teratogens

Question 1

early fetal development - when is extremely susceptible to teratogens

Answer 1

embryonic period (3-8 weeks)

Question 2

teratogens effects according to period

Answer 2

before week 3 –> all-or-none
3-8 weeks (embryonic period - most suscpetible)
after 8 weeks –> growth and function affected

Question 3

Antibiotics to avoid in pregnancy (and why)

Answer 3

1. Sulfonamides –> Kernicterus
2. Amniglycosides –> Ototoxicity
3. Fluoroquinolones –> Cartilage damage
4. macrolides –> embryotoxic
5. tetracyclines –> DIscolored teeth, inhibiton of growth
6. Chloramphenicol –> Gray babe syndrome
7. Griseofluvin –> teratogenic
8. Ribavirin (antiviral)

Question 4

drugs and substance that affect pregnancy (beside antibiotics) (14)

Answer 4

1. ACE inhibitors 2. Alkylating agents 3. Antiepileptics
2. Diethylstibestrol 5. Folate antagonists
3. Isotretinoin 7. Lithium 8. Methimazol
4. Thalidomide 10. Warfarin 11. Alcohol 12. Cocaine
5. Smoking (nicotine, CO) 14. others factors

Question 5

Alkylating agents - effects on fetus

Answer 5

1. absence of digits

2. multiple anomalies

Question 6

aminoglycosides - effects on fetus

Answer 6

ototoxicity

Question 7

Warfarin - effects on fetus

Answer 7

1. bone deformities
2. fetal hemorrhage
3. abortion
4. opthalmologic abnormalities

Question 8

lithium - effects on fetus

Answer 8

Ebstein anomay: apical displacement of tricuspid valve

Question 9

Methimazole - effects on fetus

Answer 9

aplasia cutis congenita

Question 10

tetracyclines - effects on fetus

Answer 10

1. discolored teeth

2. inhibited bone growth

Question 11

thalidomide - effects on fetus

Answer 11

limb defects (phocomelia, micromelia - flipper limbs)

Question 12

phocomelia

Answer 12

a rare congenital deformity in which the hands or feet are attached close to the trunk, the limbs being grossly underdeveloped or absent.

Question 13

micromelia

Answer 13

limb is abnormally shortened

Question 14

isotretinoin (13-cis retinoic acid) - effects on fetus

Answer 14

multiple severe birth defects (contraception mandatory)

Question 15

Folate antagonists - effects on fetus

Answer 15

neural tube defects

Question 16

Folate antagonists include ….(drugs)

Answer 16

1. TMP
2. Methotrexate
3. antiepileptic drugs

Question 17

Diethylstilbestrol - effects on fetus

Answer 17

1. vaginal clear cell adenocarcinoma

2. congenital Mullerian anomalies

Question 18

antiepileptic drugs - effects on fetus

Answer 18

1. neural tube defects
2. cardiac defects
3. cleft palate
4. skeletal abnormalities (phalanx/nail) hypoplasia, facial dysmorphism)

Question 19

antiepileptic drugs that affect fetus - which drugs Most commonly

Answer 19

1. carbamazepine
2. phenobarbital
3. phenytoin
4. valproate

Question 20

antiepileptic drugs - co-administration with

Answer 20

high-dose folate supplementation

Question 21

Ace inhibitors - effects on fetus

Answer 21

renal damage

Question 22

substance abuse that affects fetus

Answer 22

1. Alcohol
2. cocaine
3. Smoking (nicotine, CO)

Question 23

alchohol abuse - effects on fetus

Answer 23

1. common cause of birth defects and intellectual disability
2. fetal alcohol syndrome

Question 24

cocaine abuse - effects on fetus

Answer 24

1. low birth weight
2. preterm birth
3. Intrauterine growth restriction (IUGR)
4. placental abruption

Question 25

cocaine - mechanism of effect on fetus

Answer 25

vasoconstriction

Question 26

smoking - mechanism of effect on fetus

Answer 26

nicotine --> vasoconstriction | CO --> impaired 02 delivery

Question 27

smoking - effects on fetus

Answer 27

1. Low birth weight (leading cause in developed countries) 2. preterm labor 3. placental problems 4. Intrauterine growth restriction (IUGR) 5. SIDS

Question 28

Other factors that affect fetus

Answer 28

1. iodine (lack or excess) 2. Maternal diabetes 3. Methylmercury 4. Vitamin A excess 5. X-rays

Question 29

iodine (lack or excess) - effect on fetus

Answer 29

congenital goiter or hypothiroidism (cretinism)

Question 30

Maternal diabetes - effect on fetus

Answer 30

1. Caudal regression syndrome or sacral agenesis (anal atresia to sirenomelia-fused leg together) 2. congenital heart defects 3. neural tube defects 4. macrosomia

Question 31

Caudal regression syndrome

Answer 31

Sacra agenesis : anal atresia to sirenomelia-fused leg togethe

Question 32

Methylmercury - effect on fetus

Answer 32

neurotoxicity

Question 33

Methylmercury - found?

Answer 33

1. swordfish 2. shark 3. tilefish 4. king mackerel

Question 34

Vitamin A excess - effect on fetus

Answer 34

Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac)

Question 35

X-rays - effect on fetus

Answer 35

1. Microcephaly | 2. intellectual disability

Question 36

How to minimize X-rays effect on fetus

Answer 36

lead shielding

Question 37

Leading cause of low body weight in in developed countries

Answer 37

smoking

Question 38

Leading cause of intellectual disability in USA

Answer 38

Fetal alcohol syndrome

Question 39

Fetal alcohol syndrome - mechanism

Answer 39

failure of cell migration

Question 40

newborns of alcohol consumption mothers have increased incidence of congenital abnormalities, including

Answer 40

1. pre and postnatal developmental retardation 2 2. microcephaly 3. facial abnormalities 4. limb disolocation 5. heart defects 6. heart-lung fistulas 7. holoprosencephaly

Question 41

Fetal alcohol syndrome - Most severe form

Answer 41

1. heart-lung fistulas | 2. holoprosnecephaly

Question 42

Fetal alcohol syndrome - facial abnormalities

Answer 42

1. smooth philtrum 2. thin vermilion border (upper lip) 3. small palpebras fissures

Question 43

aplasia cutis congenita - drug

Answer 43

methimazole

Question 44

limb defects (phocomelia, micromelia - flipper limbs) - drug

Answer 44

Thalidomide

Question 45

congenital Mullerian anomalies - drug

Answer 45

Diethylstilbestrol

Question 46

drugs that affect bone/limbs of fetus (and how)

Answer 46

1. Warfarin (bone deformities) 2. tetracyclines (inhibited bone growth) 3. thalidomide (limb defects (phocomelia, micromelia - flipper limbs)) 4. alcohol (limb disolocation) 5. antiepileptics (skeletal abnormalities (phalanx/nail) hypoplasia, facial dysmorphism))

Question 47

opthalmologic abnormalities of fetus - drug

Answer 47

warfarin

Question 48

vaginal clear cell adenocarcinoma - drug

Answer 48

Diethylstilbestrol

Question 49

neurotoxicity of fetus - drug

Answer 49

Methylmercury

Question 50

Intrauterine growth restriction (IUGR) - drugs

Answer 50

1. Smoking | 2. cocaine

Question 51

congenital cardiac defect associations - fetal alcohol syndrome

Answer 51

1. VSD 2. ASD 3. PDA | 4. tetrallogy of fallot

Question 52

congenital cardiac defect associations - congenital rubella

Answer 52

1. septal defects 2. PDA 3. Pulmonary stenosis

Question 53

congenital cardiac defect associations - down syndrome

Answer 53

1. AV septal defect (endocardial cushion defect) | 2. VSD 3. ASD

Question 54

congenital cardiac defect associations - diabetic mother

Answer 54

transposition of great vessels

Question 55

congenital cardiac defect associations - Marfan

Answer 55

1. MVP 2. Thoracic aortic aneurysm 3. Thoracic aortic dissection 4. Aortic regurgitation

Question 56

congenital cardiac defect associations - Prenatal lithium exposure

Answer 56

Ebstein anomaly

Question 57

congenital cardiac defect associations - Turner syndrome

Answer 57

1. bicuspid aortic valve | 2. coarctation of aorta

Question 58

congenital cardiac defect associations - Williams syndrome

Answer 58

supravalvular aortic stenosis

Question 59

congenital cardiac defect associations - 22q11 syndrome

Answer 59

1. Truncus arteriosus | 2. Tetralogy of Fallot

Question 60

bicuspid aortic valve complications

Answer 60

1. AR 2. AS 3. AORTIC DISSECTION 4. THORACIC AORTIC ANEURYSM 5. coarctation of the aota