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  #1  
Old 04-15-2011
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Arrow Practice Question: Cardiovascular #1

A 1 week old infant presents to your clinic because her mother is concerned about the increasingly blue color of her child's skin. Recognizing that this could very well be a congenital heart defect, you obtain an Transthoracic ultrasound which reveals the findings shown in the attached image. You think back to your days studying for your Step 1 exam and recall that there was a teratogen that could cause this if taken during pregnancy. Which of the following is the most likely finding in the mother?

Practice Question: Cardiovascular #1-ultrasound.jpg
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A. Alcohol abuse
B. Nicotine addiction
C. Schizophrenia
D. Bipolar Disorder
E. Cocaine use
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  #2  
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a : fetal Alcohol syndrome
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Default Bipolar disorder.

That's a case of Epstein anomaly. It's caused by lithium.
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Quote:
Originally Posted by apx85 View Post
A 1 week old infant presents to your clinic because her mother is concerned about the increasingly blue color of her child's skin. Recognizing that this could very well be a congenital heart defect, you obtain an Transthoracic ultrasound which reveals the findings shown in the attached image. You think back to your days studying for your Step 1 exam and recall that there was a teratogen that could cause this if taken during pregnancy. Which of the following is the most likely finding in the mother?

Attachment 1249
click image to enlarge

A. Alcohol abuse
B. Nicotine addiction
C. Schizophrenia
D. Bipolar Disorder
E. Cocaine use
bipolar disorder... lithium causes ebstein's anomaly
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aaaaaaaaah yeah its ebstein anomaly......so the answer is BPD
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i think is Lithium too

atrialized Right ventricle
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Agreed - Lithium used to treat Bipolar disorder in the mother causes ebstein's anomaly - that is an amazing picture. Thanks!
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Bipolar disorder. S/E of Lithium.
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Yes, it is due to Lithium, being taken for Bipolar disorder.
The picture is exactly the same as in Wikepedia, my question is, is this a real question in the USMLE step 1 test?
Thanks
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Ans is D.....lithium.....
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Okay I read the thread again and this is a practice question.
Which Q bank did this came from? Kaplan or Uworld?
Thanks
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Quote:
Originally Posted by reinnerph View Post
Yes, it is due to Lithium, being taken for Bipolar disorder.
The picture is exactly the same as in Wikepedia, my question is, is this a real question in the USMLE step 1 test?
Thanks
All of the questions I post are questions that I have come up with myself. I find this to be a good way to study and I like to post these questions on this forum because they often generate very good discussions (I am always pleasantly surprised by how smart you all are)

I try to make my questions USMLE style but they may not always be. More importantly though the topics that I make questions about are those that I come across in USMLE review material.

So feel free to point out any errors in any of my questions because they are by no means board approved! But I usually try to thoroughly research before I post any questions.
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Correct Answer D is correct!

Great job everyone!!

I just came across this in my reading and I had not heard of it before but apparently you all have!

This finding is called the Ebstein anomoly and is associated with Lithium use during pregnancy (for Rx of Bipolar disorder). The ultrasound image (from wiki ) shows the characteristic finding of a very low set tricuspid valve close to the apex of the RV. This defect can be anywhere from asymptomatic to fatal (due to R--> L shunt/cyanosis) depending upon the severity of the defect.

Other toxicities of Lithium (in the adult):
1. Nephrogenic DI
2. Tremor
3. Heart Block
4. Hypothyroidism
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Quote:
Originally Posted by apx85 View Post
Great job everyone!!

I just came across this in my reading and I had not heard of it before but apparently you all have!

This finding is called the Ebstein anomoly and is associated with Lithium use during pregnancy (for Rx of Bipolar disorder). The ultrasound image (from wiki ) shows the characteristic finding of a very low set tricuspid valve close to the apex of the RV. This defect can be anywhere from asymptomatic to fatal (due to R--> L shunt/cyanosis) depending upon the severity of the defect.

Other toxicities of Lithium (in the adult):
1. Nephrogenic DI
2. Tremor
3. Heart Block
4. Hypothyroidism
yes, what happens is Atrialization of the Right ventricle
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Quote:
Originally Posted by apx85 View Post
A 1 week old infant presents to your clinic because her mother is concerned about the increasingly blue color of her child's skin. Recognizing that this could very well be a congenital heart defect, you obtain an Transthoracic ultrasound which reveals the findings shown in the attached image. You think back to your days studying for your Step 1 exam and recall that there was a teratogen that could cause this if taken during pregnancy. Which of the following is the most likely finding in the mother?

Attachment 1249
click image to enlarge

A. Alcohol abuse
B. Nicotine addiction
C. Schizophrenia
D. Bipolar Disorder
E. Cocaine use
It is atrialisation of Rt ventricle that is ebsteins anomaly which is due to mother taking lithium for her bipolar disorder.
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