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Riddler Q6
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Riddler Q6

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  • 1. Riddler #5
    • 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.
  • 2. Riddler #5
    • 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?
  • 3. 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
  • 4. Riddler #6
    • 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
  • 5. Question
    • What is the most likely diagnosis? (1pt)
    • Which of the following studies should be done next? (1pt)
      • a) Serum ceruloplasmin
      • b) Serum ferritin level
      • c) Urine porphyrin level
      • d) Nerve conduction study
      • e) Magnetic resonance image of the brain

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