Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
            - With pulmonary plethora 
 Transposition of great arteries  
 Single ventricle Total anomalies of pulmonary 
veins 
(II) Acquired heart disease: 
 Acute rheumatic fever 
 
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1) 
Congenital Heart Diseases (C.H.D) 
Etiology 
The etiology of most C.H.D. is unknown, but several factors associated 
and increase the incidence of the disease such as: 
1- Maternal rubella during pregnancy. 
2- Maternal alcoholism, age over 40 yrs., and insulin dependent 
diabetes. 
3- Hereditary Factors. 
4- Exposure to radiation in the first trimester. 
Ventricular septal defect (VSD) 
 
 
 
 
 
Hemodynamics: 
 Blood is shunted from Lt Ventricle to Rt ventricle through VSD 
lead to Rt ventricle dilatation. 
 The excess blood passes to pulmonary artery to lung to pulmonary 
veins to Lt atrium to Lt ventricle  
 It leads to:  
 Rt ventricle, Lt atrial and Lt ventricle enlargement. 
 Pulmonary artery dilatation and lung plethora 
 
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Types:  
1- Small VSD: usually in the muscular part of the septum  
2- Big VSD: usually in the membranous part of the septum 
Clinical picture: 
 Absent symptoms in small VSD 
 Loud murmur on lower left sternal border 
 Slow weight gain, failure to thrive & feeding difficulties 
 Tachypnea 
 Recurrent respiratory infection 
 Pallor and diaphoresis 
 Pulmonary artery enlargement, cardiomegaly & biventricular 
hypertrophy & left Atrial enlargement 
Investigation: 
 X-ray chest: Biventricular enlargement and lung plethora 
 ECG: BVH 
 ECHO: VSD 
 Cardiac catheterization: for more assessment 
Treatment: 
A- Medical treatment: 
 Chest infection by proper antibiotics 
 Heart failure: digoxin, Lasix  
 Prophylaxis for infective endocaradities 
B- Surgical : 
 Small VSD: (less than 5 mm) 
Close spontaneously within 1st two year of life  
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 Large VSD:  Surgical closure at 2- 4 years  
Tetralogy of fallot (TOF)
 
 
 
 
 
 
 
 
The most common congenital cyanotic heart disease. It consists of: 
 Pulmonary stenosis  
 VSD 
 Overriding aorta 
 Rt. Ventricular hypertrophy  
Hemodynamics: 
 Venous return passes into Rt atrium to Rt ventricle to VSD to aorta 
to systemic circulation bypassing the lung. 
 Only small amount of blood passes from Rt ventricle to pulmonary 
artery to the lung lead to decrease pulmonary blood flow (lung 
oligeamia). 
Clinical picture: 
 Cyanosis: The neonate who has tetralogy of Fallot is not 
cyanotic, because of the presence of patent ductus arteriosus, 
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cyanosis becomes evident after the ductus closes i.e.: after first 
months of life. 
 Dyspnea: usually exertional dyspnea 
 Clubbing: at age of 1-2 years 
 Anoxic Spells: due to pulmonary stenosis and characterized by: 
 Deep cyanosis 
 Sever dyspnea 
 Irritability 
 Improved by Squatting (knee –chest) position 
Complication: 
 Anoxic Spells 
 Cerebral infarction: due to brain anoxia 
 Brain abscesses: due to failure of blood filtration by lung  
 Infective endocarditis 
 Growth retardation: due to chronic hypoxia

            Quiz: