This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'A 29–day old child presents with features of congestive cardiac failure and left ventricular hypertrophy. Auscultation shows a short systolic murmur. Most likely diagnosis is – \nSelect and explain. \nA. Rheumatic fever, B. Tetralogy of Fallot, C. Transposition of great arteries, D. Ventricular septal defect', 'role': 'user'}, {'content': 'Answer: D \nExplanation: The answer is quite obvious.\nTOF and TGA are cyanotic heart diseases and\nRheumatic fever can be ruled out on basis of age. (Age group of rheumatic fever is 5-15 yrs)\n\nClinical manifestation of VSD \n\nThe patients become symptomatic around 6 to 10 weeks of age.\nAt this time CHF may develop.\nFrequent symptoms → Palpitation, dysnea on exertion and chest infections.\n\nSigns\n\nHyperkinetic precordium with a thrill at the left sternal border.\nPansystolic murmur at left sternal border.\nS1 & S2 are masked by pan-systolic murmur maximum intensity of murmur is at 3rd, 4th or 5th left interspace.\nS2 can be make out at the pulmonary area (upper left sternal border) where it is not masked by pan-systolic murmur → S2 is widely split with accentuation of P2\nS3 may be audible at the apex.\nA delayed diastolic murmur in mitral area.\nPulmonary systolic ejection murmur in pulmonary area.', 'role': 'assistant'}]