NBME Form 10 Step 2 Practice Test

Tetralogy of Fallot is most often associated with which murmur?

Pansystolic murmur at apex Harsh systolic murmur best heard at left upper sternal border Continuous murmur at left infraclavicular area Midsystolic click at apex

Correct Answer:

Harsh systolic murmur best heard at left upper sternal border

Explanation:

Tetralogy of Fallot produces obstruction of the right ventricular outflow tract, creating a pressure gradient during systole. That results in a harsh, systolic ejection murmur best heard along the left upper sternal border, where the RVOT and pulmonary valve sit. This murmur reflects the RVOT obstruction rather than a murmur from regurgitant lesions or continuous flows. The other murmurs described fit different conditions (pansystolic at the apex → mitral/tricuspid regurg, continuous murmur at the infraclavicular area → patent ductus arteriosus, midsystolic click → mitral valve prolapse). So the harsh systolic murmur at the left upper sternal border is most characteristic of Tetralogy of Fallot.

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