Riddler #5 <ul><li>20 y/o female in her 1 st  trimester, is referred to you for progressive dyspnea.  An echo reveals seve...
Riddler #5 <ul><li>Which of the following is associated with the lowest risk of Maternal Mortality? </li></ul><ul><li>A) T...
Riddler #5 Answer <ul><li>Pt has a new diagnosis of Primary Pulmonary HTN </li></ul><ul><li>Whether primary or secondary, ...
Riddler #6 <ul><li>68 y/o male describes a 2 year history of insomnia that she attributes to an inability to get comfortab...
Question <ul><li>What is the most likely diagnosis? (1pt) </li></ul><ul><li>Which of the following studies should be done ...
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Riddler Q6

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Riddler Q6

  1. 1. Riddler #5 <ul><li>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. </li></ul>
  2. 2. Riddler #5 <ul><li>Which of the following is associated with the lowest risk of Maternal Mortality? </li></ul><ul><li>A) Termination of pregnancy </li></ul><ul><li>B) Initiation of prostacyclin therapy </li></ul><ul><li>C) Initiation of bosentan therapy </li></ul><ul><li>D) Initiation of anticoagulation therapy </li></ul><ul><li>E) Initiation of ACE inhibitor therapy </li></ul><ul><li>Bonus: Two points: What Super Bowl did Doug Williams win and who received the 80 yard bomb pass from him during the game? </li></ul>
  3. 3. Riddler #5 Answer <ul><li>Pt has a new diagnosis of Primary Pulmonary HTN </li></ul><ul><li>Whether primary or secondary, carries a 30%-50% risk of maternal mortality </li></ul><ul><li>Pt should be counseled against continuing the pregnancy </li></ul><ul><li>Prostacyclin and Bosenten (pulmonary vasodilators) should be used if pt refuses termination </li></ul><ul><li>Anticoagulation should also be considered due to in-situ thrombosis </li></ul><ul><li>ACEI and ARB’s are teratogenic </li></ul>
  4. 4. Riddler #6 <ul><li>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. </li></ul><ul><ul><li>Absent during the day </li></ul></ul><ul><ul><li>Also bothersome when she sits </li></ul></ul><ul><ul><li>Walking relieves the sensation </li></ul></ul>
  5. 5. Question <ul><li>What is the most likely diagnosis? (1pt) </li></ul><ul><li>Which of the following studies should be done next? (1pt) </li></ul><ul><ul><li>a) Serum ceruloplasmin </li></ul></ul><ul><ul><li>b) Serum ferritin level </li></ul></ul><ul><ul><li>c) Urine porphyrin level </li></ul></ul><ul><ul><li>d) Nerve conduction study </li></ul></ul><ul><ul><li>e) Magnetic resonance image of the brain </li></ul></ul>

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