Rosh Pediatrics Practice Exam

What physical exam finding is most likely to be present in a 14-year-old boy with cold extremities, leg pain with exercise, and intermittent chest pain?

1. Delayed femoral pulse when compared to the brachial pulse

2. Episodic hypercyanotic spells

3. Midsystolic ejection murmur with a fixed split S2 heart sound

4. Respiratory stridor

The correct answer is: Delayed femoral pulse when compared to the brachial pulse

In the context of a 14-year-old boy experiencing cold extremities, leg pain with exercise (claudication), and intermittent chest pain, the most relevant physical exam finding is a delayed femoral pulse when compared to the brachial pulse. This finding suggests a potential issue with blood flow, which can be indicative of conditions such as aortic coarctation or peripheral arterial disease. A delayed femoral pulse relative to the brachial pulse points to compromised blood flow to the lower extremities. This situation can occur when there is a significant obstruction in the aorta or its major branches, preventing adequate circulation to the legs. The symptoms of cold extremities and leg pain during activities further support the idea of inadequate blood supply, reinforcing the clinical picture of potential vascular compromise. Other options present findings that are less aligned with the symptoms described. For example, episodic hypercyanotic spells are commonly seen in conditions like Tetralogy of Fallot, which would typically present differently, especially in terms of the age and symptoms. Midsystolic ejection murmurs with a fixed split S2 heart sound are more characteristic of conditions such as atrial septal defects and are not specifically tied to the vascular symptoms presented. Respiratory stridor