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Which of the following cardiac defects is NOT present in an infant presenting with Tetralogy of Fallot (TOF)?

A.

Overriding Aorta

B.

Right Ventricular Hypertrophy

C.

Left Ventricular aneurysm

D.

Pulmonic Stenosis

E.

Ventricular Septal Defect

Answer and Explanation

The Correct Answer is C

Rationale:

A. Overriding Aorta: This is one of the four hallmark defects in Tetralogy of Fallot, where the aorta is positioned directly over the ventricular septal defect, allowing oxygen-poor blood to flow into systemic circulation.

B. Right Ventricular Hypertrophy: This occurs due to increased workload from pulmonic stenosis and ventricular septal defect, causing the right ventricle to thicken, and is a key feature of TOF.

C. Left Ventricular aneurysm: This is not associated with Tetralogy of Fallot. It is a localized outpouching or thinning of the left ventricular wall and is unrelated to the structural defects seen in TOF.

D. Pulmonic Stenosis: Narrowing of the pulmonary valve or artery restricts blood flow to the lungs and is one of the defining components of TOF.

E. Ventricular Septal Defect: A large hole between the right and left ventricles allows mixing of oxygenated and deoxygenated blood and is one of the four defects in TOF.


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Related Questions

Correct Answer is D

Explanation

Rationale:

A. "This is not normal, we should consult GI for a nissen fundoplication": A Nissen fundoplication is a surgical procedure reserved for severe gastroesophageal reflux disease (GERD). It is not an appropriate first step for an otherwise healthy infant.

B. "This is not normal, we need to send you to the emergency room": Frequent spitting up without distress, feeding problems, or poor weight gain is not an emergency. This response would unnecessarily alarm the mother.

C. "This is physiologically normal because baby's central nervous system is not developed and they don't know how to swallow effectively": While neuromuscular maturity plays a role in infant feeding, spitting up in healthy infants is more often due to anatomical immaturity of the gastrointestinal system, rather than poor swallowing reflexes.

D. In healthy, thriving infants, frequent spitting up is usually a benign form of gastroesophageal reflux caused by the immaturity of the lower esophageal sphincter. This muscle strengthens over time, and symptoms typically improve as the infant grows.

Correct Answer is B

Explanation

Rationale:

A. Digoxin: Digoxin is used to improve cardiac contractility in heart failure but does not address the underlying anatomical defect in transposition of the great arteries (TGA). It is not the first-line treatment to maintain oxygenation in TGA.

B. Prostaglandin E: Prostaglandin E is administered to keep the ductus arteriosus open, allowing mixing of oxygenated and deoxygenated blood, which is critical for survival in newborns with TGA before corrective surgery.

C. Furosemide: Furosemide is a diuretic used to manage fluid overload and heart failure symptoms, but it does not address the fundamental need to maintain ductal patency in TGA.

D. Indomethacin: Indomethacin is used to close a patent ductus arteriosus, which would be harmful in TGA where keeping the ductus arteriosus open is necessary for adequate oxygenation.

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