Pediatric cardiology: 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 · Pediatric cardiology

Sample item

A 6-week-old has a harsh pansystolic murmur at the left lower sternal border, tachypnoea and poor weight gain. The murmur was soft in the first days of life. Which mechanism explains the later emergence of symptoms?

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

The answer and the reasoning

B. Falling pulmonary vascular resistance increases left-to-right flow across the defect

At birth pulmonary and systemic resistances are similar, so little blood crosses a ventricular septal defect. As pulmonary resistance falls over weeks, left-to-right shunting increases, producing murmur, pulmonary overcirculation and heart failure.

Option by option

  • A. Closure of the foramen ovale raises right atrial pressure

    Foramen ovale closure does not explain a ventricular murmur.

  • B. Falling pulmonary vascular resistance increases left-to-right flow across the defect (correct)

    Correct. Lower pulmonary resistance allows more shunting from left to right.

  • C. Closure of the ductus venosus overloads the left atrium

    The ductus venosus closure relates to hepatic circulation and does not produce this murmur.

  • D. Rising systemic resistance reverses the shunt to right-to-left

    A right-to-left shunt arises with high pulmonary resistance and would cause cyanosis.

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 B, Falling pulmonary vascular resistance increases left-to-right flow across the defect. At birth pulmonary and systemic resistances are similar, so little blood crosses a ventricular septal defect.

Why is "Closure of the foramen ovale raises right atrial pressure" not the answer?

Foramen ovale closure does not explain a ventricular murmur.

Why is "Closure of the ductus venosus overloads the left atrium" not the answer?

The ductus venosus closure relates to hepatic circulation and does not produce this murmur.

Why is "Rising systemic resistance reverses the shunt to right-to-left" not the answer?

A right-to-left shunt arises with high pulmonary resistance and would cause cyanosis.

What concept does this question test?

It tests Pediatric cardiology in Pediatrics. As pulmonary resistance falls over weeks, left-to-right shunting increases, producing murmur, pulmonary overcirculation and heart failure.

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 Pediatric cardiology?

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.