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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 4/Question#40 (reveal difficulty score)
A 28-month-old boy has a history of cyanosis ...
Tetralogy of Fallot ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: heart_sounds Cardio

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 +2  upvote downvote
submitted by โˆ—carolebaskin(109)
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A classic

There are 4 murmur characteristics described and tetra logy of fallot has 4 problems (PROVe)

  1. P ulmonary infundibular stenosis
  2. R V hypertrophy
  3. O verriding aorta
  4. V SD --> holosystolic murmur + mid-diastolic at apex (due to increased MV flow) + thrill (in small VSD due to turbulence)

Single S1 from reduced pulmonic component (remember, MTAP, MT = S1, AP = S2)

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 +1  upvote downvote
submitted by โˆ—sassy_vulpix(23)
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TOF is the only cyanotic disease out of the lot. RV heave is prob due to RV hypertrophy. Single S2 cuz of diminished pulmonic component, systolic murmur d/t VSD what does the systolic click signify? Pulmonic stenosis?

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 +0  upvote downvote
submitted by โˆ—step_prep7(71)
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  • Infant/toddler with early cyanosis and clubbing with murmur consistent with RV hypertrophy (RV heave), Pulmonic stenosis (single S2), and a VSD (systolic murmur), which are 3/4 of the features of Tetralogy of Fallot
  • Key idea: Causes of early cyanosis from primary heart defects can be remembered with mnemonic 1, 2, 3, 4 and 5 because it can be caused by (1) persistent truncus arteriosus (1 vessel) (2) transposition of the great vessels (2 switched vessels) (3) Tricuspid atresia (Tri = 3) (4) Tetralogy of Fallot (Tetra = 4) (5) Total anomalous pulmonary venous return (5 letters in name)
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