A 6-Year-Old Boy Is Brought to the Office by His

question 152

Multiple Choice

A 6-year-old boy is brought to the office by his mother for an annual physical examination.  He has had no recent illnesses but has had intermittent pain in his legs during his soccer games for the past 3 months.  The patient had no trauma preceding the onset of leg pain, has no numbness or tingling, and is able to walk without a limp.  He was born at 38 weeks gestation via a spontaneous vaginal delivery with no complications.  The patient has met all developmental milestones, and all of his immunizations are up to date.  His father was recently diagnosed with hypertension at age 55, but there is no other significant family history.  Temperature is 36.1 C (97 F) , blood pressure is 135/88 mm Hg in the right upper extremity, pulse is 110/min, respirations are 24/min, and pulse oximetry is 98% on room air.  Weight and height are at the 25th and 50th percentiles, respectively, for age.  Physical examination shows a well-appearing boy who has no dysmorphic features and who smiles and fully cooperates.  The lungs are clear to auscultation.  Heart rate and rhythm are normal.  A 2/6 continuous murmur is heard over the left interscapular area.  The lower extremities have no swelling, erythema, or tenderness.  Further evaluation would most likely show which of the following findings?

• A)Digital clubbing
• B)Hepatomegaly
• C)Lower extremity hypotension
• D)Parasternal heave
• E)Pulsus paradoxus

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Definitions:

Strategic Planning

Strategic Planning is the process by which an organization defines its strategy, direction, and decision-making on resource allocation to pursue its long-term goals.