Nokea
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.
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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.
Regarding bronchial asthma:
- A. Mortality has shown an increase during the past three decades
- B. The incidence is greater in males than females
- C. Nocturnal cough is a recognised feature
- D. Post-RSV bronchial hyperreactivity is strongly associated with atopy
Correct Answer: C
Rationale: Nocturnal cough is a common and recognized feature of bronchial asthma, often disrupting sleep.
List THREE indications for intervention for aortopathy in Marfan’s syndrome in an older teenager.
- A. Aortic root or ascending aorta dilation >44-50mm
- B. Symptomatic (pain consistent with rupture)
- C. Growth of >0.5cm/y
- D. All of the above
Correct Answer: D
Rationale: These are significant indicators that require surgical intervention to prevent further complications, such as rupture or dissection.
Recognised features of anorexia nervosa include:
- A. T-wave inversion on ECG
- B. Hypocholesterolaemia
- C. Peripheral oedema
- D. Sinus bradycardia
Correct Answer: D
Rationale: Sinus bradycardia, a slower than normal heart rate, is a recognized feature of anorexia nervosa due to the body's adaptation to starvation.
The patient experiences a headache and is unable to move the left side of his body. The most likely cause is
- A. embolic stroke
- B. cerebral thrombosis
- C. cerebral abscess
- D. moyamoya disease
Correct Answer: A
Rationale: Embolic stroke is a common complication of cyanotic congenital heart disease.