Evaluating Cardiovascular Congenital Abnormalities in a Newborn

In Episode 50 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question: A 2-week-old male newborn is brought to the pediatrician’s office by his parents for a routine visit. He was born at term to a 37-year-old woman who received good prenatal care. He has been feeding every 2-3 hours and having 5-6 wet diapers a day. Weight is in the 8th percentile, length in the 12th percentile, and head circumference in the 5th percentile. On examination, he has a flat nasal bridge, widely spaced upslanting eyes, low-set ears, and a large protruding tongue. Light grey spots are observed on both irises. A small, reducible umbilical hernia is present, along with a single palmar crease, and mild axial hypotonia. Which of the following is the most likely finding on cardiovascular examination?

• Continuous machine-like murmur
• Single S2
• Fixed wide splitting of S2
• Bounding pulses
• Upper and lower extremity BP differential
• Single S2 and crescendo-decrescendo systolic ejection murmur at LUSB
• Fixed wide splitting of S2 and systolic ejection murmur at LUSB