Examkin

Question

Difficulty: HardPediatric Cardiovascular Disorders

Match the following clinical presentations and diagnostic findings to their most likely underlying congenital heart defect.

  • A cyanotic neonate with an ECG demonstrating left axis deviation and diminished right ventricular forces (absent R waves in V1).Tricuspid atresia
  • A neonate with profound cyanosis unresponsive to 100% supplemental oxygen, a single loud S2, and a narrow mediastinum on chest radiography.Transposition of the great arteries
  • A 2-month-old infant with diaphoresis during feeding, a harsh holosystolic murmur, and an apical mid-diastolic rumble.Large ventricular septal defect
  • A cyanotic infant presenting with a systolic ejection murmur at the left upper sternal border and a normal-sized heart with an upturned apex on radiography.Tetralogy of Fallot
  • A 10-year-old child with upper extremity hypertension, brachiofemoral delay, and a continuous murmur heard over the posterior left interscapular area.Coarctation of the aorta

Answer

The correct matches are: 1 with Tricuspid atresia, 2 with Transposition of the great arteries, 3 with Large ventricular septal defect, 4 with Tetralogy of Fallot, and 5 with Coarctation of the aorta.
Each congenital heart defect has distinct pathophysiological consequences that manifest as specific clinical, radiographic, and electrocardiographic findings. Matching these findings accurately requires understanding the anatomical defects and their resulting hemodynamic changes.

Step-by-Step Solution

1
Analyze the ECG and cyanosis presentation in the first vignette.
Left axis deviation with absent right ventricular forces in a cyanotic neonate indicates a hypoplastic right ventricle.
Most cyanotic defects cause right axis deviation and right ventricular hypertrophy; left axis deviation is a key differentiator for tricuspid atresia.
2
Evaluate the response to oxygen and radiographic findings in the second vignette.
Failed hyperoxia test, single S2, and narrow mediastinum confirm transposition of the great arteries.
The narrow mediastinum is due to the aorta sitting directly anterior to the pulmonary artery.
3
Identify the cause of heart failure and specific murmurs in the third vignette.
A holosystolic murmur with an apical diastolic rumble and heart failure at 2 months aligns with a large ventricular septal defect.
The diastolic rumble reflects increased relative volume crossing the mitral valve, indicating a high-volume left-to-right shunt.
4
Interpret the radiographic silhouette and murmur in the fourth vignette.
An upturned apex ('boot-shaped' heart) with a systolic ejection murmur and cyanosis is classic for tetralogy of Fallot.
Right ventricular hypertrophy tilts the apex upward, and the murmur stems from the right ventricular outflow tract obstruction.
5
Connect the physical exam findings in the older child to a vascular anomaly.
Upper extremity hypertension, brachiofemoral delay, and an interscapular continuous murmur indicate coarctation of the aorta.
The continuous murmur is produced by large collateral vessels bypassing the aortic narrowing.

Key Concept

Distinguishing pediatric congenital heart defects using classic combinations of cyanosis onset, murmurs, electrocardiography, and chest radiography.
Estimated Time:2m 30s
Rate this question

Topics

Pediatric Cardiovascular Disorders

More questions from this topic