WBR0425
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pharmacology |
| Sub Category | SubCategory::Reproductive |
| Prompt | [[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?]] |
| Answer A | AnswerA::Trigeminal Neuralgia |
| Answer A Explanation | AnswerAExp::The first line of treatment of 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 used to treat hypertension are teratogenic medications that can cause renal injury in the newborn. |
| Answer C | AnswerC::Deep vein thrombosis (DVT) |
| Answer C Explanation | 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. |
| Answer D | AnswerD::Acne vulgaris |
| Answer D Explanation | 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. |
| Answer E | AnswerE::Rocky Mountain Spotted Fever (RMSF) |
| Answer E Explanation | [[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.]] |
| Right Answer | RightAnswer::A |
| Explanation | [[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.
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::No |
| Keyword | WBRKeyword::fingernail, WBRKeyword::hypoplasia, WBRKeyword::carbamazepine, WBRKeyword::trigeminal, WBRKeyword::neuralgia, WBRKeyword::teratogen |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |