All of the following conditions are included in Tetralogy of Fallot EXCEPT:

DSSSB 13 August 2024

Child Health Nursing (Pediatrics)

Easy

Appeared in: DSSSB 13 August 2024

Explanation

Tetralogy of Fallot is defined by four specific cardiac defects.
The septal defect characteristic of TOF is a Ventricular Septal Defect (VSD), which is a hole between the two lower chambers (ventricles) of the heart.
An Atrial Septal Defect (ASD), a hole between the upper chambers (atria), is not a defining feature of this condition, making it the correct answer for the 'EXCEPT' question.

Option A: Pulmonary stenosis is a primary, defining component of Tetralogy of Fallot. It involves the narrowing of the right ventricular outflow tract, which obstructs blood flow to the lungs.
Option C: An overriding aorta is a primary, defining component of Tetralogy of Fallot. The aorta is displaced over the ventricular septal defect, receiving blood from both the right and left ventricles.
Option D: Right ventricular hypertrophy is a secondary but defining component of Tetralogy of Fallot. It develops because the right ventricle must work harder to pump blood through the narrowed pulmonary artery.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Components of Tetralogy of Fallot as background academic context rather than a clinical decision trigger.
TOF is the most common cyanotic congenital heart disease in children beyond infancy, accounting for about 75% of 'blue babies' over one year of age.
Nurses must be vigilant for 'tet spells' (hypercyanotic episodes) characterized by sudden, deep cyanosis and rapid breathing. Immediate intervention includes placing the infant in a knee-chest position to increase systemic vascular resistance and improve pulmonary blood flow.
What if? If the pulmonary stenosis was very mild, the condition might present as 'pink tetralogy.' In this case, the shunt across the VSD would be primarily left-to-right, and the infant might not show significant cyanosis initially.

How to Approach the Question

First, identify the core subject of the question, which is the congenital heart defect 'Tetralogy of Fallot'.
Note the keyword 'EXCEPT'. This indicates you must find the option that is NOT a feature of TOF.
Recall the four classic defects of TOF. A helpful mnemonic is PROVe: Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, and Ventricular septal defect.
Systematically evaluate each option against the four components of the mnemonic.
Pulmonary stenosis, Overriding of aorta, and Right ventricular hypertrophy are all part of the tetrad.
Atrial septal defect is not part of the classic tetrad (which includes a Ventricular septal defect). Therefore, it is the correct answer.

Concept Tested & Keywords

Concept Tested: Components of Tetralogy of Fallot
Stem keywords: Tetralogy of Fallot
Lead-in keywords: EXCEPT
Negative lead-in flag: The question asks to identify the condition that is NOT a component of Tetralogy of Fallot.

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