Q. A 2-year-old male child comes to the clinic because of delayed developmental milestones. The mother cannot remember any significant perinatal events. The patient's medical history is significant for recurrent renal calcium calculi. Vital signs show a blood pressure of 130/80 mm Hg, heart rate 90/min, and a respiratory rate of 15/min. Upon examination, the infant has large ears, an upturned nose, a wide mouth, and full cheeks. Which of the following is expected during cardiac auscultation of this patient?