Cedrick
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A neonate has murmur at the apex,which is a normal transient in up to 50 % of newborns
which of the following actions concerning informing the parents about the murmur is most appropiate ?
a.-defer telling the parents and order an echocardiogram
b.-defer telling the parents because heart murmurs often resolve
c.-defer telling the parents but order a cardiology consultation
d.-tell parents and examine the infant again in 24 hrs
e.-tell parents that this finding is normal but offer a cardiology consultation
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| robin082006
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D?
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| Cedrick
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yes
D
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| mjl1717
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I like answer-c because everyone is covered, before ringing the infamous "false alarm" with anxiety.
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| study_ing
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in usmle u ususually do not pick up the answer which involves hiding informatin from the patient even if it is apparently for their own good. a and c are difinitely ruled out. hidden consultations are not a good option
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| ManuNastai
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why not e?
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| muzammil
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thats what i am thining y not e
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| young_doc
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if it's normal in 50% of newborns...better to wait a day and see what happens, before calling in the big guy (cardiologist)
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| MRMAVERICK
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E WUD BE MOST APPROPRIATE
AS U R TELLLNG THE PARENTS AD THEY HAVE THE CHOICE OF GOIN TO CARDIOLOGISTS IF THEY WISH AND R NT SATISFIED WITH THE MURMUR BEING NORMAL
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| ManuNastai
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@young_doc
the kid is a neonate/newborn up to one month. nowhere in the question does say that he's a one day old, so...
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| vallia
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it seems is D,
The cardiovascular exam constantly changes over the first few hours, days and weeks of life as the neonate changes from fetal circulation with the placental circuitry to the newborn lung circuitry. Because changes in ductal flow, decreasing pulmonary vascular resistance, and increasing systemic vascular resistance occur over the first few hours and days of life, cardiovascular assessments should be done shortly after birth, at 6-12 hours of age, and again at one to three days of life in addition to regular intervals after discharge.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
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| proctalgia
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I go for D. This give a chance to exclude 50% of murmurs that are transient.
If M persists U can decide on further action 24 hrs later.
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| docarchana
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I think its D due to vallias reason..
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| intern_doc
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it can not be E b/c you are telling the parent that is NORMAL...and turn around and call for CARDIOLOGIST ? ....think about it...the parents will be confusing...
so the best answer is to wait....observe....and check in 24hours...if not..then consult...
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| mona1976
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D is very appropriate.
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| Ancylostoma
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never pass your patient off, you do as much as you can .
D is your answer
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| Sayulita
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D
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| lq2006
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d.-tell parents and examine the infant again in 24 hrs
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| po
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D seems right,
found some link;
A systolic murmur in a well, thriving infant can often be managed with observation and careful follow-up. As you mentioned, many of these murmurs will disappear. Most are physiologic and are caused by the normal narrowing between the main pulmonary artery and its peripheral branches. Occasionally, a small muscular ventricular septal defect can cause a soft systolic murmur. Most close spontaneously. An urgent cardiac evaluation is warranted if there are any features of concern -- diastolic, harsh, loud, associated with clicks -- in the murmur, or in the infant, such as diaphoresis with feeding, signs of congestive heart failure, respiratory distress, poor weight gain or diminished femoral pulse on examination. MP
http://www.parkhurstexchange.com/qa/A.php?q=/qa/P...
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| karned2
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E
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| hitesh
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Alright. a cpl of simple rules will help here ( Ofcourse these have exceptions  )
1. never hide information from patients (rules out a,b,c)
2. Try your best to avoid tranfer of care of your patients to another physician( rules out option e)
In any case, a cardilogist is not needed at this point . If the murmur persists beyond the expected time of resolution, then you need to send a consult.
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| usmlekiller
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D no doubt about it
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| yousefreda
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yea obviously D.. first off ur supposed to tell the babys parents everything... second its normal in 50% of neonates... theres no way u should defer telling them if theres even a 1% chance of something occuring.. always tell them if there is any slight possibilities of anything...
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