 Welcome back to our MedSmarter question of the week where we're taking a smarter approach to preparing future physicians. Before we get started, if you'll take just a quick minute and click that like button and also subscribe and turn the bell on so that you'll be notified when we post new videos. Let's get right to that question. As always, we start with the last sentence of the vignette and then read the rest. Which of the following would most likely be found in this patient? A newborn is found to have strong, bounding pulses in both upper extremities and carotids, but her femoral pulses are very weak. She is diagnosed with coarctation of the aorta and is taken to surgery to correct the defect. Subsequent follow-up examinations showed no further heart abnormalities. 15 years later, the patient is noted to have poorly developed secondary sexual characteristics, including persistent, non-progressive tanner stage 2 breast and pubic hair development. She has not experienced menarche. Which of the following is the most likely to be found in this patient? What we're dealing with here is someone that had coarctation of the aorta when they were born and then started having a lack of secondary sexual characteristics and development once they hit the age of puberty. So this to me sounds like something like Turner syndrome. And they're wanting to know what would be found in the patient that would potentially have Turner syndrome. Remember, Turner syndrome is 45 XO, so they just don't have that second X chromosome there. Alright, let's check and look at our answer choices. Take a minute right now, read these choices, come up with your answer and type it in the comment box below. Let's go through these answer choices together. Normal ovaries. I know with Turner syndrome that their ovaries are not normal, they're actually a rudimentary ovary, so therefore that's my answer choice that's not a possible one for me. B, decreased estrogen levels. Decreased estrogen levels would explain the lack of progression through puberty and pubic hair development and no menarche. So I'm going to leave that one in. A 46 XY, we've already determined based on the question this is Turner syndrome, not 46 XY, which would make it a biologic male. So therefore that's not an option for me. D, semi-increase. Semi-increase is classic and down syndrome. We're talking Turner syndrome, not down syndrome, so that's not an answer choice. And then patent ductus arteriosus. So sometimes when we do have some heart and vascular issues, we can come up with a patent ductus arteriosus. In this particular case, Turner syndrome doesn't usually have any patent ductus arteriosus as part of the squella of its disease. Also, when we look up here that all they had was the coarctation of the aorta, and then for years and years later everything else showed no more heart anomalies. Therefore, why would they have a patent ductus arteriosus that should have been observed? So unless it was missed by a medical professional, patent ductus arteriosus does not fit this case either. Therefore we have B as our only remaining answer choice of decreased estrogen levels. And B is the correct answer. So, like we said earlier, this is Turner syndrome, and that is a 45 XO karyotype. And oftentimes they have coarctation in the order at birth, and then down the road when they are going through puberty, they have amenorrhea, and if you did a workup for them, a genetic workup, you would see that they have only one X chromosome. They don't have a bar body available there. They also have poor development of the secondary sex characteristics. And because of that ovary issue that we talked about, the rudimentary ovary, they are infertile. Of note here on some of these questions, if you did have a patient that was developing normally up until they got to puberty and they noticed some weird masses in their abdomen or some other similar type presentations, 46 XY karyotype, this is known as androgen insensitivity. And then one further note on the patent ductus arteriosus. We said that the cardiac exam was normal after they fixed the coarctation. If it weren't normal, we did have a patent ductus arteriosus. This is where you would see that machine-like murmur. If you found this material helpful for your studying, please like and consider subscribing to the channel. Also, share this video so that more people can benefit from it like you have.