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  #1  
Old 08-08-2011
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Default birth defect

Immediately after birth, a newborn is cyanotic and requires intubation with mechanical ventilation. A CXR reveals that the aorta is attached to the right ventricle. In order to survive, this child needs:
A. Continuous oxygen
B. Indomethecin
C. Prostaglandin
D. Epinephrine
E. Surgical construction of a septal defect
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Old 08-08-2011
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B) Indomethacin to close the PDA

Prostaglandins are used to keep it open.
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Old 08-08-2011
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Quote:
Originally Posted by ricko335 View Post
Immediately after birth, a newborn is cyanotic and requires intubation with mechanical ventilation. A CXR reveals that the aorta is attached to the right ventricle. In order to survive, this child needs:
A. Continuous oxygen
B. Indomethecin
C. Prostaglandin
D. Epinephrine
E. Surgical construction of a septal defect
prostaglandin e aorta coming frm rite ventricle abnormal positioning the aorta the blood frm aorta moves to left ventricle which is attached to pulmonary circulation

Last edited by qurat21; 08-08-2011 at 04:30 PM.
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Old 08-08-2011
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the aorta is attached to right ventricle n so keeping PDA the shunting of blood from aorta to left ventricle which is nw atteched to pulmonary circulation
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Old 08-08-2011
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agree with qurat21 it is due to abnormal positioning of the aorta ,, also PDA is uncommon to be born cynotic as it is left to right shunt that way it appears later than abnormal positing aorta which causes right to left shunt which makes the baby born cynotic
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Old 08-08-2011
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the stem does not tell if there is PDA which should be kept open with PGE, but clue that he is cyanotic -which means there might be no PDA.
Great vessel transposition is possible with maternal diabetes, to survive patients should have septal defects.
So I go with E) surgical construction of septal defect
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Old 08-08-2011
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E.surgical construction
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Old 08-09-2011
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E. Surgical construction of a septal defect
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Old 08-09-2011
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Quote:
Originally Posted by ricko335 View Post
Immediately after birth, a newborn is cyanotic and requires intubation with mechanical ventilation. A CXR reveals that the aorta is attached to the right ventricle. In order to survive, this child needs:
A. Continuous oxygen
B. Indomethecin
C. Prostaglandin
D. Epinephrine
E. Surgical construction of a septal defect
A.Continuous oxygen
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Old 08-09-2011
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I agree

[QUOTE=ricko335;59537]Immediately after birth, a newborn is cyanotic and requires intubation with mechanical ventilation. A CXR reveals that the aorta is attached to the right ventricle. In order to survive, this child needs:
A. Continuous oxygen
B. Indomethecin
C. Prostaglandin
D. Epinephrine
E. Surgical construction of a septal defect[/QUOTE]
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Old 08-09-2011
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The correct answer is C.
Early cyanosis is concerning for a right to left cardiac shunt, such as in transposition of great vessels. In this disorder, there is separation of the systemic and pulmonary circulations. The right ventricle attaches to the aorta and the left ventricle attaches to the pulmonary trunk. Without a left to right shunt, this syndrome is incompatible with life.

Prostaglandin (specifically PGE2) will allow the PDA to persist, thus allowing the L → R shunt from fetal development to stay in tact. This L → R shunt will allow oxygenated blood from the LV (which would otherwise go back to the lungs) to get to the right side of the circulation, thus allowing some mixing to occur.

Surgical construction of an ASD is a possible intervention, but not one that would be first in line. The USMLE may ask you to choose the most appropriate next step, and the answer will generally be the simplest/most cost effective one!

Indomethacin is an NSAID that will close the PDA. This will obliterate the natural L → R shunt that exists and will further exacerbate cyanosis.

R → L shunts do not respond to oxygen therapy because there is no inherent issue with oxygenation of blood in the lungs.

There is no indication to use epinephrine here.

High Yield Fact: In the case of ANY right to left (i.e. cyanotic) shunt, it is best to initially maintain the PDA using prostaglandins
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