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A 4-year-old boy wakes up frequently saying, 'It hurts here' while pointing to his chest. He was born prematurely but has done well otherwise. On examination he has a 2/6 ejection systolic murmur between the left sternal border and the apex that radiates to the base and is accompanied by an apical S3. The most likely diagnosis is
a) reflux esophagitis
b) aortic stenosis
c) pericarditis
d) pleuritis
e) costochondritic pain

b ?

premature most likely b?

b?

not a, e,b. left with c and d. i go with C because of the heart murmurs

B?

this finding can be normal in children(innocent murmurs) & s3 also. I go for e,costochondritis

is it c?

pain upon waking make me think so. in AS, pain comes when exercising. and i am not sure if some child can develop AS so early. people develop it in 60-80s. s3 is normal in childeren. i am not sure abt ejection systolic murmer in childeren. chostochondrtitis i think is common in female and young at 4th iCS and that is tenderness.

DD

THIS IS THE ONLY QS IN USMLE MAKE U LAUGH TILL THE DAY OF THE EXAM