WBR0425

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::