A 1-Week-Old Boy Is Brought to the Office for His

question 598

Multiple Choice

A 1-week-old boy is brought to the office for his first primary care visit following an uncomplicated vaginal delivery at 40 weeks gestation.  The boy was born to a 30-year-old woman who took prenatal vitamins throughout the pregnancy.  She was diagnosed with gestational diabetes mellitus at 28 weeks gestation, which was treated with dietary modification and exercise.  The nursery course was uncomplicated, and the boy was discharged at around 30 hours of life following observation of appropriate breastfeeding, voiding, and stooling.  His weight, length, and head circumference are at the 50th percentile.  Physical examination shows a grade II/VI harsh, holosystolic murmur best heard at the left mid to lower sternal border.  Birth records show that no murmur was heard by 2 different health care providers in the newborn nursery.  Which of the following is the most likely diagnosis?

• A)Coarctation of the aorta
• B)Ebstein's anomaly
• C)Patent ductus arteriosus
• D)Peripheral pulmonary stenosis
• E)Primum-type atrial septal defect
• F)Secundum-type atrial septal defect
• G)Tetralogy of Fallot
• H)Wolff-Parkinson-White syndrome
• I)Ventricular septal defect

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