Nokea
A 5-month-old previously well infant is found to have a loud holosystolic murmur (4/6) at the left sternal border. The first and second heart sounds are normal; there is no tachycardia, rumble, or gallop; and hepatomegaly is not noted. The child feeds well and has grown adequately. You suspect
- A. spontaneous closure is more common in muscular vs. membranous defects
- B. closure usually occurs in the first 2 years of life
- C. there is no risk of endocarditis
- D. pulmonary pressures are normal
Correct Answer: C
Rationale: Small VSDs still carry a risk of endocarditis despite being asymptomatic.
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Increased TSH is seen in a neonate with:
- A. Thyroxine insensitivity
- B. Iodine deficiency
- C. Hyperbilirubinaemia
- D. Thyroid agenesis
Correct Answer: B
Rationale: Iodine deficiency: Neonates with iodine deficiency often present with increased TSH levels as the body attempts to compensate for low thyroid hormone production.
A harsh, blowing grade IV/VI murmur is auscultated in a 6-month-old infant. What will the nurse practitioner do next?
- A. Get a complete blood count to rule out severe anemia.
- B. Obtain an electrocardiogram to assess for arrhythmia.
- C. Order a chest radiograph to evaluate for cardiomegaly.
- D. Refer to a pediatric cardiologist for further evaluation.
Correct Answer: D
Rationale: A harsh, blowing murmur is suspicious for pathology, so a cardiology referral is warranted.
Recognised features of ABO incompatibility include:
- A. Normal haemoglobin on day 1
- B. Worsening with subsequent pregnancies
- C. Conjugated hyperbilirubinaemia
- D. Negative Coombs test
Correct Answer: A
Rationale: In ABO incompatibility, haemoglobin levels are typically normal on day 1. The condition does not worsen with subsequent pregnancies and is associated with unconjugated hyperbilirubinaemia.
The jugular venous pressure (JVP) has a predictable relationship with pulmonary artery wedge pressure (PAWP). A JVP of >12 mm Hg predicted PAWP >22 mm Hg by 88% in which of the following trials?
- A. BNP
- B. ESCAPE
- C. EVEREST
- D. EMPA REG
Correct Answer: B
Rationale: The ESCAPE trial studied the effectiveness of therapies in patients with advanced heart failure and showed that elevated JVP was correlated with high pulmonary artery wedge pressures.
Symptoms in patients with aortic stenosis depend on the severity of the obstruction EXCEPT
- A. cardiomegaly
- B. pulmonary congestion
- C. weak pulses
- D. pale skin
Correct Answer: D
Rationale: Pale skin is not a typical symptom of aortic stenosis.