أسئلة محاضرة الـ Teratogenicity (حورس)
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Questions and Answers

What does the term teratogen refer to?

  • An agent that destroys normal cells
  • An agent that only affects certain genetic traits
  • An agent that promotes healthy fetal growth
  • An agent that alters structure or function during development (correct)
  • Which of the following principles of clinical teratology indicates that there are instances where teratogens do not cause any malformation?

  • Teratogens act at vulnerable periods
  • Teratogens can produce characteristic patterns
  • There are no absolute teratogens (correct)
  • Combination exposures increase risks
  • What is teratology primarily concerned with?

  • The treatment of congenital anomalies
  • The study of abnormalities in fetal development (correct)
  • The study of genetic disorders
  • The prevention of pregnancy complications
  • Which statement reflects the incidence of congenital anomalies globally?

    <p>Approximately 303,000 newborns die from congenital anomalies annually</p> Signup and view all the answers

    What describes the possible outcomes during the pre-implantation stage of development?

    <p>All or none response resulting in embryonic lethality</p> Signup and view all the answers

    What is the primary mechanism by which methotrexate acts as a teratogen?

    <p>Inhibition of dihydrofolate reductase</p> Signup and view all the answers

    Which of the following is a potential consequence during the fetal to neonatal stage as a result of teratogenic exposure?

    <p>Growth retardation</p> Signup and view all the answers

    Which of these categories does NOT fall under teratogenic agents?

    <p>Nutritional Supplements</p> Signup and view all the answers

    How does a deficiency of energy supply affect organogenesis during pregnancy?

    <p>Prevents the building of necessary organs</p> Signup and view all the answers

    Which of the following is an example of a congenital infection associated with teratogenicity?

    <p>Cytomegalovirus</p> Signup and view all the answers

    What type of abnormity is associated with chromosomal aberration during organogenesis?

    <p>Organ malformations</p> Signup and view all the answers

    Which of the following teratogenic agents can be classified as an environmental factor?

    <p>Tobacco smoke</p> Signup and view all the answers

    What is a common effect of hypoxia during the fetal development stage?

    <p>Reduced cognitive function</p> Signup and view all the answers

    What is the main consideration for using drugs during pregnancy?

    <p>Drugs should only be used if absolutely necessary to treat maternal health conditions</p> Signup and view all the answers

    Which of the following drug categories demonstrates that controlled human studies show no risk?

    <p>Category A</p> Signup and view all the answers

    Which category of drugs indicates that the evidence for risk outweighs any benefits?

    <p>Category X</p> Signup and view all the answers

    What can be concluded about Category B drugs?

    <p>They have OK animal studies but no human data</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with congenital syphilis?

    <p>Microphthalmia</p> Signup and view all the answers

    Which of the following is an example of a Category D drug?

    <p>Thalidomide</p> Signup and view all the answers

    What is a common finding in Fetal Cytomegalovirus syndrome?

    <p>Intracranial calcification</p> Signup and view all the answers

    What is true about Category C drugs according to the classification?

    <p>They may pose risks based on animal studies but lack human data</p> Signup and view all the answers

    Which of the following is a symptom of Fetal Rubella syndrome?

    <p>Choreo-retinitis</p> Signup and view all the answers

    Which of these drugs is associated with significant teratogenic risk?

    <p>Retinoids</p> Signup and view all the answers

    What syndrome is associated with congenital varicella zoster infection?

    <p>Fetal Varicella syndrome</p> Signup and view all the answers

    Which statement regarding drug categories in pregnancy is accurate?

    <p>Category A drugs have no demonstrated risk through controlled studies</p> Signup and view all the answers

    Which finding is typically NOT associated with congenital herpes simplex?

    <p>Saddle nose</p> Signup and view all the answers

    What is one of the most common outcomes of congenital infection by Toxoplasmosis gondii?

    <p>Fetal Toxoplasmosis syndrome</p> Signup and view all the answers

    What is a likely neurological consequence of congenital HIV/AIDS?

    <p>Microcephaly</p> Signup and view all the answers

    Which of the following is a characteristic finding of congenital cytomegalovirus?

    <p>Intracranial calcification</p> Signup and view all the answers

    What is a notable risk associated with the use of ACE inhibitors during the second and third trimester of pregnancy?

    <p>Oligohydramnios deformation sequence</p> Signup and view all the answers

    What is a potential effect of taking high doses of Vitamin A during pregnancy?

    <p>Sirenomelia</p> Signup and view all the answers

    Which antibiotics are associated with an increased risk of sensory-neural hearing loss in the fetus?

    <p>Streptomycin</p> Signup and view all the answers

    What type of birth defects can occur as a result of using Trimethoprim during pregnancy?

    <p>Cardiovascular defects</p> Signup and view all the answers

    What are common congenital anomalies linked with the use of anticonvulsants during pregnancy?

    <p>Cleft lip and/or palate</p> Signup and view all the answers

    Which of the following outcomes is linked to Corticosteroid use in pregnant women?

    <p>Cleft palate</p> Signup and view all the answers

    What is a notable risk of using Coumadin (Warfarin) during pregnancy?

    <p>Warfarin embryopathy</p> Signup and view all the answers

    What is the recommended maximum daily dose of Vitamin A during pregnancy?

    <p>8,000 units</p> Signup and view all the answers

    Which condition is associated with an increased risk of specific major malformations such as spina bifida and cleft lip?

    <p>Insulin dependent diabetes</p> Signup and view all the answers

    What is the recommended daily intake of folic acid to reduce the risk of neural tube defects during pregnancy?

    <p>400 micrograms</p> Signup and view all the answers

    What effect could hyperthyroidism, particularly due to Graves' disease, have on pregnancy?

    <p>Increased risk for loss of pregnancy</p> Signup and view all the answers

    Which teratogenic exposure is linked to anophthalmia and neural tube defects?

    <p>Excessive vitamin A</p> Signup and view all the answers

    Which maternal condition is NOT associated with an increased risk of early loss of pregnancy?

    <p>Gestational diabetes</p> Signup and view all the answers

    What is a potential consequence of paternal exposure to toxic substances?

    <p>Damaged sperm may not fertilize the egg</p> Signup and view all the answers

    What teratogenic effect is associated with malnutrition due to a lack of minerals?

    <p>Bone malformation from calcium deficiency</p> Signup and view all the answers

    Which of the following is a result of untreated fetal hyperthyroidism due to maternal Graves' disease?

    <p>Fetal hypothyroidism</p> Signup and view all the answers

    Which principle of clinical teratology suggests variability in how different embryos respond to teratogens?

    <p>Individual differences in susceptibility to teratogens exist.</p> Signup and view all the answers

    What is a significant outcome during the pre-implantation stage of development when exposed to teratogens?

    <p>Embryonic lethality.</p> Signup and view all the answers

    Which statement reflects a characteristic of teratogenic exposures in relation to patterns of anomalies?

    <p>They typically produce characteristic patterns of multiple anomalies.</p> Signup and view all the answers

    Which of the following best describes the concept of teratogenicity?

    <p>The potential to cause permanent changes in embryonic or fetal development.</p> Signup and view all the answers

    Which statement is true regarding the incidence of congenital anomalies globally?

    <p>An estimated 303,000 newborns die within the first month of life due to congenital anomalies.</p> Signup and view all the answers

    Which of the following findings is typically associated with congenital syphilis?

    <p>Rhinorrhea and conjunctival discharge at birth</p> Signup and view all the answers

    What is a noted effect of congenital rubella (German measles) on the fetus?

    <p>Cataracts and microphthalmia</p> Signup and view all the answers

    Which symptom is most directly associated with congenital varicella zoster infection?

    <p>Zigzag skin lesions</p> Signup and view all the answers

    Which of the following is a common neurological consequence of congenital herpes simplex?

    <p>Hydranencephaly</p> Signup and view all the answers

    What is a significant complication of congenital cytomegalovirus (CMV) infection?

    <p>Microcephaly and seizures</p> Signup and view all the answers

    Which of the following congenital infections is specifically linked to fetal Toxoplasmosis syndrome?

    <p>Intracranial calcifications</p> Signup and view all the answers

    Which category of drugs indicates that controlled animal studies are not acceptable, and no human data is available?

    <p>Category C</p> Signup and view all the answers

    What characteristic defines Category D drugs in terms of teratogenicity?

    <p>Evidence for risks exists but benefits outweigh them</p> Signup and view all the answers

    In congenital infections, which symptom is typically NOT associated with congenital herpes simplex?

    <p>Saddle nose</p> Signup and view all the answers

    Which condition is characterized by both gastrointestinal and genitourinary anomalies in a congenital infection?

    <p>Fetal varicella syndrome</p> Signup and view all the answers

    Which of the following is classified as a Category X drug due to its teratogenic potential?

    <p>Retinoids</p> Signup and view all the answers

    Which group of drugs is represented in the examples of potential teratogens specifically for hormonal effects?

    <p>Hormones including oral contraceptives</p> Signup and view all the answers

    What is the primary implication of categorizing a drug as Category B during pregnancy?

    <p>Animal studies indicate the drug is safe and no human data is available</p> Signup and view all the answers

    What is the main concern associated with the use of ACE inhibitors during the second and third trimesters of pregnancy?

    <p>Evidence for fetal renal impairment</p> Signup and view all the answers

    Which of the following drugs is commonly noted for its teratogenic risk particularly in the context of neurodevelopmental effects?

    <p>Antiepileptics</p> Signup and view all the answers

    Which of the following could result from maternal hyperthyroidism during pregnancy?

    <p>Risk of fetal hyperthyroidism</p> Signup and view all the answers

    What is a potential consequence of maternal hyperthermia during pregnancy?

    <p>Neural tube defects</p> Signup and view all the answers

    Which substance is primarily linked to Minamata Syndrome due to maternal exposure?

    <p>Mercury</p> Signup and view all the answers

    Which of the following maternal conditions can adversely affect fetal development?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What effect does lead exposure during pregnancy typically have?

    <p>Decreased fetal growth</p> Signup and view all the answers

    Which outcome is associated with exposure to carbon monoxide during pregnancy?

    <p>Fetal hypoxia</p> Signup and view all the answers

    Which developmental issues are linked to maternal hyperthermia at an early gestational stage?

    <p>Cleft lips and midfacial hypoplasia</p> Signup and view all the answers

    What is a likely consequence of maternal exposure to nicotine?

    <p>Inadequate fetal nutrition</p> Signup and view all the answers

    What is a common neurological disorder result of excessive lead exposure during pregnancy?

    <p>Encephalopathy</p> Signup and view all the answers

    What major developmental malformation is associated with insulin-dependent diabetes during pregnancy?

    <p>Transposition of great vessels</p> Signup and view all the answers

    How does maternal hyperthyroidism affect pregnancy outcomes?

    <p>Heightened risk for loss of pregnancy</p> Signup and view all the answers

    What nutritional deficiency during pregnancy is directly linked to conditions such as anophthalmia?

    <p>Vitamin A</p> Signup and view all the answers

    What is the recommended daily intake of folic acid to minimize risks of neural tube defects during pregnancy?

    <p>400 micrograms</p> Signup and view all the answers

    What effect does maternal malnutrition have regarding mineral deficiencies during pregnancy?

    <p>Increases the likelihood of preterm labor</p> Signup and view all the answers

    What is a significant risk associated with untreated systemic lupus erythematosus during pregnancy?

    <p>Congenital heart block in the fetus</p> Signup and view all the answers

    What consequence is likely if fathers are exposed to toxic substances affecting sperm cells?

    <p>Higher likelihood of genetic mutations in the offspring</p> Signup and view all the answers

    How does maternal hyperthyroidism, particularly in the case of Grave's disease, impact fetal development?

    <p>Can prompt fetal hypothyroidism due to antithyroid treatment</p> Signup and view all the answers

    Which of the following antisensory effects is linked to the use of aminoglycoside antibiotics during pregnancy?

    <p>Sensori-neural hearing loss</p> Signup and view all the answers

    What specific congenital defect may result from the use of Warfarin during pregnancy?

    <p>Cleft palate</p> Signup and view all the answers

    What is the teratogenic effect associated with high doses of vitamin A during pregnancy?

    <p>Sirenomelia</p> Signup and view all the answers

    Which of these drugs is likely to suppress fetal development when used during pregnancy?

    <p>Corticosteroids</p> Signup and view all the answers

    What is a potential outcome of taking Trimethoprim in pregnancy?

    <p>Cardiovascular defects</p> Signup and view all the answers

    Which of the following effects is most likely associated with the use of anticonvulsants during pregnancy?

    <p>Cleft lip and/or palate</p> Signup and view all the answers

    What is one of the major risks when using ACE inhibitors such as enalapril during the second and third trimester?

    <p>Neonatal hypotension</p> Signup and view all the answers

    Which defect is NOT commonly associated with the use of Tetracycline during pregnancy?

    <p>Congenital heart defects</p> Signup and view all the answers

    Study Notes

    Teratogenicity

    • Teratogen: An agent that causes permanent structural or functional alterations by interfering with normal embryonic/fetal development
    • Teratogenicity: The capability of producing fetal malformations
    • Teratology: The science studying causes, mechanisms, and patterns of abnormal development. Exposure to a teratogen leads to teratogenicity.

    Incidence of Birth Defects

    • Approximately 303,000 newborns die within 28 days of birth globally due to congenital anomalies (WHO, World Birth Defects Day: March 3, 2021)
    • Teratogens account for about 10% of birth defects.
    • Unknown causes or factors account for about 37% of birth defects.
    • Multifactorial factors contribute to about 42% of birth defects.
    • Chromosomal abnormalities account for approximately 3% of birth defects.
    • Monogenic disorders account for about 8% of birth defects.

    Principles of Clinical Teratology

    • No absolute teratogens exist
    • Susceptibility to teratogens differs between individuals
    • Embryogenesis and fetal development are vulnerable periods for teratogen exposure
    • Multiple teratogens can interact and have more significant effects than a single teratogen

    Critical Periods

    • Pre-implantation (fertilization to implantation)
    • Implantation to organogenesis (first two months)
    • Fetal/neonatal stage (second and third trimesters)

    Mechanisms of Action of Teratogens

    • Interference with nucleic acids (e.g., methotrexate)
    • Inhibition of enzymes
    • Deficiency in energy supply needed for organ building
    • Lack of necessary substrates
    • Replication, transcription, or RNA translation
    • Preventing folic acid formation
    • Glucose deficiency
    • Internal respiration interference
    • Hypoxia
    • Vitamin or mineral absorption issues
    • Genetic mutations
    • Chromosomal aberrations

    Teratogenic Agents

    • Infectious agents (e.g., toxoplasmosis, syphilis, CMV, rubella, varicella zoster, herpes simplex, HIV/AIDS, tuberculosis)
    • Environmental chemicals and physical agents (e.g., alcohol, ionizing radiation, toluene, tobacco, maternal hyperthermia, cocaine, lead, mercury, carbon monoxide, pesticides)
    • Drugs and pharmaceuticals
    • Maternal disorders (e.g., diabetes, hypothyroidism, hyperthyroidism, systemic lupus erythematosus, malnutrition)

    Congenital Infections (STORCH)

    • Toxoplasmosis gondii
    • Syphilis (Treponema pallidum)
    • Cytomegalovirus (CMV)
    • Rubella (German Measles)
    • Varicella-zoster (Chickenpox)
    • Herpes simplex
    • HIV/AIDS
    • Tuberculosis

    Congenital Infections (examples with syndromes)

    • Fetal toxoplasmosis syndrome
    • Fetal syphilis syndrome
    • Fetal CMV syndrome
    • Fetal rubella syndrome
    • Features of varicella zoster syndrome: hypoplasia, paresis, skin lesions, eye findings, CNS anomalies

    Drugs and Pharmaceuticals

    • All drugs have theoretical teratogenic potential.
    • Medications should be carefully considered during pregnancy.
    • FDA classification system for drug risk during pregnancy:
    • Category A: no risk in human studies
    • Category B: no risk in animal studies, limited human data
    • Category C: animal studies show risk; limited human data
    • Category D: Evidence of risk; potential benefits outweigh risk
    • Category X: risk outweighs any potential benefits

    Examples of Specific Medications and Exposures

    • Angiotensin-converting enzyme (ACE) inhibitors
    • Antibiotics (streptomycin, tetracycline, trimethoprim)
    • Anticoagulants (coumadin/warfarin)
    • Anticonvulsants
    • Vitamins (vitamin A, folic acid, vitamin D, minerals)
    • Corticosteroids
    • Oral contraceptives
    • Androgenic agents
    • Acetyl salicylic acid (aspirin)
    • Chemotherapy agents
    • Antiparasitic agent (metronidazole)
    • Lithium

    Maternal Disorders

    • Diabetes mellitus: increased risk of early pregnancy loss and major birth defects
    • Hypothyroidism: increased risk of pregnancy loss, but not affecting fetal thyroid development
    • Hyperthyroidism: increased risk of pregnancy loss

    Environmental and Chemical/Physical Agents

    • Alcohol (fetal alcohol syndrome)
    • Ionizing radiation
    • Toluene (glue sniffing)
    • Tobacco (nicotine)
    • Maternal hyperthermia
    • Cocaine
    • Lead
    • Mercury
    • Carbon monoxide
    • Pesticides

    Maternal Hyperthermia

    • Temperatures above 38.9°C (102°F) over a 24-hour period or more with an intercurrent illness
    • Minimal exposure (30-45 mins) in hot environments can be harmful during weeks 4-14 of pregnancy.
    • Can lead to IUGR, microcephaly, central nervous system damage, among others

    Tobacco (Nicotine)

    • Associated with reduced fetal growth, increased prematurity risk, and death

    Lead

    • Found in old paint and water pipes
    • Causes abortions, anemia, neurological problems, brain & MR abnormal development

    Mercury

    • Exposure through fish consumption or contaminated seed corn
    • Associated with Minamata Syndrome.

    Carbon Monoxide

    • Results from incomplete combustion, inhalation leads to oxygen starvation (hypoxia) in the fetus.
    • Associated with spontaneous abortion, stillbirth, and growth/development retardation.

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