WBR0514

Author	[[PageAuthor::Gonzalo A. Romero, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Anatomy, MainCategory::Behavioral Science/Psychiatry, MainCategory::Embryology, MainCategory::Pathology, MainCategory::Pharmacology
Sub Category	SubCategory::Cardiology, SubCategory::General Principles
Prompt	[[Prompt::A 5-year-old boy is brought to the emergency department by his mother for difficulty breathing and cyanosis. Physical examination reveals cyanotic extremities and bounding jugular venous pulsations. Initial imaging reveals the cardiac anomaly shown below. The physician suspects a medication related congenital abnormality. What is the most likely presentation of the mother considering the drug she was presumably prescribed? ]]
Answer A	AnswerA::Mild episodes of increased shopping, rapid speech and insomnia lasting at least 2 years
Answer A Explanation	[[AnswerAExp::Cyclothymia is a milder form of bipolar lasting at least for 2 years, which commonly is treated with psychotherapy]]
Answer B	AnswerB::Hypersomnia, overeating, and mood reactivity
Answer B Explanation	[[AnswerBExp::This describes atypical depression, which is typically treated with MAO inhibitors]]
Answer C	AnswerC::Alternating intense sad symptoms with episodes of increased shopping, rapid speech and insomnia intense in nature
Answer C Explanation	AnswerCExp::See overall explanation.
Answer D	AnswerD::Recurring intrusive thoughts, feelings, or sensations that cause severe distress; relieved partly by repetitive actions
Answer D Explanation	[[AnswerDExp::This refers to OCD (Obsessive compulsive personality disorder) which is commonly treated with SSRIs]]
Answer E	AnswerE::Excessive and unreasonable fear that interferes with normal function
Answer E Explanation	[[AnswerEExp::This refers to specific phobia, which is treated with SSRIs]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::The picture is showing an atrialized portion of the right ventricle. The opening of the tricuspid valve is displaced towards the apex of the right ventricle of the heart (congenital apical displacement of the tricuspid valve that typically causes significant tricuspid regurgitation). This cardiologic malformation is known as Ebstein anomaly, which is highly associated with Lithium use during pregnancy. Lithium is used to treat bipolar disorder, which is characterized by intense depressive symptoms alternated with manic episodes (characterized by: distractibility, irresponsibility, seeks pleasure without regard to consequences (hedonistic), grandiosity-inflated self-esteem, flight of ideas-racing thoughts, in goal-directed activity/psychomotor agitation, insomnia, talkativeness or pressured speech. Educational Objective: Bipolar disorder is treated with lithium, a mood stabilizer, which is associated with Ebstein anomaly, an atrialization of the right ventricle. References: Romfh A, Pluchinotta FR, Porayette P, Valente AM, Sanders SP. Congenital Heart Defects in Adults : A Field Guide for Cardiologists. J Clin Exp Cardiolog. 2012;(Suppl 8) (Image) First Aid 2014 p. 518]]
Approved	Approved::Yes
Keyword	WBRKeyword::Ebstein anomaly, WBRKeyword::Lithium, WBRKeyword::Bipolar disorder
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::