Cardiology: Ebstein anomaly features: 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: Ebstein anomaly features

Sample item

A 22-year-old woman has mild cyanosis, widely split heart sounds and a systolic murmur at the lower left sternal border. The chest radiograph shows a very large, box-shaped heart from a massively dilated right atrium, and the ECG shows tall P waves and a delta wave. Which lesion is most likely?

APulmonary stenosis with an atrial septal defectBEbstein anomaly with apical displacement of the tricuspid valveCTricuspid atresia with a small right ventricleDTetralogy of Fallot with a boot-shaped heart

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

The answer and the reasoning

B. Ebstein anomaly with apical displacement of the tricuspid valve

In Ebstein anomaly the septal and posterior tricuspid leaflets are displaced toward the apex, atrialising part of the right ventricle. Cyanosis comes from right-to-left shunting through an ASD or patent foramen ovale, and accessory pathways with pre-excitation are common.

Option by option

A. Pulmonary stenosis with an atrial septal defect
Pulmonary stenosis with an ASD does not produce an atrialised right ventricle or pre-excitation.
B. Ebstein anomaly with apical displacement of the tricuspid valve (correct)
Correct. A giant right atrium, a delta wave and mild cyanosis point to Ebstein anomaly.
C. Tricuspid atresia with a small right ventricle
Tricuspid atresia usually causes left axis deviation and early cyanosis, and a delta wave is not a feature.
D. Tetralogy of Fallot with a boot-shaped heart
Tetralogy of Fallot shows a boot-shaped heart with a small pulmonary segment, not a box-shaped right atrial silhouette.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Ebstein anomaly with apical displacement of the tricuspid valve. In Ebstein anomaly the septal and posterior tricuspid leaflets are displaced toward the apex, atrialising part of the right ventricle.

Why is "Pulmonary stenosis with an atrial septal defect" not the answer?

Pulmonary stenosis with an ASD does not produce an atrialised right ventricle or pre-excitation.

Why is "Tricuspid atresia with a small right ventricle" not the answer?

Tricuspid atresia usually causes left axis deviation and early cyanosis, and a delta wave is not a feature.

Why is "Tetralogy of Fallot with a boot-shaped heart" not the answer?

Tetralogy of Fallot shows a boot-shaped heart with a small pulmonary segment, not a box-shaped right atrial silhouette.

What concept does this question test?

It tests Cardiology: Ebstein anomaly features in General Medicine. Cyanosis comes from right-to-left shunting through an ASD or patent foramen ovale, and accessory pathways with pre-excitation are common.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: Ebstein anomaly features?

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.