Nokea
A 3-month-old infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. A grade III/VI, low-pitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely?
- A. Atrial septal defect (ASD)
- B. Coarctation of the aorta (COA)
- C. Patent ductus arteriosis (PDA)
- D. Ventricular septal defect (VSD)
Correct Answer: D
Rationale: The symptoms above are characteristic of a VSD and may not present at birth but appear later as CHF becomes more pronounced.
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All of the following are features of Behcet disease except
- A. Reduced T helper cell 1 activity
- B. Increased expression of HSP60
- C. Association with HLA-B51
- D. Vasculitis with fibrinoid necrosis
Correct Answer: A
Rationale: Behcet disease is associated with increased T helper cell 1 activity
Down syndrome and VSD
- A. Doesn't close spontaneously as in children without downs
- B. Inaudible murmur is a characteristic feature / Murmur is not audible
- C. Pulmonary Hypertension is a late complication
- D. If no murmur, condition need not be investigated
Correct Answer: C
Rationale: Pulmonary hypertension is a known late complication in Down syndrome with VSD.
All patients with clinical evidence of a PDA are at increased risk for endocarditis. As a result, patients with PDA should be considered for irreversible closure EXCEPT
- A. small, hemodynamically insignificant PDA
- B. small, hemodynamically significant PDA
- C. moderate PDA
- D. large PDA
Correct Answer: A
Rationale: Small, hemodynamically insignificant PDAs may not require closure.
Features that would increase suspicion of cerebral palsy at age 9 months include:
- A. Presence of Moro reflex
- B. Abductor spasm
- C. Hand dominance
- D. Grasp reflex
Correct Answer: C
Rationale: Hand dominance at 9 months is a red flag for cerebral palsy. The persistence of primitive reflexes like the Moro and grasp reflexes can also be indicative.
The following features are more suggestive of biliary atresia rather than neonatal hepatitis in an infant 6 weeks of age:
- A. Hepatomegaly
- B. Prolonged INR (prothrombin time)
- C. Biopsy specimen showed proliferation of bile ductules, periportal fibrosis and bile lakes
- D. HillA scan reveals delayed uptake and excretion of the contrast material
Correct Answer: C
Rationale: Proliferation of bile ductules, periportal fibrosis, and bile lakes on biopsy are hallmark features of biliary atresia.