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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|QuestionAuthor= {{YD}} (Reviewed by  {{YD}} and  {{AJL}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|MainCategory=Pharmacology
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|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Reproductive
|SubCategory=Reproductive
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
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|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Reproductive
|SubCategory=Reproductive
|Prompt=A 1-year-old male is brought by his mother to the physician’s office because she observes that “he does not look like other children”.  Upon further questioning, the mother explains to you that she did not follow-up with her obstetrician and continued all her medications during pregnancy. Upon physical examination, you note that the patient has fingernail hypoplasia and with further evaluation, you inform the mother that her child’s abnormal appearance most likely resulted from the teratogenic effect of a medication during pregnancy. Which of the following conditions does the infant’s mother most likely suffer from before or during pregnancy?
|Prompt=A 1-year-old boy is brought to the physician’s office because his mother thinks that “he does not look like other children”.  The mother explains that she did not follow up with her obstetrician and continued all her prescribed drugs during pregnancy. Physical examination is remarkable for fingernail hypoplasia. Upon further evaluation, the physician informs the mother that her child’s abnormal appearance is most likely a result of the teratogenic effect of a drug she received during pregnancy. Which of the following diseases has this patient's mother suffered from before or during pregnancy?
|Explanation=[[Carbamazepine]] is the first line of treatment for [[trigeminal neuralgia]] and is also administered to treat [[bipolar disorder]] and [[seizures]]. [[Carbamazepine]] frequently has [[teratogenic]] effects.  [[Carbamazepine]] intake during pregnancy is associated with [[craniofacial]] defects, [[fingernail hypoplasia]], and [[developmental delay]].
|Explanation=[[Carbamazepine]] is the first line therapy for [[trigeminal neuralgia]]. It is also used to treat [[bipolar disorder]] and numerous [[types of seizures]]. Carbamazepine has [[teratogenic]] effects and administration during pregnancy is associated with the development of [[craniofacial]] [[defects]], [[fingernail hypoplasia]], and [[developmental delay]].
 
|AnswerA=Trigeminal neuralgia
|EducationalObjectives= Carbamazepine is the first line treatment for [[trigeminal neuralgia]].  Carbamazepine intake during pregnancy is associated with [[craniofacial defects]], [[fingernail hypoplasia]], and developmental delay.
|AnswerAExp=The first line therapy for trigeminal neuralgia (tic douloureux) is [[carbamazepine]], which is a [[teratogen]] associated with the development of finger hypoplasia.
|References= Lyons K, Lacro RV, Johnson KA, et al. Pattern of malformations in the children of women treated with carbamazepine during pregnancy. N Eng J Med. 1989;320:1661-1666.
 
|AnswerA=Trigeminal Neuralgia
|AnswerAExp=The first line of treatment for trigeminal neuralgia is [[carbamazepine]], a [[teratogen]] that may cause finger hypoplasia.
|AnswerB=Hypertension
|AnswerB=Hypertension
|AnswerBExp=[[Angiotensin II converting enzyme]] (ACE) inhibitors, frequently used to treat hypertension, are teratogenic medications that may cause renal injury in newborns.
|AnswerBExp=[[Angiotensin II converting enzyme]] (ACE) inhibitors are among the first line therapeutic options for the management of [[hypertension]]. ACE inhibitors are teratogens that is associated with renal injury among newborns.
|AnswerC=Deep vein thrombosis (DVT)
|AnswerC=Deep vein thrombosis (DVT)
|AnswerCExp=Patients who suffer from DVT are frequently started on [[warfarin anticoagulation]]. [[Warfarin]] is a teratogenic anticoagulant that may lead to bone deformities, ophthalmologic abnormalities, and fetal hemorrhage.
|AnswerCExp=Patients who experience a venous thromboembolism (VTE) event, namely DVT and PE, are administered [[warfarin]] for anticoagulation. [[Warfarin]] is a teratogenic anticoagulant that is associated with bone deformities, ophthalmological abnormalities, and fetal hemorrhage.
|AnswerD=Acne vulgaris
|AnswerD=Acne vulgaris
|AnswerDExp=A vitamin A derivative, [[isotretinoin]] is frequently used to treat [[acne vulgaris]]. It is a teratogenic that may cause malformed ears, [[cleft palate]], limb reduction defects, cardiac abnormalities, and craniofacial bone anomalies.
|AnswerDExp=Isotretinoin is a vitamin A derivative that is indicated for the treatment of [[acne vulgaris]]. It is a teratogen that is associated with ear malformations, [[cleft palate]], limb reduction defects, cardiac abnormalities, and craniofacial bone anomalies.
|AnswerE=Rocky Mountain Spotted Fever (RMSF)
|AnswerE=Rocky Mountain Spotted Fever (RMSF)
|AnswerEExp=[[Doxycycline]], a tetracycline, is frequently used to treat [[rickettsial infections]], including RMSF. [[Doxycycline]], a teratogenic antibiotic that can cause discoloration of the teeth in children, is contraindicated in pregnancy and in young children.  
|AnswerEExp=[[Doxycycline]] is a tetracycline that is indicated for the management of [[rickettsial infections]], including [[RMSF]]. [[Doxycycline]] is a teratogenic antibiotic agent that is associated with teeth discoloration among children when administered to pregnant women or children < 8 years of age.
|EducationalObjectives=Carbamazepine is the first line therapy for trigeminal neuralgia. Carbamazepine administration during pregnancy is associated with the development of craniofacial defects, fingernail hypoplasia, and developmental delay.
|References=Lyons K, Lacro RV, Johnson KA, et al. Pattern of malformations in the children of women treated with carbamazepine during pregnancy. N Eng J Med. 1989;320:1661-6.<br>
First Aid 2014 page 492, 554
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=fingernail hypoplasia, carbamazepine, trigeminal neuralgia, teratogen, pregnancy, medication, side-effects
|WBRKeyword=Fingernail hypoplasia, Carbamazepine, Trigeminal neuralgia, Teratogen, Pregnancy, Medication, Side effect, Drug, Adverse event, Adverse effect
|Approved=Yes
|Approved=Yes
}}
}}

Latest revision as of 00:31, 28 October 2020
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D. and Alison Leibowitz [1])]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Reproductive
Prompt [[Prompt::A 1-year-old boy is brought to the physician’s office because his mother thinks that “he does not look like other children”. The mother explains that she did not follow up with her obstetrician and continued all her prescribed drugs during pregnancy. Physical examination is remarkable for fingernail hypoplasia. Upon further evaluation, the physician informs the mother that her child’s abnormal appearance is most likely a result of the teratogenic effect of a drug she received during pregnancy. Which of the following diseases has this patient's mother suffered from before or during pregnancy?]]
Answer A AnswerA::Trigeminal neuralgia
Answer A Explanation [[AnswerAExp::The first line therapy for trigeminal neuralgia (tic douloureux) is carbamazepine, which is a teratogen associated with the development of finger hypoplasia.]]
Answer B AnswerB::Hypertension
Answer B Explanation [[AnswerBExp::Angiotensin II converting enzyme (ACE) inhibitors are among the first line therapeutic options for the management of hypertension. ACE inhibitors are teratogens that is associated with renal injury among newborns.]]
Answer C AnswerC::Deep vein thrombosis (DVT)
Answer C Explanation [[AnswerCExp::Patients who experience a venous thromboembolism (VTE) event, namely DVT and PE, are administered warfarin for anticoagulation. Warfarin is a teratogenic anticoagulant that is associated with bone deformities, ophthalmological abnormalities, and fetal hemorrhage.]]
Answer D AnswerD::Acne vulgaris
Answer D Explanation [[AnswerDExp::Isotretinoin is a vitamin A derivative that is indicated for the treatment of acne vulgaris. It is a teratogen that is associated with ear malformations, cleft palate, limb reduction defects, cardiac abnormalities, and craniofacial bone anomalies.]]
Answer E AnswerE::Rocky Mountain Spotted Fever (RMSF)
Answer E Explanation [[AnswerEExp::Doxycycline is a tetracycline that is indicated for the management of rickettsial infections, including RMSF. Doxycycline is a teratogenic antibiotic agent that is associated with teeth discoloration among children when administered to pregnant women or children < 8 years of age.]]
Right Answer RightAnswer::A
Explanation [[Explanation::Carbamazepine is the first line therapy for trigeminal neuralgia. It is also used to treat bipolar disorder and numerous types of seizures. Carbamazepine has teratogenic effects and administration during pregnancy is associated with the development of craniofacial defects, fingernail hypoplasia, and developmental delay.

Educational Objective: Carbamazepine is the first line therapy for trigeminal neuralgia. Carbamazepine administration during pregnancy is associated with the development of craniofacial defects, fingernail hypoplasia, and developmental delay.
References: Lyons K, Lacro RV, Johnson KA, et al. Pattern of malformations in the children of women treated with carbamazepine during pregnancy. N Eng J Med. 1989;320:1661-6.
First Aid 2014 page 492, 554]]

Approved Approved::Yes
Keyword WBRKeyword::Fingernail hypoplasia, WBRKeyword::Carbamazepine, WBRKeyword::Trigeminal neuralgia, WBRKeyword::Teratogen, WBRKeyword::Pregnancy, WBRKeyword::Medication, WBRKeyword::Side effect, WBRKeyword::Drug, WBRKeyword::Adverse event, WBRKeyword::Adverse effect
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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