WBR0873

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Biochemistry, MainCategory::Embryology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 16 year old boy presents to the pediatrics clinic for 2 weeks of fatigue and dyspnea on exertion. On physical exam, the physician notices mild finger cyanosis and clubbing and an elevated jugular venous pressure. The pediatrician orders an echocardiogram that shows apical displacement of the septal tricuspid leaflet of 9 mm/m2 with a dilated right ventricle and decreased contractility. Which of the following medications was the patient's mother most likely taking during her pregnancy?]]
Answer A	AnswerA::Carbamazepine
Answer A Explanation	AnswerAExp::Carbamazepine intake during pregnancy is associated with neural tube defects, IUGR, and craniofacial defects. Ebstein's anomaly has not been linked to carbamazepine intake.
Answer B	AnswerB::Lithium
Answer B Explanation	AnswerBExp::Lithium intake during pregnancy has been associated with Ebstein's anomaly development.
Answer C	AnswerC::ACE inhibitors
Answer C Explanation	AnswerCExp::ACE Inhibitor intake during pregnancy is associated with renal damage in the fetus. Ebstein's anomaly has not been linked to ACEI intake.
Answer D	AnswerD::Tetracyclines
Answer D Explanation	AnswerDExp::Tertacycline intake during pregnancy is associated with discolored primary teeth in infants. Ebstein's anomaly has not been linked to tertacycline intake.
Answer E	AnswerE::Warfarin
Answer E Explanation	AnswerEExp::Warfarin intake during pregnancy is associated with bone deformities and fetal hemorrhage. Ebstein's anomaly has not been linked to warfarin intake.
Right Answer	RightAnswer::B
Explanation	[[Explanation:: Ebstein's anomaly is a congenital heart defect characterized by apical displacement of the septal leaflet of the tricuspid valve leading to a small right ventricle with atrialization of the right heart. Patients usually do not present early in life, but rather in early adulthood. Symptoms are usually related to right heart failure often with evidence of cyanosis and right-to-left shunt in cases of associated septal defects. Classically Ebstein's anomaly has been associated with maternal intake of lithium during pregnancy. Poorer prognosis is usually seen in early presentations, and those with advanced stage heart failure. Most patients do well with surgical correction if performed soon after diagnosis. Educational Objective: Ebstein's anomaly is characterized by the atrialization of the right ventricle and has been associated with maternal intake of lithium during pregnancy. Reference: Attie F, Casanova JM, Zabal C, et al. Ebstein's anomaly. Clinical profile in 174 patients. Arch Inst Cardiol Mex. 1999;69(1):17-25. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Lithium, WBRKeyword::Ebstein's Anomaly
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::