Cardiac imaging: atrial septal defect: practice question

A Radiology 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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Radiology · Cardiac imaging: atrial septal defect

Sample item

An adult has an ejection systolic murmur and fixed splitting of the second heart sound. The chest radiograph shows cardiomegaly with right atrial prominence, a small aortic knuckle and plethoric lungs. What is the likely lesion?

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

The answer and the reasoning

A. Ostium secundum atrial septal defect

A left to right atrial shunt overloads the right heart and pulmonary circulation, causing pulmonary plethora and a prominent pulmonary artery, with a small aortic knuckle because systemic output is relatively low. Fixed splitting is the classic auscultatory finding.

Option by option

  • A. Ostium secundum atrial septal defect (correct)

    Correct. Plethora with right heart enlargement and a small aortic knuckle fits an ASD.

  • B. Tetralogy of Fallot

    Tetralogy of Fallot causes oligaemic lungs and a boot-shaped heart.

  • C. Coarctation of the aorta

    Coarctation gives rib notching and a figure 3 sign.

  • D. Mitral stenosis

    Mitral stenosis shows left atrial enlargement and venous congestion.

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 Radiology question

What is the answer to this Radiology question?

The best answer is A, Ostium secundum atrial septal defect. A left to right atrial shunt overloads the right heart and pulmonary circulation, causing pulmonary plethora and a prominent pulmonary artery, with a small aortic knuckle because systemic output is relatively low.

Why is "Tetralogy of Fallot" not the answer?

Tetralogy of Fallot causes oligaemic lungs and a boot-shaped heart.

Why is "Coarctation of the aorta" not the answer?

Coarctation gives rib notching and a figure 3 sign.

Why is "Mitral stenosis" not the answer?

Mitral stenosis shows left atrial enlargement and venous congestion.

What concept does this question test?

It tests Cardiac imaging: atrial septal defect in Radiology. Fixed splitting is the classic auscultatory finding.

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 Cardiac imaging: atrial septal defect?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology 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.