Congenital cyanosis + Holosystolic murmur - USMLE Forums
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Old 07-06-2011
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Heart Congenital cyanosis + Holosystolic murmur

A 2 1/2 y old male child comes with blue discoloration. He had this problem since birth. On examining he has mild sob and tachypnea. On auscultation holosystolic murmur on left lower sternal border was found with thrill, also SEM at left 2nd ICS. You cannot examine him further because he became uncoperative. So what diagnosis u will be thinking in mind?
A. ASD
B. VSD
C. TS
D. VSD WITH HF
E. TOF
F. PDA
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Old 07-06-2011
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Answer is E:TOF
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Old 07-06-2011
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Answer is Tetralogy of Fallot : Upper sternal click then SEM , right parasternal lift, S2, decreased pulmonary vascularity on chest x-ray, if the child is crying he becomes blue
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Old 07-06-2011
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holosystolic murmur apear in 1-VSD-2- TOF 3-tricusp regugr

so the answer

E. TOF
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Old 07-06-2011
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another clue is the age of 2.5 yrs. Most severe congenital heart diseases will be corrected much earlier and if not the child will die. Only TOF can come this far. I remember reading this somewhere.
Of course the whole clinical scenario must be taken into consideration for Dx
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Old 07-06-2011
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yes answer is TOF
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