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 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:: |
| 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.
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| Approved | Approved::No |
| Keyword | WBRKeyword::Lithium, WBRKeyword::Ebstein's Anomaly |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |