Rosh Pediatrics Practice Exam

A 6-month-old girl presents with fatigue during feeding and a holosystolic murmur. What is the most likely diagnosis?

1. Atrial septal defect

2. Innocent Still murmur

3. Patent ductus arteriosus

4. Ventricular septal defect

The correct answer is: Ventricular septal defect

The presentation of a 6-month-old girl who exhibits fatigue during feeding along with a holosystolic murmur strongly suggests the diagnosis of a ventricular septal defect (VSD). In this scenario, the fatigue during feeding is indicative of heart failure, which can occur when there is increased workload on the heart due to shunting of blood from the left ventricle to the right ventricle through the defective septum. This leads to volume overload and causes symptoms like fatigue, especially during exertion, such as feeding in infants. The holosystolic murmur is characteristic of the turbulent blood flow that occurs across the opening of a VSD. This murmur typically starts at the first heart sound and continues throughout systole, which aligns with the clinical findings in this case. While other options might present with murmurs as well, they are less likely to present with this specific combination of symptoms in a 6-month-old. An atrial septal defect usually presents with a different type of murmur and symptoms that may not appear until later in life. An innocent Still murmur is typically found in healthy children without signs of heart failure. Patent ductus arteriosus would typically present differently and is often associated with a continuous