CLINICAL MEDICINE

A 10-year-old boy comes to your office for an initial visit. He has been in foster care for several years, but is reunited with his mother. He had heart surgery at 2 years of age, but the patient does not have any records from that procedure. As far as his mother knows, he has never been hospitalized for respiratory illnesses such as asthma or pneumonia. He does not take any medications. He has decreased exercise tolerance. On PE, he is a slender boy is no acute distress. His weight is at the 10th percentile for his age, and height is at the 50th percentile. His heart rate is 100 bpm and respiratory rate is 28 breaths/min. Oxygen saturation on room air is 89%. His blood pressure is 96/65 mmHg in the right arm, and his blood pressure is 115/90 mmHg in the right leg. His neck veins are not distended. His chest shows clear and equal breath sounds. There is a well-healed sternotomy scar. His heart examination shows a normal S1 with a very loud P2 component to S2. There is a 2/6 soft systolic murmur at the right midsternal border that does not radiate to either axilla. There is no organomegaly on abdominal examination. The femoral pulses are 2+. His Hg level is 17 g/dL. Diagnosis: