<prompt> A child presenting to the clinic is showing features of Downs syndrome. Which is the MOST common cardiac lesion in a child with Downs syndrome?Atrioventricular Septal DefectVSDCoarctation of aoaTransposition of great vessels  <response>: The most common cardiac abnormality in children with Downs syndrome is atrioventricular septal defect which occur in 45 of cases. Isolated VSD occur in 35 cases, isolated secundum ASD is seen in 8 of cases and TOF is seen in 5 cases. Clinical manifestations of Downs syndrome are: Congenital anomalies of hea and GIT Epicanthal folds Flattened facial profile Small rounded ears Upslanted palpabral fissures Excess nuchal skin Brachycephaly Increased risk of leukemia Immune system defects Alzheimer like dementia Ref: Hursts The Hea, 13e chapter 82. 