12-05-2009, 02:44 PM
A 6-week-old boy is brought to the physician
because of poor feeding and a nonproductive
cough for 1 week. He has been breast-fed
exclusively since birth; he sweats profusely
during feeding and frequently stops to catch
his breath. His temperature is 36.8°C (98.2°F),
pulse is 140/min, respirations are 48/min, and
blood pressure is 70/48 mm Hg in the left leg.
Examination shows no cyanosis. Crackles are
heard at both lung bases. A splitting S2 varies
with respirations. A grade 3/6 holosystolic
murmur is heard best at the left midsternal
border. The liver edge is palpated 3 cm below
the right costal margin. Which of the
following is the most likely diagnosis?
(A) Aortic insufficiency
(B) Aortic stenosis
© Atrial septal defect
(D) Coarctation of the aorta
(E) Ebstein anomaly
(F) Hypoplastic left heart syndrome
(G) Mitral insufficiency
(H) Mitral stenosis
(I) Patent ductus arteriosus
(J) Pulmonary stenosis
(K) Tetralogy of Fallot
(L) Total anomalous pulmonary venous
connection
(M) Transposition of the great arteries
(N) Tricuspid atresia
(O) Ventricular septal defect
because of poor feeding and a nonproductive
cough for 1 week. He has been breast-fed
exclusively since birth; he sweats profusely
during feeding and frequently stops to catch
his breath. His temperature is 36.8°C (98.2°F),
pulse is 140/min, respirations are 48/min, and
blood pressure is 70/48 mm Hg in the left leg.
Examination shows no cyanosis. Crackles are
heard at both lung bases. A splitting S2 varies
with respirations. A grade 3/6 holosystolic
murmur is heard best at the left midsternal
border. The liver edge is palpated 3 cm below
the right costal margin. Which of the
following is the most likely diagnosis?
(A) Aortic insufficiency
(B) Aortic stenosis
© Atrial septal defect
(D) Coarctation of the aorta
(E) Ebstein anomaly
(F) Hypoplastic left heart syndrome
(G) Mitral insufficiency
(H) Mitral stenosis
(I) Patent ductus arteriosus
(J) Pulmonary stenosis
(K) Tetralogy of Fallot
(L) Total anomalous pulmonary venous
connection
(M) Transposition of the great arteries
(N) Tricuspid atresia
(O) Ventricular septal defect