18: 6-week old male with poor feeding

Question 1

What is a cause of hepatomegaly in infancy?

Answer 1

Decreased renal blood flow leading to RAAS and water retention

Question 2

What are the 5 classic findings of CHF in an infant a few weeks after birth?

Answer 2

1. Dyspnea with feedings
2. Diaphoresis
3. Poor growth
4. An active precordium
5. Hepatomegaly

Question 3

What murmur is musical/vibratory and is heard at the L lower sternal border in the supine position?

Answer 3

Still’s murmur (benign; common)

Question 4

Widely split S2, systolic ejection murmur?

Answer 4

ASD

“That ASD is wide”

Question 5

Poor femoral pulses, brachiofemoral delay, and occasionally a murmur to the L scapula?

Answer 5

Aortic coarctation

Question 6

Blowing, holosystolic murmur?

Answer 6

VSD

Question 7

Systolic ejection murmur with early systolic click?

Answer 7

Pulmonic stenosis

Question 8

Continuous machine-like murmur with bounding pulses?

Answer 8

PDA

Question 9

Systolic ejection murmur just after S1 radiating to lung fields?

Answer 9

Tetralogy of Fallot

Question 10

Which 4 heart defects present with signs of CHF in infancy?

Answer 10

1. VSD
2. Aortic stenosis
3. Coarctation of aorta
4. PDA

Question 11

Which heart condition is caused by lack of tissue or lack of fusion?

Answer 11

VSD

Question 12

What direction is the shunt in VSD?

Answer 12

L to R

Question 13

Why aren’t VSDs heard in the newborn nursery?

Answer 13

Bc the SVR and PVR are nearly equal at birth

Question 14

What 2 meds are good to use in CHF?

Answer 14

1. Furosemide

2. Enalapril

Question 15

What do high voltage QRS complexes in leads V2 and V2 suggest?

Answer 15

VSD