Systemic paediatrics: tetralogy of Fallot: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Systemic paediatrics: tetralogy of Fallot

Sample item

A cyanosed 8-month-old has a single S2 and an ejection systolic murmur at the left upper sternal border. The chest X-ray shows a boot-shaped heart with oligaemic lung fields. What is the likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Tetralogy of Fallot

Tetralogy of Fallot consists of a VSD, right ventricular outflow obstruction, overriding aorta and right ventricular hypertrophy. The boot-shaped heart (coeur en sabot) and decreased pulmonary vascularity are classic X-ray findings.

Option by option

  • A. Total anomalous pulmonary venous return

    TAPVR shows a snowman or plethora.

  • B. Large ventricular septal defect

    A large VSD gives plethoric lungs without cyanosis early.

  • C. Tetralogy of Fallot (correct)

    Correct. Boot-shaped heart with oligaemia is TOF.

  • D. Transposition of the great arteries

    TGA shows an egg-on-side silhouette with plethora.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is C, Tetralogy of Fallot. Tetralogy of Fallot consists of a VSD, right ventricular outflow obstruction, overriding aorta and right ventricular hypertrophy.

Why is "Total anomalous pulmonary venous return" not the answer?

TAPVR shows a snowman or plethora.

Why is "Large ventricular septal defect" not the answer?

A large VSD gives plethoric lungs without cyanosis early.

Why is "Transposition of the great arteries" not the answer?

TGA shows an egg-on-side silhouette with plethora.

What concept does this question test?

It tests Systemic paediatrics: tetralogy of Fallot in Pediatrics. The boot-shaped heart (coeur en sabot) and decreased pulmonary vascularity are classic X-ray findings.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic paediatrics: tetralogy of Fallot?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.