USMLE Forum Archives - USMLE Step 2 CK - peads 2
peads 2
Sarahhh - 02-05-08 08:57
A 0ne-day-old infant appears dusky in the newborn nursery during feeding. Oxygen is
immediately administered by nasal cannula. Shortly afterwards she developed tachypnea.
On physical examination her blood pressure from right upper arm is 50/30, her pulse is
180 and her respirations are 60. An echocardiogram is consistent with hypoplastic left
heart syndrome. Which of the following will most likely be found on auscultation.
A. Continuous ductal murmur, bounding pulses.
B. Continuous ductal murmur, poor peripheral pulses.
C. Holosystolic murmur, Poor peripheral pulses, quite second heart sound.
D. No murmur, pericardial hyperactivity, loud second heart sound.
E. No murmur, pericardial hyperactivity, quite second heart sound.
Sarahhh - 02-05-08 08:57
A 0ne-day-old infant appears dusky in the newborn nursery during feeding. Oxygen is
immediately administered by nasal cannula. Shortly afterwards she developed tachypnea.
On physical examination her blood pressure from right upper arm is 50/30, her pulse is
180 and her respirations are 60. An echocardiogram is consistent with hypoplastic left
heart syndrome. Which of the following will most likely be found on auscultation.
A. Continuous ductal murmur, bounding pulses.
B. Continuous ductal murmur, poor peripheral pulses.
C. Holosystolic murmur, Poor peripheral pulses, quite second heart sound.
D. No murmur, pericardial hyperactivity, loud second heart sound.
E. No murmur, pericardial hyperactivity, quite second heart sound.
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#1
Re: peads 2 radhamesramos - 02-05-08 12:48 C? I would like to think about it more. But I guess ist's C. Kind of rusty here
#3
Re: peads 2
Sarahhh - 02-05-08 20:58 D. Hypoplastic left heart (HLH) syndrome is a group of closely
related cardiac anomalies characterized by underdevelopment of the left cardiac
chambers, atresia or stenosis of the aortic and/or the mitral orifices, and hypoplasia of
the aorta. These anomalies are an especially common cause of heart failure in the 1st
week of life. The left atrium and ventricle often exhibit endocardial fibroelastosis.
Pulmonary venous blood traverses a patent foramen ovale, and a dilated and
hypertrophied right ventricle acts as the systemic, as well as pulmonary, ventricle; the
systemic circulation receives blood by way of a patent ductus arteriosus. Infants who
have HLH syndrome develop poor perfusion, and metabolic acidosis when systemic blood
flow decreases. When the ductus closes, inadequate blood flow to the body occurs
because the ductus is the only path for blood to flow from the right ventricle to the
body. Even if the ductus remains open, when the infant is given oxygen, the oxygen will
dilate the vasculature of the pulmonary circulation, and blood will preferentially flow to
the lower pressure pulmonary system, depriving the systemic circulation of adequate
perfusion.
ECG usually shows right axis deviation, right atrial and ventricular enlargement, and
nonspecific ST and T-wave abnormalities in the left precordial leads. Chest radiography
may show only slight enlargement shortly after birth, but with clinical deterioration
there is marked cardiomegaly with increased pulmonary vascular markings.
Echocardiography is diagnostic and will show a diminutive aortic root and left ventricular
cavity and absence or poor visualization of aortic and mitral valves.
#6
Re: peads 2 laparotomy - 02-28-08 12:36 
posted by Sarahhh on 02-05-08 08:57
A 0ne-day-old infant appears dusky in the newborn nursery during feeding. Oxygen is
immediately administered by nasal cannula. Shortly afterwards she developed tachypnea.
On physical examination her blood pressure from right upper arm is 50/30, her pulse is
180 and her respirations are 60. An echocardiogram is consistent with hypoplastic left
heart syndrome. Which of the following will most likely be found on auscultation.
A. Continuous ductal murmur, bounding pulses.
B. Continuous ductal murmur, poor peripheral pulses.
C. Holosystolic murmur, Poor peripheral pulses, quite second heart sound.
D. No murmur, pericardial hyperactivity, loud second heart sound.
E. No murmur, pericardial hyperactivity, quite second heart sound.
A 0ne-day-old infant appears dusky in the newborn nursery during feeding. Oxygen is
immediately administered by nasal cannula. Shortly afterwards she developed tachypnea.
On physical examination her blood pressure from right upper arm is 50/30, her pulse is
180 and her respirations are 60. An echocardiogram is consistent with hypoplastic left
heart syndrome. Which of the following will most likely be found on auscultation.
A. Continuous ductal murmur, bounding pulses.
B. Continuous ductal murmur, poor peripheral pulses.
C. Holosystolic murmur, Poor peripheral pulses, quite second heart sound.
D. No murmur, pericardial hyperactivity, loud second heart sound.
E. No murmur, pericardial hyperactivity, quite second heart sound.
I think non of the above because it is variable. They would never ask such a question on the USMLEs
The following is what you really hear:
* Palpable right ventricular impulse
* Normal first heart sound
* Loud single second heart sound
* Nonspecific, soft, systolic ejection murmur at the left sternal border
(not always present)
* High-pitched holosystolic murmur at the lower left sternal border, indicating tricuspid regurgitation (not always present)
Diastolic flow rumble over the precordium, indicating increased right ventricular diastolic filling (not always present)
#8
Re: peads 2 babbu5508 - 06-29-10 03:03 C. Holosystolic murmur, Poor peripheral pulses, quite second heart sound....hopefully correct and a real tough one .......
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