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  #1  
Old 12-14-2011
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Stethoscope A murmur and widely split S2!

A healthy 4-year-old girl is brought for a well-child examination. A grade 2/6 systolic ejection murmur is heard along the upper left sternal border. S2 is widely split and does not vary with respiration. A soft mid-diastolic murmur is heard along
the lower left sternal border. Examination shows no other abnormalities. Which of the following is the most likely diagnosis?

A) Aortic stenosis
B) Atrial septal defect
C) Coarctation of the aorta
D) Mitral valve prolapse
E) Patent ductus arteriosus
F) Pulmonary stenosis
G) Tetralogy of Fallot
H) Transposition of the great arteries
I) Ventricular septal defect
J) Normal heart

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  #2  
Old 12-14-2011
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F) Pulmonary stenosis
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  #3  
Old 12-15-2011
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ASD?wide fixed split s2
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  #4  
Old 12-15-2011
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yes i did ASD cz of the wide fixed split.. but m not sure of the answer though
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Old 12-15-2011
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Default ASD

Yes it is ASD 1) wide fixed splitting
2) pulmonoray flow murumur
3) mid diastolic rumble
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Old 12-16-2011
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fixed and Wide split S2 is specific for ASD.

Pulmonary flow murmur due to increased blood flow( at times a normal finding in kids)

mid-diastolic rumble is due to high flow across Tricuspid valve
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Old 12-16-2011
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B) Atrial septal defect
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Old 12-17-2011
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B) atrial septal defect wide split S2
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Old 12-17-2011
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Atrial Septal defect....
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Old 12-18-2011
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ASD
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  #11  
Old 08-26-2013
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there are two differential diagnosis for this child:
  • ASD: fixed wide split S2, mid-diastolic murmur, soft systolic ejection murmur
  • PS: fixed wide split S2, systolic ejection murmur wich radiates to back,
so you can see the difference. also, there is some difference in clinical picture: in PS the child has exertional dyspnea and fatigue and even cyanosis because of right to left shunt!...in the case, the child has no symptoms and the answer seems to be ASD.
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  #12  
Old 08-26-2013
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Quote:
Originally Posted by Rawalian View Post
A healthy 4-year-old girl is brought for a well-child examination. A grade 2/6 systolic ejection murmur is heard along the upper left sternal border. S2 is widely split and does not vary with respiration. A soft mid-diastolic murmur is heard along
the lower left sternal border. Examination shows no other abnormalities. Which of the following is the most likely diagnosis?

A) Aortic stenosis
B) Atrial septal defect
C) Coarctation of the aorta
D) Mitral valve prolapse
E) Patent ductus arteriosus
F) Pulmonary stenosis
G) Tetralogy of Fallot
H) Transposition of the great arteries
I) Ventricular septal defect
J) Normal heart

ASD -- Fixed split, and the diastolic murmur is due to increased flow across the tricuspid during diastole.
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