A 3-year-old patient is admitted to the Emergency Room

Vital signs

• Temperature-102.3
• Weight 16 kg
• Respiratory rate-44
• Blood pressure- 98/62
• Heart rate-122

History of present illness

Mom brought the child to the ER presenting with a fever for 6 days a strawberry tongue, cervical lymphadenopathy, and irritable

Complete the following sentence from the list of options

The patient is at the highest risk for developing.......

evidenced by the patient's diagnosis of …....

Tetralogy of Fallot is a congenital heart defect characterized by a combination of four specific heart abnormalities:
Ventricular septal defect (VSD): A hole in the wall (septum) between the two lower chambers (ventricles) of the heart.
Overriding aorta: The aorta is positioned over both the left and right ventricles, allowing oxygen-poor (deoxygenated) blood from the right ventricle to mix with oxygen-rich (oxygenated) blood from the left ventricle.
Pulmonic stenosis: Narrowing of the pulmonary valve or artery, which restricts blood flow from the right ventricle to the lungs.
Right ventricular hypertrophy: The right ventricle becomes thicker and more muscular as it works harder to pump blood against the narrowed pulmonary valve or artery.
The combination of these defects results in deoxygenated blood from the right ventricle being pumped into the systemic circulation, leading to cyanosis (blueness of the skin) due to decreased oxygen levels in the arterial blood.
The other options (A, B, and C) describe different congenital heart defects but do not specifically result in cyanosis due to deoxygenated blood entering the systemic circulation:

A. Coarctation of the aorta results in the narrowing of the aorta but does not directly lead to cyanosis from the mixing of oxygen-poor blood.

B. Aortic stenosis involves narrowing of the aortic valve but does not typically result in cyanosis in the same way as Tetralogy of Fallot.

C. Patent ductus arteriosus (PDA) involves a connection between the aorta and pulmonary artery but does not cause cyanosis from mixing to the extent seen in the Tetralogy of Fallot.

Hypospadias is a congenital condition where the opening of the urethra is located on the underside of the penis instead of the tip. Circumcision is contraindicated in infants with hypospadias because the foreskin may be used for surgical repair in some cases. The urologist may need to use the foreskin tissue for reconstructive surgery to correct the hypospadias, making circumcision inappropriate at this time.

The other options are appropriate:

A. Hepatitis B vaccine: Vaccination is important for the prevention of infectious diseases.

B. Straight catheterization: This may be necessary for medical evaluation or management but should be done as indicated by the medical team.

C. Hearing screening: Hearing screening is a routine evaluation for newborns and infants to identify hearing problems early.