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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|MainCategory=Pharmacology
Line 20: Line 20:
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Reproductive
|SubCategory=Reproductive
|Prompt=An infant is brought by his mother to his physician’s office because she thinks her child “does not look like other children”.  Upon further questioning, the mother informs the physician that she did not follow-up with her obstetrician during pregnancy and continued all her medications during pregnancy.   On physical examination, the physician notes that the patient has fingernail hypoplasia.  After appropriate evaluation, the physician tells the mother that her child’s abnormal appearance is due to 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 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?
|Explanation=[[Carbamazepine]] is the first line treatment for [[trigeminal neuralgia]].  It is also used to treat [[bipolar disorder]] and many [[types of seizures]].   There is sufficient evidence that carbamazepine has [[teratogenic]] effects.  Carbamazepine intake during pregnancy is associated with [[craniofacial]] [[defects]], [[fingernail hypoplasia]], and [[developmental delay]].  
|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]].  


Educational Objective:
|EducationalObjectives= Carbamazepine is the first line treatment for [[trigeminal neuralgia]].  Carbamazepine intake during pregnancy is associated with [[craniofacial defects]], [[fingernail hypoplasia]], and developmental delay.
Carbamazepine is the first line treatment for trigeminal neuralgia.  Carbamazepine intake during pregnancy is associated with 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;320:1661-1666.
 
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
|AnswerA=Trigeminal Neuralgia
 
|AnswerAExp=The first line of treatment for trigeminal neuralgia is [[carbamazepine]], a [[teratogen]] that may cause finger hypoplasia.
 
|AnswerAExp=The first line of treatment of 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 used to treat hypertension are teratogenic medications that can cause renal injury in the newborn.
|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 suffer DVT are required to be started on warfarin anticoagulation.  Warfarin is a teratogenic anticoagulant that causes bone deformities, ophthalmologic 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=Vitamin A derivative, isotretinoin is used to treat acne vulgaris.  It is a teratogenic that causes malformed ears, 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, a tetracycline, is used to treat rickettsial infections, including RMSF.  Doxycycline is a teratogenic antibiotic that causes discoloration of the teeth in children that might be permanent.  It is contraindicated in pregnancy and in young children.  
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=fingernail, hypoplasia, carbamazepine, trigeminal, neuralgia, teratogen
|WBRKeyword=fingernail hypoplasia, carbamazepine, trigeminal neuralgia, teratogen, pregnancy, medication, side-effects
|Approved=No
|Approved=Yes
}}
}}

Revision as of 15:12, 21 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Reproductive
Prompt [[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?]]
Answer A AnswerA::Trigeminal Neuralgia
Answer A Explanation [[AnswerAExp::The first line of treatment for trigeminal neuralgia is carbamazepine, a teratogen that may cause finger hypoplasia.]]
Answer B AnswerB::Hypertension
Answer B Explanation [[AnswerBExp::Angiotensin II converting enzyme (ACE) inhibitors, frequently used to treat hypertension, are teratogenic medications that may cause renal injury in newborns.]]
Answer C AnswerC::Deep vein thrombosis (DVT)
Answer C Explanation [[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.]]
Answer D AnswerD::Acne vulgaris
Answer D Explanation [[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.]]
Answer E AnswerE::Rocky Mountain Spotted Fever (RMSF)
Answer E Explanation [[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.]]
Right Answer RightAnswer::A
Explanation [[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.

Educational Objective: Carbamazepine is the first line treatment for trigeminal neuralgia. Carbamazepine intake during pregnancy is associated with 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;320:1661-1666.]]

Approved Approved::Yes
Keyword WBRKeyword::fingernail hypoplasia, WBRKeyword::carbamazepine, WBRKeyword::trigeminal neuralgia, WBRKeyword::teratogen, WBRKeyword::pregnancy, WBRKeyword::medication, WBRKeyword::side-effects
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