Murmurs and Oedema

Question 1

A 10 year old boy, Matteo, presents with a sore knee and fever of 40°C. He has redness and restriction of movement of the right knee. When you listen to the apex of his heart you hear a loud pansystolic murmur that obscures the first heart sound and can be heard all over the precordium. What is the likely cause of the murmur?

Question 1Select one:

a.
Aortic stenosis

b.
Innocent murmur

c.
Aortic regurgitation

d.
Mitral regurgitation

Answer 1

MR

Question 2

A 10 year old boy presents with a red, hot and painful knee, fever and a pansystolic murmur at the apex. He had a sore throat 2 weeks ago, now resolved. You suspect rheumatic fever. What further investigation finding is required to confirm the diagnosis?

Question 2Select one:

a.
Prolonged PR interval on resting ECG

b.
Raised neutrophil count and ESR

c.
Haematuria with urine red cell casts

d.
Changing Gp A strep antibody levels

Answer 2

Changing Gp A strep antibody levels

Question 3

A 4-year old boy, Jeremy, is re-checked for a systolic murmur heard when he was younger.

He remains asymptomatic and well grown. An ejection systolic murmur is still heard.

It is maximal at the upper left sternal border, and can be heard over both sides of the chest including posteriorly, but not in the neck. It is associated with a lift but no thrill over the left precordium. It can be heard in both the lying and standing positions.

What is the most likely cause of the murmur?

Question 3Select one:

a.
Innocent pulmonary flow

b.
Typical atrial septal defect

c.
Patent ductus arteriosus

d.
Mild aortic regurgitation

Answer 3

Typical atrial septal defect

Question 4

A 6 year old boy seen for a chest infection is incidentally found to have a systolic murmur at the left sternal age, radiating to the neck and is associated with a palpable thrill over the left sternal border. The murmur does not disappear with standing.

What conclusions can you draw about this murmur?

Question 4Select one:

a.
Atrial septal defect

b.
Innocent murmur

c.
Valvular abnormality

d.
Venous abnormality

Answer 4

Valvular abnormality

Question 5

A 4 week old baby has presented following increasing respiratory rate and difficulty feeding, sweating and pale limbs during feeds, and losing weight. In the last few days the weight has started to increase again rapidly. On examination, the baby looks breathless, peripherally cold and sweaty, has an overactive heart pulsation on palpation, and has a large liver 5 cm below the right costal margin. There are occasional crackles at the lung bases. There is no peripheral oedema.

What is the likely diagnosis?

Question 5Select one:

a.
Coarctation of the aorta

b.
Isolated atrial septal defect

c.
Heart failure due to VSD

d.
Transposition of great arteries

Answer 5

Heart failure due to VSD

Question 6

A 3 year old boy, who is active and well, attends a doctor’s clinic for a respiratory infection with fever of 39°C. He is found to have a Grade soft, blowing ejection systolic murmur at the upper left sternal edge. There is no thrill and no radiation of the murmur elsewhere. The murmur disappears when his chest is auscultated while he is standing. He is not known to have had a murmur before. What is the most likely cause of the murmur?

Question 6Select one:

a.
Venricular septal defect

b.
Atrial septal defect

c.
Innocent murmur

d.
Aortic stenosis

Answer 6

Innocent murmur

Question 7

Upon physical examination of a three year old girl who is new to your practice and entirely well, you note a grade 3 murmur at the third left interspace. The murmur has a vibratory and slightly musical quality. Blood pressure, pulse, precordial palpation and auscultation of heart sounds are normal. What is the most likely nature of the murmur?

Question 7Select one:

a.
Secundum ASD

b.
Pulmonary flow

c.
Still’s murmur

d.
Persistent PDA

Answer 7

Stills Murmur