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: Gynaecology & Obstetrics
All of the following are causes of pansystolic murmur, EXCEPT : 
Select and explain. 
A. VSD, B. TR, C. MR, D. ASD
D: ASD
Answer: D: ASD 
Explanation: Conditions associated with pansystolic murmur are VSD, TR and MR. On auscultation of patients with ASD: S1 is normal or split with accentuation of the tricuspid valve closure sound. Increased flow across the pulmonary valve result in mid systolic pulmonary outflow murmur. S2 is widely split. Amid diastolic rumbling murmur is heard in the tricuspid valve due to increased flow across the tricuspid valve. Ref: Child J.S., Aboulhosn J. (2012). Chapter 236. Congenital Hea Disease in the Adult. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.