Category: Cardiology


A 15-month-old boy is brought to the emergency room because of fever and a rash. Six hours earlier he was fine, except for tugging on his ears; another physician diagnosed otitis media and prescribed amoxicillin. During the interim period, the child has developed an erythematous rash on his face, trunk, and extremities. Some of the lesions, which are of variable size, do not blanch on pressure. The child is now very irritable, and he does not interact well with the examiner. Temperature is 39.5°C (103.1°F). He continues to have injected, immobile tympanic membranes, but you are concerned about his change in mental status. Which of the following is the most appropriate next step in the management of this infant?

  1.  Begin administration of intravenous ampicillin
  2.  Begin diphenhydramine
  3.  Discontinue administration of ampicillin and begin trimethoprim with sulfamethoxazole
  4.  Perform bilateral myringotomies
  5.  Perform a lumbar puncture

the answer is below…

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A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. Which of the following is the most likely diagnosis?

  1.  Rheumatic fever
  2.  Kawasaki disease
  3.  Scarlet fever
  4.  Endocarditis
  5.  Tuberculosis

the answer is below…

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A patient comes to your office for a hospital follow-up. You had sent him to the hospital three weeks earlier for persistent fevers but no other symptoms; he was diagnosed with infective endocarditis and is currently being treated appropriately. Advice to this family should now include which of the following?

  1.  Restrict the child from all strenuous activities
  2.  Give the child a no-salt-added diet
  3.  Provide the child with antibiotic prophylaxis for dental procedures
  4.  Test all family members in the home with repeated blood cultures
  5.  Avoid allowing the child to get upset or agitated

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During a physical examination for participation in a sport, a 16-year old girl is noted to have a late apical systolic murmur, which is preceded by a click. The rest of the cardiac examination is normal. She states that her mother also has some type of heart “murmur” but knows nothing else about it. Which of the following is the most likely diagnosis?

a. Atrial septal defect

b. Aortic stenosis

c. Tricuspid regurgitation

d. Mitral valve prolapse

e. Ventricular septal defect

the answer is below…

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A child has a 2-week history of spiking fevers, which have been as high as 40°C (104°F). She has spindle-shaped swelling of finger joints and complains of upper sternal pain. When she has fever, the parents note a faint salmon-colored rash that resolves with the resolution of the fever. She has had no conjunctivitis or mucositis, but her heart sounds are muffled and she has increased pulsus paradoxus. Which of the following is the most likely diagnosis?

a. Rheumatic fever

b. Juvenile rheumatoid arthritis

c. Toxic synovitis

d. Septic arthritis

e. Osteoarthritis

the answer is below…

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During a regular checkup of an 8-year-old child, you note a loud first heart sound with a fixed and widely split second heart sound at the upper left sternal border that does not change with respirations. The patient is otherwise active and healthy. Which of the following heart lesions most likely explains these findings?

a. Atrial septal defect

b. Ventricular septal defect

c. Isolated tricuspid regurgitation

d. Tetralogy of Fallot

e. Mitral valve prolapse

the answer is below…

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