The mother of a 10-month-old infant tells the nurse that she has ...

[c0205847]

The mother of a 10-month-old infant tells the nurse that she has noticed that her son becomes blue when he is crying and that the frequency of this is increasing. He is also not crawling yet.
 
  During the examination the nurse palpates a thrill at the left lower sternal border and auscultates a loud systolic murmur in the same area. What would be the most likely cause of these findings?
  a.
  Tetralogy of Fallot
  b.
  Atrial septal defect
  c.
  Patent ductus arteriosus
  d.
  Ventricular septal defect

Question 2

The nurse is performing a cardiac assessment on a 65-year-old patient 3 days after her myocardial infarction (MI). Heart sounds are normal when she is supine, but when she is sitting and
 
  leaning forward, the nurse hears a high-pitched, scratchy sound with the diaphragm of the stethoscope at the apex. It disappears on inspiration. The nurse suspects:
  a.
  Increased cardiac output.
  b.
  Another MI.
  c.
  Inflammation of the precordium.
  d.
  Ventricular hypertrophy resulting from muscle damage.

[hanadaa]

Answer to Question 1

ANS: A
The cause of these findings is tetralogy of Fallot. Its subjective findings include: (1) severe cyanosis, not in the first months of life but developing as the infant grows, and right ventricle outflow (i.e., pulmonic) stenosis that gets worse; (2) cyanosis with crying and exertion at first and then at rest; and (3) slowed development. Its objective findings include: (1) thrill palpable at the left lower sternal border; (2) the S1 is normal, the S2 has a loud A2, and the P2 is diminished or absent; and (3) the murmur is systolic, loud, and crescendo-decrescendo.

Answer to Question 2

ANS: C
Inflammation of the precordium gives rise to a friction rub. The sound is high pitched and scratchy, similar to sandpaper being rubbed. A friction rub is best heard with the diaphragm of the stethoscope, with the person sitting up and leaning forward, and with the breath held in expiration. A friction rub can be heard any place on the precordium. Usually, however, the sound is best heard at the apex and left lower sternal border, which are places where the pericardium comes in close contact with the chest wall.

[c0205847]

Excellent

[yeungji]

TYSM