Cardiology — MCQs

Q: All of the following are true regarding Tetralogy of Fallot except which of the following?

Predominantly left to right shunt. ***Predominantly left to right shunt*** - Tetralogy of Fallot is characterized by a **right-to-left shunt** due to subpulmonary stenosis, leading to cyanosis [1]. - A persistent **left-to-right shunt** is inconsistent with the typical presentation of Tetralogy of Fallot [1]. *Ejection systolic murmur in second intercostal space* - The **ejection systolic murmur** in the second intercostal space is due to the **pulmonic stenosis**, which is a key component of Tetralogy of Fallot [1]. - The murmur's intensity is inversely proportional to the severity of the obstruction. *Single second heart sound* - The single second heart sound is a common finding because of the **reduced pulmonary blood flow** and thus the soft or absent pulmonary component of S2. - The **aortic component** is typically heard clearly, but the pulmonary component is diminished. *Normal jugular venous pressure* - **Normal jugular venous pressure** is expected in Tetralogy of Fallot unless there is associated right-sided heart failure, which is not a primary feature of uncomplicated TOF. - The primary hemodynamic derangement involves shunting at the ventricular level, not elevated right atrial pressure.

Q: What is the most important prognostic marker of tetralogy of Fallot?

Degree of pulmonary stenosis. **Degree of pulmonary stenosis** - The severity of **pulmonary stenosis** dictates the degree of right ventricular outflow obstruction and thus the amount of **right-to-left shunting** through the VSD, which directly impacts the patient's cyanosis and overall prognosis [1]. - More severe stenosis leads to greater cyanosis, earlier presentation of symptoms, and a higher risk of complications and mortality without intervention. *Ventricular septal defect (VSD)* - A **VSD** is a required component of tetralogy of Fallot, allowing for communication between the ventricles [1]. - While essential for the pathophysiology, its presence alone does not determine the severity of the clinical presentation or prognosis as much as the degree of pulmonary outflow obstruction. *Overriding aorta* - An **overriding aorta** is another structural component of tetralogy of Fallot, meaning the aorta originates over both ventricles [1]. - This anatomical feature is a defining characteristic but does not directly dictate the clinical severity or prognosis as much as the blood flow dynamics determined by pulmonary stenosis. *Right ventricular hypertrophy* - **Right ventricular hypertrophy** is a compensatory response to the increased pressure load from pulmonary stenosis [1]. - It is a consequence of the obstruction, not the primary determinant of prognosis, although severe hypertrophy can lead to complications such as arrhythmias and decreased ventricular function.

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Cardiology — MCQs

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