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Failure to thrive from congenital heart disease — MCCQE Part 1 MCQ

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EasyPaediatricsFailure to thrive from congenital heart diseaseMCCQE Part 1

A 10-month-old has crossed down two major weight percentiles; parent reports prolonged feeds and sweating with feeds, and examination reveals a harsh systolic murmur. Which of the following is the most appropriate next step?

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Correct answer: A — Evaluate for organic causes including congenital heart disease while assessing feeding and social context

Evaluate for organic causes including congenital heart disease while assessing feeding and social context is the single best answer because the age, timing, examination findings and investigations in the vignette fit Failure to thrive from congenital heart disease better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to CPS growth monitoring guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: CPS growth monitoring guidance