Rosh Pediatrics Practice Exam

Which physical exam finding is most concerning for a child with suspected heart disease?

1. ACyanosis during crying

2. BPallor associated with feeding

3. CHypertensive response to exertion

4. DCentral obesity

The correct answer is: CHypertensive response to exertion

A hypertensive response to exertion is particularly concerning in a child with suspected heart disease because it indicates that the cardiovascular system is under significant stress and is not responding appropriately to physical demand. In a healthy child, blood pressure should not significantly increase during exertion; if it does, this might suggest an underlying pathology such as hypertension or increased vascular resistance, which can be associated with congenital heart defects or other forms of heart disease. Any significant rise in blood pressure during physical activity can indicate potential complications, particularly if there are other symptoms present, such as exertional dyspnea or syncope. This physiological response could signify that the heart is struggling to cope with normal increases in workload, suggesting possible structural or functional abnormalities in the heart. While other options may reflect concerning symptoms, such as cyanosis, pallor, or obesity, the direct indication of a poor response to exertion provides a more immediate concern for heart function and possible underlying cardiac issues.