Review Question - QID 109448

A 6-year-old boy presents to the pediatrician for a well-child visit. The patient’s parents report that they are struggling to manage his temper tantrums, which happen several times per day. They usually occur in the morning before school and during mealtimes when his parents try to limit how much he eats. The patient often returns for 2nd or 3rd helpings at meals and snacks throughout the day. The patient’s parents have begun limiting the patient’s food intake because he has been gaining weight. The patient recently began 1st grade but still struggles with counting objects and naming letters consistently. The patient sat without support at 11 months of age and walked at 17 months of age. The patient’s temperature is 98.6°F (37°C), blood pressure is 106/63 mmHg, pulse is 105/min, and respirations are 21/min. He is in the 99th percentile for weight and the 5th percentile for height. On physical exam, he has almond-shaped eyes and a downturned mouth. He has poor muscle tone. Which of the following additional findings would most likely also be seen in this patient?