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  #1  
Old 06-15-2014
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Default CVS Question

A 38 year old nulligravida female presents with exercise intolerance with lower extremity pain on moderate exertion. Chest x-ray reveals notching of the ribs. Which of the following findings do you most likely expect on this patient?

A. Prenatal rubella infection
B. Triploidy of X-chromosome
C. Cystic Hygroma
D. A Crescendo-Decrescendo murmur later in life
E. Horse-shoe kidney
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  #2  
Old 06-15-2014
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C. I think cystic hygroma. Patient has Turners Syndrome?
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  #3  
Old 06-15-2014
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Try again.
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  #4  
Old 06-15-2014
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I think its E, Horse shoe kidney
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  #5  
Old 06-15-2014
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Default The answer is D

The whole point of this question is differentiating between Pre-ductal and Post-ductal coarctation.
The vignette described points to post-ductal (Adult type):
1. Age is 38
2. Notching of ribs
The word nulligravida is a distractor, she can be nulligravid and not have Turner's.
The Post-ductal type is not associated with Turner's. It is associated with bicuspid aortic valve which commonly predispose to aortic stenosis, giving rise to crescendo-decrescendo systolic murmur usually in the sixth decade of life.
Horseshoe kidney and cystic hygroma are both associated with Turner's syndrome.
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The above post was thanked by:
coliris (06-18-2014), drryan (06-16-2014)
  #6  
Old 06-16-2014
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Quote:
Originally Posted by hemlock View Post
The whole point of this question is differentiating between Pre-ductal and Post-ductal coarctation.
The vignette described points to post-ductal (Adult type):
1. Age is 38
2. Notching of ribs
The word nulligravida is a distractor, she can be nulligravid and not have Turner's.
The Post-ductal type is not associated with Turner's. It is associated with bicuspid aortic valve which commonly predispose to aortic stenosis, giving rise to crescendo-decrescendo systolic murmur usually in the sixth decade of life.
Horseshoe kidney and cystic hygroma are both associated with Turner's syndrome.
This is a classic post ductal coarctation question. If you did not immediately recognize this, please Google "Boards and Beyond Ryan" to find a new step 1 resource to help you out. Use promo code XLGH3678 for a free account and watch the module on Congenital Heart Disease. After doing that this question will appear very simple and straightforward. Trust me and try this out. The module is only about 15min. You will not be disappointed.

Dr Ryan
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