A 10-Year-Old Boy Who Recently Immigrated from Overseas with His

A 10-year-old boy who recently immigrated from overseas with his family is brought to the office due to exertional dyspnea and fatigability.  The boy tires easily when walking and cannot keep up with his peers at the playground.  According to his parents, he was diagnosed with congenital heart disease in infancy, but corrective surgery was unavailable.  They cannot recall the details of his diagnosis.  He takes a daily multivitamin and no medications.  Pulse oximetry of the right hand shows 99% on room air.  Physical examination reveals no murmurs.  There is bilateral cyanosis and clubbing of the toes.  The fingers are normal.  All extremity pulses are full and equal.  Which of the following is the most likely diagnosis?

A) Atrial septal defect
B) Patent ductus arteriosus
C) Tetralogy of Fallot
D) Transposition of the great arteries
E) Ventricular septal defect

Correct Answer:

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