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A 2-month-old male is brought to the pediatrician by his mother who is concerned that he is not gaining weight. She also notes that his color is poor, especially when he tries to feed, when he often grunts and turns dusky. Which of the following cardiac lesions is most likely to cause the patient’s symptoms?

A. Atrial septal defect
B. Patent ductus arteriosus
C. Patent foramen ovale
D. Tetralogy of Fallot
E. Ventricular septal defect
 

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This is kinda "the odd one out" question. Tetralogy of Fallot is the only cyanotic congenital heart disease among the available options. Cyanosis is most probable to develop in exertion, i.e. during feeding. Moreover ToF is the most common cyanotic congenital heart disease.

Should there have been options such as Tricuspid Atresia or Transposition of Great Vessels (which are also cyanoTic), have in mind that these entities present with cyanosis at the immediate newborn period. On the contrary, ToF may take months or even years to manifest clinically (cyanosis depends on the degree of pulmonary artery stenosis).
 
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