Intensive Care Medicine (ICM) Practice Exam

During a routine cardiac examination of a pediatric patient, you hear a murmur. What must occur to justify further workup?

1. If it's a Still's murmur

2. If it is a grade 2 murmur

3. If it doesn't go away

4. If the patient has enlarged neck veins

The correct answer is: If the patient has enlarged neck veins

In the context of a pediatric cardiac examination, certain findings can indicate the need for further workup to assess for potential underlying pathology. When considering the justification for additional evaluation, the presence of enlarged neck veins is particularly significant. Enlarged neck veins in a pediatric patient can suggest increased central venous pressure, which may indicate heart failure or other cardiac issues. This physical finding raises a concern for possible hemodynamic instability or structural heart disease, warranting further investigation through echocardiography or additional diagnostic testing. Other options, such as whether the murmur is classified as a Still's murmur (characteristically innocent and common in children), its grade, or persistence, do not independently necessitate further workup unless accompanied by concerning symptoms or findings. While the nature of the murmur may provide some diagnostic insight, the presence of enlarged neck veins presents a more immediate indication of potential cardiac compromise, highlighting the need for comprehensive assessment.