A 2-day-old male neonate presents to the emergency department with increasing cyanosis and difficulty breathing. The baby was born at term via vaginal delivery with no complications during pregnancy or birth. The Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. On day 2 of life, the parents noticed the baby turning blue during feeding and being less active. The family denies any history of congenital heart disease. On physical examination, the baby appears cyanotic with oxygen saturation of 78% on room air. There is a systolic murmur best heard at the left sternal border and diminished peripheral pulses. The neonate’s respiratory rate is 70 breaths/min, and he shows signs of poor perfusion with cool extremities. Initial workup includes a chest X-ray showing cardiomegaly and reduced pulmonary vascular markings. An echocardiogram reveals severe coarctation of the aorta, a ductal-dependent cardiac lesion where systemic blood flow relies on a patent ductus arteriosus (PDA) to bypass the narrowing in the aortic arch. Which of the following medications is used to keep the ductus arteriosus patent and can be life-saving in neonates with ductal dependent cardiac lesions? 

A mother brought her 8 month-old baby to the emergency room because the baby appears to be having trouble breathing. He is also not gaining weight as he should, gets frequent respiratory infections, gets short of breath and becomes sweaty when crying or playing. Upon further enquiry, the mother reports that she took some medications during her pregnancy with this child, ‘a vitamin pill’ ‘an energy pill’ and ‘some other pill’ her father-in-law gave her, which helped him a lot. She is not able to recollect its name. On physical examination of the baby, a continuous “machinelike” murmur is heard and you note signs of pulmonary congestion. Of the following, this mother probably took which medication, that caused a congenital heart disorder in this baby?

A 7-month-old male infant is brought to the emergency room by his mother, who notes that he appears to be having trouble breathing. Upon speaking with the mother, you discover that she suffered from a serious infection during her pregnancy and that the this baby was born with fever, stuffy nose, pink eyes, swollen glands around the head and neck and a red-pink skin rash made up of small spots which the delivering doctor called ‘blueberry muffin rash’. On physical examination of the baby, a continuous “machinelike” murmur is heard and you note signs of pulmonary congestion. Which of the following, which congenital infection is most commonly associated with this disorder of the baby?

You’re overseeing the discharge of a 26-year-old woman from the hospital after she had stayed in the hospital for 3 days for pulmonary embolism. As you prepared her discharge instructions, the floor nurse came and informed you that the patient developed a severe headache, sudden trouble seeing in one eye, dizziness, loss of balance and right sided weakness. Patient reports that her symptoms started suddenly while she was straining at the stool during a bowel movement. You suspected a stroke in this patient and wondered how such a young woman all of a sudden could get a stroke. You glanced over her medical record. She has no history of hypertension, diabetes or prior stroke or transient ischemic attacks. She does not smoke but drinks occasionally. She is sexually active. She works as a bank executive and four days ago, she returned home taking a 17-hour long transcontinental flight after attending a financial conference in Singapore. She developed chest pains 3 days ago, came to the emergency department, eventually diagnosed with pulmonary embolism, admitted and treated for it. Her current medications include a combination pill for contraception, colace for constipation, and a low-molecular weight heparin for the treatment of pulmonary embolism. On physical examination, you notice right sided weakness and normal heart examination. Which of the following is a risk factor for paradoxical emboli-associated cryptogenic stroke in this patient?

You’re overseeing the discharge of a 26-year-old woman from the hospital after she had stayed in the hospital for 3 days for pulmonary embolism. As you prepared her discharge instructions, the floor nurse came and informed you that the patient developed a severe headache, sudden trouble seeing in one eye, dizziness, loss of balance and right sided weakness. Patient reports that her symptoms started suddenly while she was straining at the stool during a bowel movement. You suspected a stroke in this patient and wondered how such a young woman all of a sudden could get a stroke. You glanced over her medical record. She has no history of hypertension, diabetes or prior stroke or transient ischemic attacks. She does not smoke but drinks occasionally. She is sexually active. She works as a bank executive and four days ago, she returned home taking a 17-hour long transcontinental flight after attending a financial conference in Singapore. She developed chest pains 3 days ago, came to the emergency department, eventually diagnosed with pulmonary embolism, admitted and treated for it. Her current medications include a combination pill for contraception, colace for constipation, and a low-molecular weight heparin for the treatment of pulmonary embolism. On physical examination, you notice right sided weakness and normal heart examination. Which of the following is the most likely cause of her stroke?