Pregnancy: lithium: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Pregnancy: lithium

Sample item

A newborn is cyanosed with cardiomegaly, and echocardiography shows downward displacement of the tricuspid valve and an atrialised right ventricle. His mother took lithium for bipolar disorder in the first trimester. What is the diagnosis?

ATransposition of the great arteriesBCoarctation of the aortaCTetralogy of FallotDEbstein anomaly

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Ebstein anomaly

First-trimester lithium exposure is associated with Ebstein anomaly, a malformed tricuspid valve with apical displacement of the septal leaflet and an atrialised right ventricle. The absolute risk is small, but fetal echocardiography is advised. Maternal levels also change greatly in pregnancy and must be monitored.

Option by option

A. Transposition of the great arteries
Transposition is more often linked with maternal diabetes and does not feature tricuspid displacement.
B. Coarctation of the aorta
Coarctation is linked with Turner syndrome and shows a narrowing of the aortic arch.
C. Tetralogy of Fallot
Tetralogy of Fallot has pulmonary stenosis, VSD, overriding aorta and RV hypertrophy.
D. Ebstein anomaly (correct)
Correct. Apical displacement of the tricuspid valve is the hallmark of Ebstein anomaly.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Ebstein anomaly. First-trimester lithium exposure is associated with Ebstein anomaly, a malformed tricuspid valve with apical displacement of the septal leaflet and an atrialised right ventricle.

Why is "Transposition of the great arteries" not the answer?

Transposition is more often linked with maternal diabetes and does not feature tricuspid displacement.

Why is "Coarctation of the aorta" not the answer?

Coarctation is linked with Turner syndrome and shows a narrowing of the aortic arch.

Why is "Tetralogy of Fallot" not the answer?

Tetralogy of Fallot has pulmonary stenosis, VSD, overriding aorta and RV hypertrophy.

What concept does this question test?

It tests Pregnancy: lithium in Pharmacology. The absolute risk is small, but fetal echocardiography is advised. Maternal levels also change greatly in pregnancy and must be monitored.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pregnancy: lithium?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.