Examkin

Question

Difficulty: MediumPediatric Cardiovascular Disorders

Match each pediatric clinical presentation to the most likely underlying congenital cardiovascular anomaly.

  • A 3-day-old premature infant develops a bounding pulse, widened pulse pressure, and a continuous machine-like murmur at the left infraclavicular region.Patent ductus arteriosus
  • A 6-month-old infant experiences episodes of profound cyanosis while crying, which are relieved when the parents bring the child's knees to their chest; physical examination reveals a single S2 and a harsh systolic ejection murmur.Tetralogy of Fallot
  • A 5-year-old child presents with frequent epistaxis and claudication during physical activity; examination shows a significant blood pressure discrepancy between the upper and lower extremities.Coarctation of the aorta
  • A 4-year-old boy is found to have a harsh, blowing holosystolic murmur best heard at the left lower sternal border; an electrocardiogram indicates biventricular hypertrophy.Ventricular septal defect
  • A healthy 8-year-old girl is noted during a routine physical to have a widely split and fixed second heart sound, alongside a soft systolic ejection murmur at the left upper sternal border.Atrial septal defect

Answer

The premature infant with a continuous murmur matches Patent ductus arteriosus. The infant with cyanotic spells relieved by knee-chest positioning matches Tetralogy of Fallot. The child with upper extremity hypertension and lower extremity claudication matches Coarctation of the aorta. The boy with the holosystolic murmur at the lower sternal border matches Ventricular septal defect. The girl with a fixed, widely split second heart sound matches Atrial septal defect.
Each clinical vignette contains pathognomonic findings for specific congenital heart defects: PDA presents with a machine-like continuous murmur and bounding pulses; Tetralogy of Fallot presents with hypercyanotic spells relieved by squatting; Coarctation of the aorta presents with upper-to-lower extremity blood pressure discrepancies; VSD presents with a harsh holosystolic murmur at the left lower sternal border; and ASD presents with a fixed, widely split S2.

Step-by-Step Solution

1
Analyze the clinical findings of the 3-day-old premature infant.
The combination of prematurity, bounding pulses, and a continuous murmur points to an open duct connecting the aorta and pulmonary artery.
This identifies Patent Ductus Arteriosus.
2
Evaluate the infant with cyanosis relieved by knee-chest positioning.
The knee-chest position increases systemic vascular resistance, reversing right-to-left shunting through a ventricular septal defect in the setting of right ventricular outflow tract obstruction.
This mechanism defines hypercyanotic spells in Tetralogy of Fallot.
3
Assess the 5-year-old with epistaxis, claudication, and blood pressure discrepancy.
These symptoms indicate obstruction of aortic flow distal to the left subclavian artery, causing proximal hypertension and distal hypoperfusion.
This confirms Coarctation of the Aorta.
4
Review the 4-year-old with a harsh holosystolic murmur at the left lower sternal border.
This murmur characterizes blood flowing from the high-pressure left ventricle to the lower-pressure right ventricle during systole.
This identifies a Ventricular Septal Defect.
5
Interpret the fixed, widely split S2 in the 8-year-old girl.
A fixed split S2 indicates constant, increased volume in the right heart that delays pulmonic valve closure, irrespective of the respiratory cycle.
This is the classic auscultatory finding of an Atrial Septal Defect.

Key Concept

Clinical recognition of common congenital heart defects based on classic physical examination findings and patient demographics.
Estimated Time:1m 30s
Rate this question

Topics

Pediatric Cardiovascular Disorders

More questions from this topic