WBR0514
| Author | [[PageAuthor::Gonzalo A. Romero, M.D., Serge Korjian M.D. (Reviewed by Serge Korjian)]] |
|---|---|
| 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 likely prescribed?
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| Answer A | AnswerA::Multiple mild episodes of increased impulsivity, rapid speech and insomnia for at least 2 years |
| Answer A Explanation | [[AnswerAExp::Cyclothymia is a milder form of bipolar lasting for at least for 2 years. Treatment of cyclothemia is commonly with psychotherapy.]] |
| Answer B | AnswerB::Hypersomnia, overeating, and mood reactivity |
| Answer B Explanation | [[AnswerBExp::These are the classical symptoms of atypical depression. Treatment typically involves MAO inhibitors and psychotherapy.]] |
| Answer C | AnswerC::Alternating symptoms of depression with episodes of increased impulsivity, rapid speech and insomnia |
| Answer C Explanation | [[AnswerCExp::Bipolar disorder classically presents with manic episodes characterized by significant distractibility, irresponsibility, hedonistic behavior, grandiosity, racing thoughts, psychomotor agitation, insomnia, and talkativeness or pressured speech.]] |
| Answer D | AnswerD::Recurring intrusive thoughts, feelings, or sensations that cause severe distress; relieved partly by repetitive actions |
| Answer D Explanation | [[AnswerDExp::These are the classical symptoms of obsessive compulsive disorder (OCD) which is commonly treated with SSRIs]] |
| Answer E | AnswerE::Excessive and unreasonable anxiety that interferes with normal function |
| Answer E Explanation | AnswerEExp::Generalized anxiety disorder is characterized by excessive and unreasonable anxiety that interferes with normal function. It is treated with SSRIs. |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::400px Ebstein’s anomaly is a congenital heart disease characterized by abnormalities of the tricuspid valve, right atrium and right ventricle. Apical displacement of the tricuspid valve leaflets leads to an atrialized right ventricle that is often too small to circulate sufficient blood. Ebstein's anomaly is relatively rare with an incidence of 1 in 200000. Patient's with severe forms present with cyanosis, dyspnea, and failure to thrive. A majority of these patients have early presentation soon after PDA closure as they and may be dependent on the PDA for pulmonary blood flow. The development of Ebstein's anomaly has be associated with Lithium intake particularly in the first trimester. Lithium is mood stabilizer that remains a first line agent for the treatment of bipolar disorder. Bipolar disorder classically presents with manic episodes characterized by significant distractibility, irresponsibility, hedonistic behavior, grandiosity, racing thoughts, psychomotor agitation, insomnia, and talkativeness or pressured speech. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Ebstein anomaly, WBRKeyword::Lithium, WBRKeyword::Bipolar disorder |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
