#march2020mccqe1
A 2-year-old girl is referred to the hospital for evaluation of her inability to gain weight. She is well fed by her parents, but appears to tire during feedings and has been losing weight despite frequent high-calorie meals. There is no family history of developmental delay or short stature. She is well dressed, her hair is brushed, and she is playful but tires quickly. Her temperature is 36.5°C (97.7°F), pulse is 110/min, blood pressure is 90/50 mm Hg, and respiratory rate is 24/min. She has a harsh 2/6 holosystolic murmur that is best heard at the left sternal border, which is unchanged and has been present since birth. Which of the following is the most appropriate next step in management?
(A) Continue to monitor the patient for increased weight loss and increased shunting
(B) pH probe for gastroesophageal reflux disease
(C) Refer for evaluation and possible closure of ventricular septal defect
(D) Skeletal survey
(E) Stool culture
A 2-year-old girl is referred to the hospital for evaluation of her inability to gain weight. She is well fed by her parents, but appears to tire during feedings and has been losing weight despite frequent high-calorie meals. There is no family history of developmental delay or short stature. She is well dressed, her hair is brushed, and she is playful but tires quickly. Her temperature is 36.5°C (97.7°F), pulse is 110/min, blood pressure is 90/50 mm Hg, and respiratory rate is 24/min. She has a harsh 2/6 holosystolic murmur that is best heard at the left sternal border, which is unchanged and has been present since birth. Which of the following is the most appropriate next step in management?
(A) Continue to monitor the patient for increased weight loss and increased shunting
(B) pH probe for gastroesophageal reflux disease
(C) Refer for evaluation and possible closure of ventricular septal defect
(D) Skeletal survey
(E) Stool culture