Approach to congenital heart diseases (cyanotic) Quiz: Ace Your Exams

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A 4-month-old girl is brought to the clinic for a well-child visit. Her parents report that her lips turn blue when she is crying vigorously, and they return to normal color once she stops crying. She was delivered at 37 weeks' gestation. The pregnancy and delivery were uncomplicated, and the parent and fetus had routine prenatal care. The infant is breastfeeding and at times she takes a long time to feed. All immunizations are up-to-date. Temperature is 36.8�C (98.2�F), heart rate is 170/min, respiratory rate is 45/min, blood pressure is 85/47 mmHg, and oxygen saturation is 81% on room air while crying. Physical examination reveals central cyanosis when the infant is crying. Cardiac examination is significant for a grade 3/6 harsh systolic crescendo-decrescendo murmur heard along the left sternal border that radiates to the axillae and back. The rest of the physical examination is within normal limits. Chest x-ray is shown below. Which of the following is the most likely diagnosis?



Reproduced from: Statdx   

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