A 12yo child with episodes of sudden bluish discoloration and brief loss of consciousness. Exam:
clubbing, central cyanosis, systolic thrill with systolic ejection murmur in 2nd left ICS. What is the
most probable dx?
a. TOF
b. ASD
c. VSD
d. PDA
e. CoA
Ans. The key A. TOF. [TOF usually does not become symptomatic at birth or early infancy and given
features (central cyanosis and clubbing with murmur of right ventricular outflow obstruction i.e. ejection
systolic murmur in 2nd left ICS) are well known features of TOF]. [Tetralogy of fallot = 1. VSD + 2.
Overriding of the aorta + Right ventricular outflow tract obstruction + Right ventricular hypertrophy].