NMS Q&A Family Medicine

62 NMS Q&A Family Medicine(C) Shunt reversal(D) Clubbing of the fingernails(E) Left ventricular CHF7 A 15-year-old girl complains of chest pains and palpitations.Her mother is concerned that the girl mayhave mitral valve prolapse (MVP). In what position(s)is a click that is attendant to MVP most likely to beheard upon auscultation?(A) Supine(B) Sedentary(C) Standing(D) Prone(E) Reverse Trendelenburg position8 You are examining a 4-year-old boy for routine wellchild care. You hear a soft grade I/II murmur loudestin the left second intercostal space. Which of the followingwould most reassure you and the parents thatthis is a venous hum and not the murmur of pulmonicvalvular stenosis?(A) A venous hum has only a diastolic component.(B) A venous hum has a coarse, harsh sound.(C) The murmur stops with compression of softtissue.(D) With PS, cyanosis is present.(E) In venous hum, S 2 is normal.9 While examining a 3-week-old male infant for hisfirst well child visit, you notice that he has a harsh,pansystolic loud murmur at the lower left sternalborder. There is also a heave over the left precordium.The child has been eating normally and the familyhas not observed any episodes of cyanosis or dyspnea.You find no cyanosis. You had examined thischild at birth and before his discharge from the newbornnursery and did not discern any murmurs duringthese examinations. S 2 is normally split (increaseswith inspiration). Which of the following lesions isthe most likely to account for the murmur?(A) Tetralogy of Fallot(B) ASD(C) PDA(D) VSD(E) Venous hum10 Regarding the child in Question 9, for which of thefollowing complications is the child at risk?(A) Heart failure(B) Eisenmenger syndrome(C) Bacterial endocarditis(D) Failure of the defect to spontaneously close(E) All of the above11 You detect a grade III/VI harsh murmur over the leftsternal border and second right intercostal space in a13-year-old adolescent boy. He has no dyspnea,orthopnea, syncope, or chest pains. You suspect hehas congenital aortic stenosis. Each of the followingfindings on physical examination correlates with thatdiagnosis, except which one?(A) There is radiation of the murmur to the neck.(B) There is presence of an ejection click.(C) The murmur is loud and harsh both at the baseand left sternal border.(D) There is radiation of murmur to the left axilla.(E) There is presence of a palpable thrill in thesuprasternal notch.12 On a routine examination of a new patient, diminishedblood pressure readings are found in an adolescent’slegs, relative to that found in the upperextremities. You suspect coarctation of the aorta.Each of the following may be associated with coarctationexcept for which factor?(A) This may be an XO female patient.(B) There may be notching of the ribs seen on x-ray.(C) A delay in the femoral pulse may be found.(D) Cyanosis of the lips and clubbing of thefingernails may be observed.(E) The patient is more likely to be male than female.13 A 16-year-old boy is brought to you for the first timeby his parents, complaining of increasing fatigability.Auscultation of the heart reveals a grade III/VI systolicejection murmur and thrills at the right secondintercostal space and in the suprasternal notch. S 2 isnot split, either in inspiration or in expiration. Themurmur is heard neither over the carotid arteries norin the left axilla. Which of the following lesionsexplains these findings?(A) PS(B) Aortic stenosis (AS)(C) ASD(D) VSD(E) Mitral valve prolapse (MVP)14 A baby is born prematurely, at a weight of 3.64 lb(1.65 kg). What is the treatment of choice for a hemodynamicallysignificant PDA in this infant that persistsfor longer than 48 hours?(A) Observation for clinical deterioration(B) Thrombosing the patent ductus through cardiaccatheterization(C) Surgical ligation(D) Vasodilators(E) Indomethacin