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  #1  
Old 09-11-2012
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Arrow Gyrus Daily Questions; Pediatrics #46

A 2-year-old child with minimal cyanosis has an S3 and S4 (a quadruple rhythm), a systolic murmur in the pulmonic area, and a mid-diastolic murmur along the lower left sternal border. An electrocardiogram shows right atrial hypertrophy and a ventricular block pattern in the right chest leads. The child most likely has


a. Tricuspid regurgitation and pulmonic stenosis
b. Pulmonic stenosis and a ventricular septal defect (tetralogy of Fallot)
c. An atrioventricular canal
d. Ebstein’s anomaly
e. Wolff-Parkinson-White syndrome
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Old 09-11-2012
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Answer B ....but not sure
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Old 09-11-2012
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Quote:
Originally Posted by step_enhancer View Post
Answer B ....but not sure
Diastolic murmur & VSD?
i better go for Ebstein's
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Old 09-11-2012
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I think it is C. Not sure though.
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Old 09-12-2012
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I say it's B
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Old 09-12-2012
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What is the answer ??
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The answer is d.

A quadruple rhythm associated with the murmur of tricuspid regurgitation and a mid-diastolic murmur at the lower left sternum suggests the diagnosis of Ebstein anomaly (downward displacement of the tricuspid valve). The presence of right atrial hypertrophy and right ventricularconduction defects confirms the diagnosis.

Both tricuspid regurgitation with pulmonic stenosis and tetralogy of Fallot give electrocardiographic evidence of right ventricular enlargement.

The Wolff-Parkinson-White syndrome,which frequently accompanies Ebstein malformation, is not associated with murmurs or cyanosis as an isolated entity but also includessupraventricular tachycardia.
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d. Ebstein’s anomaly

Ebstein’s anomaly

Quote:
The anulus of the valve is still in the normal position. The valve leaflets, however, are to a varying degree, attached to the walls and septum of the right ventricle. There is subsequent 'atrialization' of a portion of the morphologic right ventricle (which is then contiguous with the right atrium). This causes the right atrium to be large and the anatomic right ventricle to be small in size.
  • S3 heart sound
  • S4 heart sound
  • Systolic murmur of tricuspid regurgitation
  • Middiastolic murmur along the lower left sternal border
  • Right atrial hypertrophy
  • Right ventricular conduction defects
  • Wolff-Parkinson-White syndrome often accompanies
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