Intensive Care Medicine (ICM) Practice Exam

A pediatric patient presents with intermittent claudication and headache. What finding would likely be seen on an X-ray?

1. Rib notching

2. Boot-shaped heart

3. Transposition of the great vessels

4. Egg-on-a-string sign

The correct answer is: Rib notching

The finding of rib notching on an X-ray is indicative of a chronic process related to abnormal blood flow or a vascular issue. In a pediatric patient with symptoms such as intermittent claudication and headaches, rib notching is often associated with coarctation of the aorta. This condition leads to decreased blood flow to the lower part of the body, which stimulates the growth of collateral circulation. Over time, the ribs may become eroded by these collateral vessels, resulting in characteristic notching that is visible on imaging. The presence of intermittent claudication suggests that the patient is experiencing symptoms related to decreased perfusion, which aligns with the vascular compromise seen in coarctation of the aorta. The headaches can also occur due to elevated blood pressure in the upper body resulting from the obstruction. Other choices present different clinical implications: a boot-shaped heart is typically associated with tetralogy of Fallot, while transposition of the great vessels and the egg-on-a-string sign indicate distinct conditions that do not correlate with the symptoms described. Therefore, rib notching is the most logical X-ray finding for this clinical scenario involving intermittent claudication in a pediatric patient, often pointing towards coarctation of the aorta.