questions 2

Teratogens / Fetal Alcohol Syndrome

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Topic updated on 01/19/17 9:58pm

Overview

  • Week 1-3
    • "all-or-none": the embryo either dies or survives without any complications
  • Week 3-8 (Embryonic Period)
    • most vulnerable time period due to organogenesis
  • Week 8-38
    • growth and function of organ/embryo is affected
    • decreased susceptibility due to organs already formed
Teratogens
 
Examples
Effects on fetus
ACE inhibitors
  • Renal damage
    • renal dysplasia
Alcohol
  • Fetal Alcohol Syndrome
Alkylating agents
  • Absence of digits
  • Cleft palate
  • Renal agenesis
Aminoglycosides
  • CN VIII toxicity
Anticonvulsants
  • Cleft lip and palate
Cocaine
  • Abnormal fetal development
  • Fetal addiction
  • Low-birth weight
  • Placental abruption
Diethylstilbestrol (DES)
  • Vaginal clear cell adenocarcinoma
  • Other cervical, ovarian, and uterine abnormalities
Folate antagonists
  • Neural tube defects
    • myelomeningocele
Lithium
  • Ebstein's anomaly
    • atrialized right ventricle
Maternal diabetes
  • Caudal regression syndrome 
    • sirenomelia
    • renal dysplasia or aplasia
    • imperforate anus
Phenytoin
  • Cleft lip and palate
  • Congenital heart defects
Potassium iodide
  • Congenital goiter or hypothyroidism
  • Cretinism
Nicotine
  • Premature delivery
  • Low birth weight
  • Intrauterine growth retardation
  • ADHD
Tetracyclines
  • Discolored/stained teeth
Thalidomide
  • Gastrointestinal atresia 
  • Absence or malformation of external ear
  • Phocomelia 
    • "seal" limbs
Valproate
  • Inhibits intestinal folate absorption leading to neural tube defects
  • Cleft lip
  • Renal defects
Vitamin A/isotretinoin
  • Spontaneous abortions
  • Cleft palate
  • Cardiac abormalities
  • Eye and external abnormalities
Warfarin
  • Bone deformities
    • femur, vertebral, and calcaneus show stippled appearance on X-ray
  • Fetal hemorrhage
  • Abortion
  • Spasticity and seizures
 
Fetal Alcohol Syndrome
  • Fetal alcohol syndrome (FAS)
    • pregnant mothers who consume alcohol increase their risk of delivering a child with FAS:
      • mental retardation
      • limb dislocation
      • cardiovascular defects such as ventricular septal defects
      • microcephaly
      • holoprosencephaly
      • facial abnormalities: hypertelorism, short palepebral fissures, long philtrum
      • heart and lung fistulas
    • alcohol is leading cause of mental retardation


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(M1.EB.70) A 5-year-old boy presents for a regularly scheduled check-up. The child is wheelchair bound due to lower extremity paralysis and suffers from urinary incontinence. At birth, it was noted that the child had lower limbs of disproportionately small size in relation to the rest of his body. Radiograph imaging at birth also revealed several abnormalities in the spine, pelvis, and lower limbs. Complete history and physical performed on the child's birth mother during her pregnancy would likely have revealed which of the following? Topic Review Topic

1. Maternal hyperthyroidsim
2. Uncontrolled maternal diabetes mellitus
3. Maternal use of tetracyclines
4. Maternal use of lithium
5. Maternal use of nicotine

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