嵐哥嵐嫂說病例第2季第02期(病例部分)

A newborn girl is evaluated in the nursery by a pediatrician. She was born 6 hours ago at 37 weeks’ gestation via spontaneous vaginal delivery after an uncomplicated pregnancy to a 35-year-old woman who had good prenatal care.

On physical examination, her skin is pink with no rashes or lesions. Her eyes appear regularly shaped and spaced, and she has a red reflex present in both eyes. Her lips and nose are normal,and her palate has a high arch. She has a webbed neck that is flexible. Her chest is shield shaped with widely spaced nipples. Her lungs are clear to auscultation bilaterally, and her breathing is unlabored with a respiratory rate of 50/min. Her femoral pulses are delayed compared to her radial pulses. She is able to move all extremities equally but has edematous hands and feet. She is alert and has normal Moro and rooting reflexes.

1、Which of the following cardiac examination findings is most likely?

(A) Continuous machinery murmur at the left upper sternal border
(B) Harsh holosystolic murmur at the left lower sternal border
(C) Single loud S2
(D) Systolic murmur loudest below the left scapula
(E) Widely split fixed S2 and systolic ejection murmur at the left upper sternal border

2.Give the explanation.

譯文:
本次病例的主人公是一名女性患兒。故事呢,是這樣發生的……某天,一位兒科醫生在嬰兒室檢查一名6小時前出生的女嬰,該女嬰是由一名產前狀況良好、無任何并發癥的35歲女性在妊娠37周后順產的。

在體檢中,女嬰的皮膚呈現粉紅色并未出現任何皮疹或皮損。她的雙眼等大等圓且大小正常,均存在紅光反射,鼻子和嘴唇也都正常,她的腭弓高,有柔韌的頸蹼。胸廓呈盾狀,乳頭間距較大。肺部聽診呼吸音清,頻率為50次/分,且呼吸不費力。她的股動脈搏動相對于橈動脈搏動有所延遲。她的手和腳水腫,但可以活動。她非常警覺,而且擁有正常的擁抱反射和覓食反射。

1、如果醫生對女嬰的心臟進行聽診,他會聽見什么呢?
A、上段胸骨左緣出現連續性雜音
B、下段胸骨左緣出現粗糙的全收縮期雜音
C、單一響亮的第二心音
D、左肩胛骨下緣出現的收縮期雜音最響
E、上段胸骨左緣出現固定分裂的第二心音和收縮期噴射性雜音

2、第一題為什么選這個選項呀?給出理由唄

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