WBR0425
| 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. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::fingernail hypoplasia, WBRKeyword::carbamazepine, WBRKeyword::trigeminal neuralgia, WBRKeyword::teratogen, WBRKeyword::pregnancy, WBRKeyword::medication, WBRKeyword::side-effects |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |