Mr. ABC, a 12-year-old boy, presented with pain and weakness of legs for the last about one year. A
practising child specialist diagnosed his problem as “growing pains”. Since then he received several tonics providing calcium, iron, and vitamins (including vitamin E) but nothing did him much good.
For the last month or so, his problem had become rather worse. Besides, weakness and pain, he also complained of breathlessness on running for a while. This was in
contrast to his earlier stamina for long races.His dietetic intake was quite good. There was no loss of weight during the course of this ailment.
On examination, he was found to be a tall and fairly well nourished boy. The only relevant finding in the
general physical examination was impalpable femorals while the brachial arteries were rather strong.
The heart size was normal but the apex was heaving. A systolic thrill was palpable in the suprasternal notch.
There were also prominent arterial pulsations in the
suprasternal notch and the carotid vessels. A loud ejection systolic murmur was heard, best over the interscapular area. Preceding it was a loud ejection click.
Questions:
1. What was the major diagnosis?
2. What do you expect to find in ECG?
3. What do you expect to find in X-ray chest?
4. What is the cause of systemic hypertension in
this disease?
5. Describe briefly the course and complications of
the disease.
6. The practising child specialist’s diagnosis of “growing pains” was sure wrong. State what your concept of this vague entity is?
Answers: 17/8/2019
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