NMS Q&A Family Medicine

chap ter 9Pediatric CardiologyExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 4-year-old male patient is brought to the family doctorby his mother after 5 days of fever (101 F), becauseof cracking and fissuring lips and bilateral painlessconjunctivitis. On examination he manifests a “strawberrytongue,” unilateral cervical adenopathy, and rednessand swelling of the palms of the hands. A rapidstrep flocculation test and, 2 days later, a throat culturewere “negative” (latter meaning no beta-hemolyticstreptococcus growth). The fever remains over thenext 2 days. Each of the following complications mayoccur during the next few days except for which one?(A) Coronary aneurysm(B) Myocarditis(C) Pericarditis(D) Valvular heart disease(E) Coronary arteritis2 A 10-year-old boy is brought to the family physicianby his parents because of the onset of involuntaryand random jerking movements of the extremities,incoordination of purposeful movements and slurredspeech, Sydenham chorea. Further history reveals theboy to be atopic with asthma that he “outgrew,” pneumoniaon one occasion treated outside the hospital,and an episode characterized by upper respiratorysymptoms during a family vacation 4 years ago thatwas never treated but was followed by several weeksof mild to moderate changing joint pains and transient“bumps” under skin. The boy has been asymptomaticsince and has participated heartily in outdoorplay and athletics. Which of the following is the mostlikely diagnosis?(A) Huntington chorea(B) Sydenham chorea(C) Parkinson disease(D) Cerebral embolism from the heart(E) Seizure disorder3 Each of the following statements is true regardingnormal electrocardiogram tracings in infancy andchildhood except for which one?(A) Heart rate decreases with age during the first year.(B) The PR interval increases during the first year.(C) Left ventricular dominance prevails at birth.(D) Leads I and AVF show QRS that is net positivein the 1-year-old.(E) The P wave deflection is positive in II, III, andAV F.4 On a routine well child examination of a 9-year-oldboy, you hear a grade III/VI systolic murmur alongthe left sternal border. You believe it is a functionalmurmur. Which of the following would assist you inmaking that determination by decreasing the intensityof a functional murmur?(A) Temperature of 102 F(B) Hemoglobin level of 8(C) Anxiety(D) Performing a Valsalva maneuver(E) Cutaneous vasodilatation5 A 4-year-old boy is brought to you for routine wellchild examination after his family moved into thearea, seeking a new physician for their care. The boyhas manifested normal growth and development. Hehas normal energy output, playing outdoors with hisage peers without difficulty. He manifests no cyanosis.On examination you notice a grade IV/VI smoothsounding(i.e., not harsh) systolic murmur, which isloudest at the pulmonic auscultatory area. The secondsound has a fixed split, not varying with inspiration.Which of the following is the most likelydiagnosis of this murmur?(A) Pulmonic stenosis (PS)(B) Ventricular septal defect (VSD)(C) Functional murmur(D) Atrial septal defect (ASD)(E) Patent ductus arteriosus (PDA)6 Regarding the patient in Question 5, which of the followingis the most significant complication, besidescongestive heart failure (CHF), that may result fromlate diagnosis?(A) Frequent and severe upper respiratory infections(B) Right ventricular CHF61