20 y/o female in her 1 st trimester, is referred to you for progressive dyspnea. An echo reveals severe pulmonary hypertension. Right Ventricular systolic pressure is 90 with a systemic pressure of 110 mm hg. No PE and no intracardiac shunt.
Which of the following is associated with the lowest risk of Maternal Mortality?
A) Termination of pregnancy
B) Initiation of prostacyclin therapy
C) Initiation of bosentan therapy
D) Initiation of anticoagulation therapy
E) Initiation of ACE inhibitor therapy
Bonus: Two points: What Super Bowl did Doug Williams win and who received the 80 yard bomb pass from him during the game?
Riddler #5 Answer
Pt has a new diagnosis of Primary Pulmonary HTN
Whether primary or secondary, carries a 30%-50% risk of maternal mortality
Pt should be counseled against continuing the pregnancy
Prostacyclin and Bosenten (pulmonary vasodilators) should be used if pt refuses termination
Anticoagulation should also be considered due to in-situ thrombosis
ACEI and ARB’s are teratogenic
68 y/o male describes a 2 year history of insomnia that she attributes to an inability to get comfortable in bed due to a “creepy crawly” sensation in her lower limbs. Physical exam is normal.
Absent during the day
Also bothersome when she sits
Walking relieves the sensation
What is the most likely diagnosis? (1pt)
Which of the following studies should be done next? (1pt)