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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=[[User:Gonzalo Romero|Gonzalo A. Romero, M.D.]], {{SSK}} (Reviewed by Serge Korjian)
|QuestionAuthor=[[User:Gonzalo Romero|Gonzalo A. Romero, M.D.]], {{SSK}} (Reviewed by Serge Korjian and  {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, General Principles
|SubCategory=Cardiology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, General Principles
|SubCategory=Cardiology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, General Principles
|SubCategory=Cardiology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, General Principles
|SubCategory=Cardiology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, General Principles
|SubCategory=Cardiology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, General Principles
|SubCategory=Cardiology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, General Principles
|SubCategory=Cardiology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|MainCategory=Anatomy, Behavioral Science/Psychiatry, Embryology, Pathology, Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, General Principles
|SubCategory=Cardiology
|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?
|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. Upon further investigation, the mother admits that she received several medications during her pregnancy and did not receive any prenatal care. The physician suspects a medication-induced congenital abnormality. The patient's mother has most likely received medications during pregnancy for which disorder? <br>
[[File:WBR0514a.jpg|400px]]
[[File:WBR0514a.jpg|400px]]
|Explanation=[[File:Ebstein_anomaly.png|400px]]<br>
|Explanation=[[File:Ebstein_anomaly.png|400px]]<br>
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.
Ebstein’s anomaly is a congenital heart disease characterized by abnormalities of the tricuspid valve, the right atrium, and the 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 200,000. Patients with severe forms present with cyanosis, dyspnea, and failure to thrive. The majority of these patients have early manifestation of the disease following close of the PDA and may be dependent on the PDA for pulmonary blood flow. Nonetheless, it is not uncommon that manifestations be delayed until childhood, adolescence, and even early adulthood. The development of Ebstein's anomaly has been associated with lithium administration during pregnancy particularly in the first trimester. Lithium is a mood stabilizer indicated for bipolar disorder, which is characterized by alternating symptoms of depression and episodes of mania. Manic episodes are usually described as significant distractibility, irresponsibility, hedonistic behavior, grandiosity, racing thoughts, psychomotor agitation, insomnia, and talkativeness or pressured speech.
|AnswerA=Multiple mild episodes of increased impulsivity, rapid speech and insomnia for at least 2 years
|AnswerA=Several mild episodes of increased impulsivity, rapid speech, and insomnia for at least 2 years
|AnswerAExp=[[Cyclothymia]] is a milder form of bipolar lasting for at least for 2 years. Treatment of cyclothemia is commonly with psychotherapy.
|AnswerAExp=[[Cyclothymia]] is a mild form of bipolar that lasts for at least 2 years. Psychotherapy is the optimal management approach for patients with cyclothemia.
|AnswerB=Hypersomnia, overeating, and mood reactivity
|AnswerB=Hypersomnia, overeating, and mood reactivity
|AnswerBExp=These are the classical symptoms of [[atypical depression]]. Treatment typically involves MAO inhibitors and psychotherapy.
|AnswerBExp=Hypersomnia, overeating, and mood reactivity are the classical symptoms of [[atypical depression]]. Treatment typically involves MAO inhibitors and psychotherapy.
|AnswerC=Alternating symptoms of depression with episodes of increased impulsivity, rapid speech and insomnia
|AnswerC=Alternating symptoms of depression with episodes of increased impulsivity, rapid speech, and insomnia
|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.
|AnswerCExp=Bipolar disorder classically presents with alternating symptoms of depression and episodes of mania. Manic episodes are usually described as significant distractibility, irresponsibility, hedonistic behavior, grandiosity, racing thoughts, psychomotor agitation, insomnia, and talkativeness or pressured speech.
|AnswerD=Recurring intrusive thoughts, feelings, or sensations that cause severe distress; relieved partly by repetitive actions
|AnswerD=Recurring intrusive thoughts or sensations that cause severe distress and are relieved partly by repetitive actions
|AnswerDExp=These are the classical symptoms of [[obsessive compulsive disorder]] (OCD) which is commonly treated with [[SSRIs]]
|AnswerDExp=Compulsions that are relieved by repetitive behavior are the classical symptoms of [[obsessive compulsive disorder]] (OCD). The optimal pharmacological therapy for OCD is [[SSRI]]
|AnswerE=Excessive and unreasonable anxiety that interferes with normal function
|AnswerE=Excessive and unreasonable anxiety that interferes with normal function
|AnswerEExp=Generalized anxiety disorder is characterized by excessive and unreasonable anxiety that interferes with normal function. It is treated with SSRIs.
|AnswerEExp=[[Generalized anxiety disorder]] (GAD) is characterized by excessive and unreasonable anxiety that interferes with normal function. The optimal The optimal pharmacological therapy for GAD is [[SSRI]]
|EducationalObjectives=Lithium is mood stabilizer used for the treatment of bipolar disorder that is associated with the devlopment of Ebstein's anomaly if administered to women in the first trimester. 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.
|EducationalObjectives=Lithium is a mood stabilizer indicated for bipolar disorder. Lithium administration during pregnancy is associated with the development of Ebstein's anomaly, especially when administered during the first trimester. Bipolar disorder classically presents with alternating symptoms of depression and episodes of mania.
|References=Romfh A, Pluchinotta FR, Porayette P, Valente AM, Sanders SP. Congenital Heart Defects in Adults : A Field Guide for Cardiologists. J Clin Exp Cardiolog. 2012;(Suppl 8) '''(Image)'''<br>
|References=Romfh A, Pluchinotta FR, Porayette P, et al. Congenital heart defects in adults: a field guide for cardiologists. J Clin Exp Cardiolog. 2012;(Suppl 8) '''(Image)'''<br>
First Aid 2014 p. 518
First Aid 2014 page 518
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Ebstein anomaly, Lithium, Bipolar disorder
|WBRKeyword=Ebstein's anomaly, Lithium, Bipolar disorder, Mania, Depression, Congenital heart disease
|Approved=Yes
|Approved=Yes
}}
}}

Latest revision as of 00:49, 28 October 2020

 
Author [[PageAuthor::Gonzalo A. Romero, M.D., Serge Korjian M.D. (Reviewed by Serge Korjian and Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Cardiology
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. Upon further investigation, the mother admits that she received several medications during her pregnancy and did not receive any prenatal care. The physician suspects a medication-induced congenital abnormality. The patient's mother has most likely received medications during pregnancy for which disorder?

]]

Answer A AnswerA::Several mild episodes of increased impulsivity, rapid speech, and insomnia for at least 2 years
Answer A Explanation [[AnswerAExp::Cyclothymia is a mild form of bipolar that lasts for at least 2 years. Psychotherapy is the optimal management approach for patients with cyclothemia.]]
Answer B AnswerB::Hypersomnia, overeating, and mood reactivity
Answer B Explanation [[AnswerBExp::Hypersomnia, overeating, and mood reactivity 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 alternating symptoms of depression and episodes of mania. Manic episodes are usually described as significant distractibility, irresponsibility, hedonistic behavior, grandiosity, racing thoughts, psychomotor agitation, insomnia, and talkativeness or pressured speech.]]
Answer D AnswerD::Recurring intrusive thoughts or sensations that cause severe distress and are relieved partly by repetitive actions
Answer D Explanation [[AnswerDExp::Compulsions that are relieved by repetitive behavior are the classical symptoms of obsessive compulsive disorder (OCD). The optimal pharmacological therapy for OCD is SSRI]]
Answer E AnswerE::Excessive and unreasonable anxiety that interferes with normal function
Answer E Explanation [[AnswerEExp::Generalized anxiety disorder (GAD) is characterized by excessive and unreasonable anxiety that interferes with normal function. The optimal The optimal pharmacological therapy for GAD is SSRI]]
Right Answer RightAnswer::C
Explanation [[Explanation::

Ebstein’s anomaly is a congenital heart disease characterized by abnormalities of the tricuspid valve, the right atrium, and the 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 200,000. Patients with severe forms present with cyanosis, dyspnea, and failure to thrive. The majority of these patients have early manifestation of the disease following close of the PDA and may be dependent on the PDA for pulmonary blood flow. Nonetheless, it is not uncommon that manifestations be delayed until childhood, adolescence, and even early adulthood. The development of Ebstein's anomaly has been associated with lithium administration during pregnancy particularly in the first trimester. Lithium is a mood stabilizer indicated for bipolar disorder, which is characterized by alternating symptoms of depression and episodes of mania. Manic episodes are usually described as significant distractibility, irresponsibility, hedonistic behavior, grandiosity, racing thoughts, psychomotor agitation, insomnia, and talkativeness or pressured speech.
Educational Objective: Lithium is a mood stabilizer indicated for bipolar disorder. Lithium administration during pregnancy is associated with the development of Ebstein's anomaly, especially when administered during the first trimester. Bipolar disorder classically presents with alternating symptoms of depression and episodes of mania.
References: Romfh A, Pluchinotta FR, Porayette P, et al. Congenital heart defects in adults: a field guide for cardiologists. J Clin Exp Cardiolog. 2012;(Suppl 8) (Image)
First Aid 2014 page 518]]

Approved Approved::Yes
Keyword WBRKeyword::Ebstein's anomaly, WBRKeyword::Lithium, WBRKeyword::Bipolar disorder, WBRKeyword::Mania, WBRKeyword::Depression, WBRKeyword::Congenital heart disease
Linked Question Linked::
Order in Linked Questions LinkedOrder::