Review Question - QID 109133

A 4-month-old girl presents with her parents to her pediatrician. The patient’s parents are concerned because she used to push up to her elbows during tummy time, but she now struggles to lift her head. She has been urinating and stooling well but her parents report decreased interest in food. All prenatal screening for the patient was unremarkable. There is no family history of genetic abnormalities in the patient’s mother. The patient’s father was adopted and knows little about his biological family. The patient has 2 older siblings who are both developmentally normal. Her temperature is 98.6°F (37°C), blood pressure is 76/46 mmHg, pulse is 116/min, and respirations are 24/min. On physical exam, the patient appears well-developed and well-nourished. She is in the 40th and 48th percentile for height and weight, respectively. She has no dysmorphic features. Her abdomen is soft and non-tender. Hepatosplenomegaly is present. An ophthalmologic exam reveals the finding seen in Figure A. Which of the following additional findings is most likely to be present in this patient?