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: Medicine
All of the following conditions are associated with systolic thrill in left 2nd and 3rd intercostal space, EXCEPT: 
Select and explain. 
A. Pink TOF, B. Subpulmonic VSD, C. Pulmonic stenosis, D. Ebstein's anomaly
A: Pink TOF
Answer: A: Pink TOF 
Explanation: Pink TOF is not commonly associated with a left upper parasternal systolic thrill. It is associated with a systolic thrill in second and third intercostal space. The physiology of TOF depends primarily on the severity of pulmonary stenosis and on the size of the VSD. Pink TOF is said to occur in patients with a large VSD and mild pulmonary stenosis. These patients are initially asymptomatic and gradually develop congestive hea failure over few weeks to months as the pulmonary vascular resistance falls and left to right shunt predominates. They are clinically similar to patients with an isolated large VSD. Ref: Congenital Hea Defects By Diego. F. Wyszynski, Pages 218-220