Question

A 5 year old female presents for a pre-kindergarten physical and is found to have a blood pressure of 146/85 in both arms. Past medical history is unremarkable, and the child has been healthy and asymptomatic. Physical examination reveals a short, stocky female with a broad, shield shaped chest and widely-spaced nipples. There are diminished femoral pulses bilaterally. On cardiac auscultation, a short 2/6 midsystolic murmur is heard at the left paravertebral interscapular area. Which of the following is the most likely associated finding in this patient?

A. Increased urine homovanillic acid (HVA) and vanillylmandelic acid (VMA)
B. Tonsillar hypertrophy
C. Decreased levels of thyroid stimulating hormone (TSH)
D. Chest x-ray showing notching of the ribs bilaterally
E. Sensorineural hearing loss and hematuria

Answer 1

The most likely associated finding in this patient is Chest x-ray showing notching of the ribs bilaterally.

Step-by-step explanation:

The most likely associated finding in this patient is Chest x-ray showing notching of the ribs bilaterally.

The patient in the question presents with several features suggestive of a congenital heart defect called coarctation of the aorta. The short, stocky female with a broad, shield-shaped chest and widely-spaced nipples are characteristic physical findings in patients with this condition. Additionally, the associated diminished femoral pulses and presence of a 2/6 midsystolic murmur at the left paravertebral interscapular area further support this diagnosis.

Chest x-ray findings showing notching of the ribs bilaterally is a classic radiographic finding in patients with coarctation of the aorta due to collateral circulation development. This finding occurs because blood flow is redirected from the descending thoracic aorta to the intercostal arteries, resulting in rib notching over time.