0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Picture of the Month FREE

Hassib Narchi, MD; Marissa Santos, MD; Walter W. Tunnessen Jr, MD
[+] Author Affiliations

From the Pediatric Unit, Saudi Aramco–Al Hasa Health Center, Mubarraz, Kingdom of Saudi Arabia.


Section Editor: Walter W. Tunnessen, MD


Arch Pediatr Adolesc Med. 1999;153(9):997. doi:10.1001/archpedi.153.9.997.
Text Size: A A A
Published online

A 6-WEEK-OLD INFANT, the product of a full-term, uncomplicated pregnancy and the first child of unrelated parents, had a history of irritability and poor feeding. The mother reported that the infant had been irritable and crying for a few days, especially during feeding, with episodes of pallor and breathlessness.

On physical examination, the infant appeared well nourished and had no dysmorphic features. She was irritable and cried constantly. Her respirations were 50/min with intermittent grunting; pulse, 160/min; and temperature, 37°C. Oxygen saturation was 97% by pulse oximetry. Her skin was pale and extremities cool. On chest examination there were mild intercostal retractions, clear lung fields to auscultation, and a grade 3/6 systolic murmur along the left sternal border with a loud second heart sound and a gallop rhythm. The abdomen was soft with the liver edge palpable 4 cm below the right costal margin. Pulse and blood pressure were equal in all 4 extremities. A chest x-ray film (Figure 1) and electrocardiogram (Figure 2) were obtained.

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
JAMAevidence.com

The Rational Clinical Examination
Accuracy of ECG

The Rational Clinical Examination
Accuracy of Electrocardiography and Chest Radiography