USMLE Question of the Week

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
Click to Reveal the Correct Answer

Fixed wide splitting of S2 and systolic ejection murmur at LUSB

Faustine Ramirez

Faustine graduated from the University of Washington in Seattle with a B.A. in Medical Anthropology and Global Health. She attends medical school at University of California, San Francisco where she designed and taught a course on clinical reasoning skills, developed curriculum materials for the pre-clinical pediatrics course, and led case-based sessions in pediatrics and infectious disease. She received a 253 on Step 1 and a 266 on Step 2 CK, and she scored in the 90th percentiles on all of her shelf exams.

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