A 30-year-old woman comes to the physician complaining of headaches, blurry vision, and fatigue. She can walk only 3-4 blocks before becoming tired and developing cramps in her legs. She does not use alcohol or tobacco.
Her blood pressure is 188/105 mm Hg and pulse is 78/min. Funduscopic examination reveals retinal hemorrhages. A continuous murmur is heard at the left and right sides of the anterior chest. Lungs are clear. No abdominal masses are palpated. Femoral pulses are faint bilaterally.
Laboratory results are as follows:

Which of the following is the most likely associated feature in this patient?

Question

A 30-year-old woman comes to the physician complaining of headaches, blurry vision, and fatigue.  She can walk only 3-4 blocks before becoming tired and developing cramps in her legs.  She does not use alcohol or tobacco.
Her blood pressure is 188/105 mm Hg and pulse is 78/min.  Funduscopic examination reveals retinal hemorrhages.  A continuous murmur is heard at the left and right sides of the anterior chest.  Lungs are clear.  No abdominal masses are palpated.  Femoral pulses are faint bilaterally.
Laboratory results are as follows:

Which of the following is the most likely associated feature in this patient?

Quizplus · Accepted Answer

11ec193a_9753_5118_853d_217aa5f18411_MD0002_00 This patient's clinical signs of continuous cardiac murmur, hypertension, and diminished femoral pulses are suggestive of coarctation of the aorta. Severe hypertension can cause headaches, blurred vision, or epistaxis or can present as aortic dissection. Coarctation of the aorta is an associated anomaly in approximately 3%-10% of patients with Turner syndrome. Women with Turner syndrome have typical phenotypic features with short stature, short and webbed neck, broad square-shaped chest with widely spaced nipples, facies with micrognathia, and high arched palate. There is a 20%-30% prevalence of bicuspid aortic valve in these patients. Aortic root dilation and/or dissection can also be seen. Coarctation of the aorta (Choices A and E) These findings are not associated with aortic coarctation or Turner syndrome. (Choice B) Epicanthic folds are skin folds over the medial aspect of the eyes seen in patients with trisomy 21 (Down syndrome). Typical cardiovascular abnormalities seen in Down syndrome are atrioventricular septal defects, ventricular septal defect, atrial septal defect, tetralogy of Fallot, and patent ductus arteriosus. (Choice C) Skeletal abnormalities in Turner syndrome patients include short stature, short webbed neck, scoliosis, cubitus valgus, and short metacarpals. Short forearms and thumbs are not phenotypic features of this syndrome. Educational objective: Patients with phenotypic features of Turner syndrome should be evaluated for associated cardiovascular anomalies, including bicuspid aortic valve, coarctation of the aorta, and aortic root dilatation. __________ References: Turner syndrome: diagnosis and management. (http://www.ncbi.nlm.nih.gov/pubmed/17708142) Cardiovascular malformations in Turner syndrome. (http://www.ncbi.nlm.nih.gov/pubmed/16232358)

A 30-Year-Old Woman Comes to the Physician Complaining of Headaches