When To Refer Eight year old boy with generalized malaise History Auscultation Diagnosis Refer? Patient History Eight year old boy with lack of appetite, low energy, crying, doesn't play with friends. Clicks Is there a click? YesNo Splitting If the second heart sound is split, is this splitting fixed (with respiration)? YesNo Murmur Is there a murmur? YesNo Table of Contents 14 month old girl. Failure to thrive. 26 month old boy 34 year old with fainting episode 410 year old with chest pain. 56 month old with poor appetite 612 year old with respiratory infections 7Twelve year old girl with periodic dizziness 8Eleven year old girl seen after bicycle accident 9Eight year old girl with elevated temperature 10Eight year old boy with generalized malaise 11Fifteen year old boy complains of dizziness