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Morning Quiz ☕️ Day 106
Dr. Shoaib Ahmad Baig
February 16, 2025
Morning Quiz ☕️
A 6-year-old boy is brought in for evaluation due to fatigue. Over the past year, he has been avoiding outdoor activities with his peers because of poor energy and shortness of breath. He also reports occasional pounding in his chest.
Physical Examination Findings:
A holosystolic murmur is heard, best auscultated at the lower sternal border.
Echocardiography Findings:
Apical displacement of the tricuspid valve leaflets.
Decreased right ventricular volume.
Atrialization of the right ventricle.
Moderate to severe tricuspid regurgitation.
Question:
If this patient's condition is due to a side effect of a drug taken during pregnancy, which of the following conditions was his biological mother most likely suffering from?
Options:
A. Alcohol use disorder
B. Bipolar disorder
C. Cocaine use disorder
D. Down syndrome
E. Epilepsy
F. Gestational diabetes
G. Hypothyroidism
H. Opioid use disorder
I. Schizophrenia
Correct Answer 🎯: B. Bipolar Disorder
The patient’s findings are consistent with Ebstein’s anomaly, a congenital heart defect.
Ebstein’s anomaly is associated with maternal use of teratogenic drugs during pregnancy.
The most likely teratogenic drugs linked to this condition are lithium (used for bipolar disorder)
⚙️
Maternal Drug Exposure During Pregnancy (Bipolar Disorder)
⬇
Use of Lithium
(Lithium is used to treat acute mania, hypomania, and bipolar and unipolar depression)
⬇
Inhibition of GSK-3β (⚙)
⬇
Disruption of Wnt/β-Catenin Signaling Pathway (⚙)
⬇
Abnormal Cardiac Morphogenesis (⚙)
⬇
Abnormal Development of Tricuspid Valve and Right Ventricle
⬇
Apical Displacement of Tricuspid Valve Leaflets
⬇
Atrialization of the Right Ventricle
⬇
Decreased Right Ventricular Volume
⬇
Moderate to Severe Tricuspid Regurgitation
⬇
Right Ventricular Dysfunction
⬇
Reduced Pulmonary Blood Flow
⬇
Systemic Hypoxemia
⬇
Fatigue and Shortness of Breath
⬇
Compensatory Tachycardia
⬇
Pounding in the Chest (Palpitations)
⬇
Holosystolic Murmur (Best Heard at Lower Sternal Border)
Differential Table ⚖️
Differential ⚖️ | Key Features 🔑 | Why Incorrect? 🔴 |
|---|---|---|
Alcohol Use Disorder | Fetal alcohol syndrome: facial dysmorphisms, growth retardation, neurodevelopmental issues. | Does not cause congenital heart defects like Ebstein's anomaly. |
Cocaine Use Disorder | Placental abruption, preterm labor, neurodevelopmental issues. | Not associated with congenital heart defects. |
Down Syndrome | Atrioventricular septal defects, intellectual disability, characteristic facies. | Associated with different congenital heart defects (not Ebstein's anomaly). |
Gestational Diabetes | Macrosomia, hypoglycemia, hypertrophic cardiomyopathy in the fetus. | Causes metabolic and structural changes, not Ebstein's anomaly. |
Hypothyroidism | Developmental delays, growth retardation. | No direct link to congenital heart defects. |
Opioid Use Disorder | Neonatal abstinence syndrome. | Causes withdrawal symptoms, not congenital heart defects. |
Schizophrenia | No direct association with congenital heart defects. | Not linked to Ebstein's anomaly. |
Epilepsy | Anti-epileptic drugs (AEDs) can cause neural tube, renal , skeletal, cleft palate and congenital anomaly but not Ebstein’s anomaly | Not linked to Ebstein’s anomaly |
Flashcards 📔
Practice Questions ⏳️
Most Importantly Solve UWorld Questions with IDs:
1490, 507, 8325
Stay Hungry, Stay Curious!
Your Brother in This Struggle
Dr. Shoaib Ahmad
