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  #1  
Old 02-23-2013
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Default Can anyone explain why the answers is what it is

A 5-year-old girl is brought to the physician
by her parents for evaluation of recurrent
injuries. Her parents say that she started
walking at the age of 14 months and since then
has always seemed clumsier and had more
injuries than other children. She has had
increasingly frequent chest pain with exertion
since starting a soccer program 3 months ago.
She usually has pain or swelling of her knees
or ankles after practice. She has been wearing
glasses for 2 years. Her 16-year-old brother
has required two operations for a severe
rotator cuff injury he sustained while taking a
shower, and she has a maternal cousin who
died of a ruptured aortic aneurysm at the age
of 26 years. Today, the patient walks with a
limp. She is at the 99th percentile for height
and 50th percentile for weight. A midsystolic
click is heard at the apex. The left ankle is
swollen and tender; range of motion is limited
by pain. The joints of the upper and lower
extremities are hypermobile, including 25
degrees of genu recurvatum, thumbs that may
be extended to touch the forearms, and
flexibility at the waist, with palms easily
touching the floor with straight knees. Which
of the following is the most appropriate next
step in diagnosis?
(A) Skeletal survey
(B) Echocardiography
(C) Bone scan
(D) MRI of the shoulder
(E) Aortic angiography


The answer mentioned is echocardiography, which I quiet understand that it should be done, but not exactly, the most appropriate next step. I would argue more in the favor of aortic angiography. Can you guys chip in and give your opinion?
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  #2  
Old 02-23-2013
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Its an inherited heart defect probably. Mayb some kind of cardiimyopathy(restrictive?dilated?hypertrophic is auto dominant though). Tjats why u hv swollen lower limb(right side fail/dilated?). N therefore better use echo. I think. But im nt sure if im right or nt. Hoho
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Old 02-23-2013
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Echocardiography can be used to assess aortic root diameter as well as detect other valvular defects such as the mitral valve prolapse this child probably has. I guess aortic angiography is a much more invasive procedure so it's better to start with echo.
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  #4  
Old 02-23-2013
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True. Echo can tell alot about the heart including an aneurysm. and is less invasive. Makes sense if its the next and the first actually, step in management.
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Old 02-24-2013
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thanks buddy i like it
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  #6  
Old 02-24-2013
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I guess the patient is suffering from marfans syndrome and with echocardiography both heart valves and aorta can be checked
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