This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: C.V.S, Subject name: Pediatrics
Ebstein anomaly is associated with all the following except 
Select and explain. 
A. Patent foramen ovale, B. Massive hea on chest X-ray, C. VSD, D. Tall, broad P wave
C: VSD
Answer: C: VSD 
Explanation: Ebstein Anomaly - It is a rare cyanotic congenital hea disease with abnormality of tricuspid valve. The foramen ovale may be patent . C/f : cyanosis , effo intolerance , fatigue , paroxysmal attacks of tachycardia , clubbing , jugular venous pulse may show a dominant V wave but there is usually no venous engorgement. ECG - shows prominent P wave X Ray - It shows cardiac enlargement due to right atrial and right ventricular enlargement. The main pulmonary aery segment may be prominent and the aoic knuckle small. The pulmonary vasculature diminished . Ref : pg 424 ghai pediatrics eighth edition