Cardiology: Eisenmenger syndrome: practice question

A General Medicine 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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General Medicine · Cardiology: Eisenmenger syndrome

Sample item

A 24-year-old woman with a large ventricular septal defect that was never repaired now has exertional breathlessness, central cyanosis and clubbing. The pansystolic murmur she had in childhood is no longer audible, and she has a loud pulmonary second sound with a right ventricular heave. What best explains her cyanosis?

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

The answer and the reasoning

A. Pulmonary vascular resistance has risen above systemic resistance, so the shunt has reversed to right-to-left

A large left-to-right shunt exposes the pulmonary vasculature to high flow and pressure, causing progressive obstructive pulmonary vascular disease. When pulmonary resistance exceeds systemic resistance the shunt reverses and deoxygenated blood enters the systemic circulation (Eisenmenger syndrome). The shunt murmur fades because the pressure gradient across the defect disappears, and the loud P2 reflects pulmonary hypertension.

Option by option

  • A. Pulmonary vascular resistance has risen above systemic resistance, so the shunt has reversed to right-to-left (correct)

    Right-to-left shunting through the defect delivers desaturated blood to the systemic circulation, producing cyanosis and clubbing.

  • B. Acquired infundibular stenosis has developed and has reduced the left-to-right flow

    Infundibular stenosis can complicate a small defect, but here the loud P2 and heave point to high pulmonary pressure, not an obstructed outflow.

  • C. Left ventricular failure has caused pulmonary venous congestion and impaired oxygenation

    Left ventricular failure causes congestion and breathlessness but not a fading shunt murmur, a right ventricular heave or clubbing.

  • D. Infective endocarditis has developed on the defect and has produced septic pulmonary emboli

    Endocarditis would cause fever and embolic phenomena and does not explain a loud P2 with a disappearing murmur.

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Pulmonary vascular resistance has risen above systemic resistance, so the shunt has reversed to right-to-left. A large left-to-right shunt exposes the pulmonary vasculature to high flow and pressure, causing progressive obstructive pulmonary vascular disease.

Why is "Acquired infundibular stenosis has developed and has reduced the left…" not the answer?

Infundibular stenosis can complicate a small defect, but here the loud P2 and heave point to high pulmonary pressure, not an obstructed outflow.

Why is "Left ventricular failure has caused pulmonary venous congestion and i…" not the answer?

Left ventricular failure causes congestion and breathlessness but not a fading shunt murmur, a right ventricular heave or clubbing.

Why is "Infective endocarditis has developed on the defect and has produced s…" not the answer?

Endocarditis would cause fever and embolic phenomena and does not explain a loud P2 with a disappearing murmur.

What concept does this question test?

It tests Cardiology: Eisenmenger syndrome in General Medicine. When pulmonary resistance exceeds systemic resistance the shunt reverses and deoxygenated blood enters the systemic circulation (Eisenmenger syndrome). The shunt murmur fades because the pressure gradient across the defect disappears, and the loud P2 reflects pulmonary hypertension.

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 Cardiology: Eisenmenger syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.