<prompt> VACTERAL syndrome is associated with -BlindnessNerve deafnessTracheo-esophageal fistulaMyoclonic epilepsy  <response>: Ans. is c i.e., Tracheo-esophageal fistula Tracheoesophageal fistula TEF and esophageal atresiao Esophageal atresia is the most common congenital anamoly of the esophagus. More than 90 are associated with tracheoesophageal fistula.o The most common variety is the one where upper part of esophagus ends blindly and the lower part is connected to trachea by a fistula. TEF should be suspected in all cases of hydroamnion.o There may be associated anomalies - VACTERL vertebral, anorectal, cardiac, tracheal, esophageal, renal, radial, limb syndrome.Classification of tracheoesophageal fistula TEFo TEF is classified into five types based on presence of esophageal atresia and location of fistula:-1 Type A: There is esophageal atresia without TEF. There is no gas in abdomen. It is 2nd most common type.2 Type B: There is proximal TEF. There is no gas in abdomen.3 Type C: There is proximal esophageal atresia with distal TEF. Gas in abdomen is present. It is most common.4 Type D: Both proximal and distal fistula are present. Gas in abdomen is present. It is least common.5 Type E: Isolated TEF H or N type is there.Clinical featureso Neaonates present with frothing, excessive drooling, coughing and cyanosis with feeding. This is followed by respiratory distress. Newborn regurgitates of its first and subsequent feeds.Diagnosiso Inability to pass a nasogastric tube confirms the diagnosis of TEF.o Lateral chest X-ray shows a lucent proximal pouch that may displace trachea anteriorlyo X-ray abdomen shows gas in stomach in commonest variety type-C TEF. 