Down syndrome (Trisomy 21) Quiz: Ace Your Exams

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A 1-day-old male infant is brought to the nursery 2 hours after birth. He was born via normal vaginal delivery at 38 weeks gestation to a 40-year-old woman. The infant’s mother did not receive prenatal care. Family history is unremarkable for hereditary disorders. Vitals are within normal limits. A harsh holosystolic murmur is heard at the lower left sternal border on auscultation. The lungs are clear to auscultation bilaterally. A karyotype analysis is ordered, and the results are shown:  

A human karyotype image shows 23 pairs of chromosomes, numbered 1-22 for autosomes and X, Y for sex chromosomes. Each pair is aligned by size and banding patterns.
Reproduced from https://embryology.med.unsw.edu.au/embryology/index.php/File:Trisomy21male.jpg
Which of the following additional findings are most likely to be present in this patient on physical examination?  

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