USMLE Forum Archives - USMLE Step 3 - Obstetrics- VSD
Obstetrics- VSD
harry206 - 05-13-09 09:34
A 25-year-old female comes to your office because she thinks that she might be pregnant. She has been a patient of yours for the past year. When she first came to your office last year, she was complaining of shortness of breath that occurs "even during the usual daily activities." In addition, her fingers would turn blue when she performed moderate activities. At that time, the physical findings and diagnostic work-up confirmed that she was suffering from ventricular septal defect with reversal of the shunt. She had developed severe pulmonary hypertension, which had caused the shunt reversal and symptoms of poor-exercise tolerance. Ever since, you have been managing her conservatively with the help of a cardiologist. She currently insists that she might be pregnant because she had unprotected sexual intercourse approximately two months ago, and she has not had her menses since that episode. Her urine sample is positive for beta-HCG. Which of the following is the most appropriate next step in the management of this patient?
harry206 - 05-13-09 09:34
A 25-year-old female comes to your office because she thinks that she might be pregnant. She has been a patient of yours for the past year. When she first came to your office last year, she was complaining of shortness of breath that occurs "even during the usual daily activities." In addition, her fingers would turn blue when she performed moderate activities. At that time, the physical findings and diagnostic work-up confirmed that she was suffering from ventricular septal defect with reversal of the shunt. She had developed severe pulmonary hypertension, which had caused the shunt reversal and symptoms of poor-exercise tolerance. Ever since, you have been managing her conservatively with the help of a cardiologist. She currently insists that she might be pregnant because she had unprotected sexual intercourse approximately two months ago, and she has not had her menses since that episode. Her urine sample is positive for beta-HCG. Which of the following is the most appropriate next step in the management of this patient?
The correct answer and explanation will be available after you answer.
Page 1
#1
Re: Obstetrics- VSD usmlefever3 - 05-13-09 10:07 My answer is: a.
Eisenmenger syndrome with right to left shunt causing cyanosis.this happens due to low systemic resistance in pregnancy than pulmonary resistance ...so blood flows from right to left .management should aim to correct systemic hypotension.
#10
Re: Obstetrics- VSD conym5 - 04-14-10 13:18 My answer is: a.
Continue conservative management and start treatment when she becomes symptomatic. Recommend an elective termination of pregnancy is obsolutely not done
#14
Re: Obstetrics- VSD babbu5508 - 08-31-10 05:03 My answer is: d.
d. Recommend an elective termination of pregnancy because eisenmenger syndrome has high fatality rate during pregnancy
Page 1