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Short Case

This document contains summaries of examinations of three patients: 1) Hannah, a 12-month-old girl with plagiocephaly and venepuncture scars, who has a left lateral thoracotomy scar and murmur, consistent with repaired persistent ductus arteriosus. 2) Jason, a 4-month-old boy with Down's syndrome, cardiac impulse just medial to axillary line, and murmur at lower left sternal border, consistent with Down's syndrome with atrioventricular septal defect. 3) Larry, an 8-year-old boy with thrill and grade 4 pansystolic murmur at left sternal edge, consistent with ventricular septal defect.

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Li Faung
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48 views

Short Case

This document contains summaries of examinations of three patients: 1) Hannah, a 12-month-old girl with plagiocephaly and venepuncture scars, who has a left lateral thoracotomy scar and murmur, consistent with repaired persistent ductus arteriosus. 2) Jason, a 4-month-old boy with Down's syndrome, cardiac impulse just medial to axillary line, and murmur at lower left sternal border, consistent with Down's syndrome with atrioventricular septal defect. 3) Larry, an 8-year-old boy with thrill and grade 4 pansystolic murmur at left sternal edge, consistent with ventricular septal defect.

Uploaded by

Li Faung
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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PDA

Hannah is a 12-month-old girl. She is not attached to any monitoring or supplementary oxygen. On inspection she is
pink in air with no respiratory distress. I noted she has plagiocephaly and her hands show scars consistent with
multiple venepuncture. She appears appropriate for her age but I would like to plot her on a growth chart.

Examination of peripheral pulses reveals no delay. The pulse is 120 beats per min with strong volume, regular
rhythm & normal character. Otherwise, there is no clubbing, peripheral stigmata of IE, jaundice or pallor and oral
hygiene is good with no pedal edema.

On examination of the precordium, Hannah has a left lateral thoracotomy scar. The apex can be felt mid-clavicular
line at the level of the 4th ICS. Otherwise, no thrill or heaves were felt. Both 1st & 2nd heard sounds are present,
although the second heart sound is louder than the first. There is a loud murmur heard at the lower left sternal
border. The chest is clear and a liver edge is just palpable below left subcostal margin.

I would like to complete my examination by taking a blood pressure, oxygen saturation level and plotting him/her on a
growth chart appropriate for age and sex.

DX :

This acyanotic child has a left lateral thoracotomy scar which would make a repaired persistent ductus arteriosus the
most likely diagnosis.

Down's syndrome with AVSD

Jason is a 4-month-old boy. He is not attached to any monitoring or supplementary oxygen but he is attached to IV
branula at the dorsum of left hand. On inspection he is pink in air with no respiratory distress. There is
dysmorphology consistent with Down’s syndrome. She looks small for her age but I would like to plot on a growth
chart.

Examination of peripheral pulses reveals no delay or collapsing pulse. The pulse is 120 beats per min with strong
volume, regular rhythm & normal character. Otherwise, there is no clubbing, peripheral stigmata of IE, jaundice or
pallor and oral hygiene is good.

On examination of the sternum you can see an obvious cardiac impulse. The apex can be felt just medial to the
axillary line at the level of the 4th ICP. Otherwise, no thrill or heaves were felt. Both 1st & 2nd heard sounds are
present, although the second heart sound is louder than the first. There is a murmur head at the lower left sternal
border.

The chest is clear and a liver edge is just palpable below left subcostal margin. Otherwise, bilateral pedal edema was
absent.

VSD
I have examined Larry, who is a 8-years-old boy. He looks appropriate for age, but I would like to plot his height and
weight on a growth chart. There is no evidence of respiratory distress & positive findings are a thrill at the left sternal
edge with a grade 4 pansystolic murmur loudest in this region. This is a VSD and I note there is no evidence of heart
failure.

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