrome Airway Features — FRCA Final MCQ

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ModeratePaediatric AnaesthesiaDown Syndrome Airway FeaturesFRCA Final

A 4-year-old child (16 kg) with Down syndrome is listed for cardiac surgery for repair of an atrioventricular septal defect. In addition to the cardiac defect, which airway feature is characteristically associated with Down syndrome?

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Correct answer: D — Macroglossia and subglottic stenosis

Down syndrome (trisomy 21) is associated with multiple airway challenges: relative macroglossia, subglottic stenosis (often requiring a tracheal tube 1-2 sizes smaller than age-predicted), atlantoaxial instability (C1/C2 – requires cautious neck manipulation), midface hypoplasia, and short neck. These children are also prone to upper respiratory tract infections and post-operative stridor. Echocardiographic assessment for congenital heart disease is essential (40-50% prevalence). Other concerns include hypothyroidism and obstructive sleep apnoea.

Reference: APA – 2019 – Paediatric anaesthesia guidelines; RCOA – 2023 – Paediatric module