a question from an NBME can someone please answer

5/31/2013 7:06:27 PM
A 6-month old girl is brought to the doctor because of poor feeding and labored breading for 2 months. She has had recurrent respiratory tract infections since birth. Examination shows a to-and-fro murmur in the 2nd left intercostal space, a loud S2, bounding peripheral pulses, and a widened pulse pressure. which of the following is most likely the dx:

a. ASD (ostium primum)
b. ASD (ostium secundum)
c. Atrioventricular canal
d. Coarc of aorta
e. Hypoplasia left heart syndrome
f. PDA
g. TOF
h. TOGV
i. Tricuspid Atresia
J. VSD

please be honest and give an explanation of why you think which is the correct answer. Thank you so much everyone.


5/31/2013 7:44:19 PM
the answer is actually F. i think i did about 1/2 research on google.

" to and fro" murmur means continuous like "continuous machinery murmur" PDA
PDA also has wide pulse pressure.

coarctation of the aorta does have bounding pulses and higher arm pressure than leg pressure, but you actually have to give prostaglandin to keep PDA open in coarc...so legs get higher perfusion of blood.


5/31/2013 7:46:45 PM
to comment on your reasons.. there is no characteristics of aortic regurg. aortic regurge is a diastolic murmur...not a to and fro murmur.


6/3/2013 2:20:20 PM
pda..........agree wid u


6/22/2016 9:26:32 AM
According to ncbi: the continous murmur and 'to and fro murmur' are different entitities.

The presence of a systolic-diastolic murmur (systolic murmur and diastolic murmur) so called a to-and-fro murmur, is not a continuous murmur, being different, by separating the two murmurs through a small "silence". A to-and-fro murmur, involves two components: a systolic one, in which the blood flows in one direction, and a diastolic one in which the blood flows in the opposite direction, while those with true continuous murmur, the blood flows in the same direction in both systole and diastole.

Double murmur occurs most frequently in cases in which there is a valvular stenosis and a valvular regurgitation (aortic, mitral, tricuspid or pulmonary). This is due to a major reshuffle of valve cusps, they cannot open or close, being fenestrated, shortened or immobilized.
here's the link to this article on continous murmurs.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307079/


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