Updated: 4/1/2020

Teratogens

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Topic
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Questions
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https://upload.medbullets.com/topic/103005/images/aplasia_1.jpg
https://upload.medbullets.com/topic/103005/images/meningo_1.jpg
https://upload.medbullets.com/topic/103005/images/teeth_.jpg
https://upload.medbullets.com/topic/103005/images/03252020vldebstein_sanomaly.jpg
https://upload.medbullets.com/topic/103005/images/meningomy_us.jpg
Snapshot
  • A 35-year-old G1P0 woman gives birth to a baby with the scalp finding seen in the image. A few months prior to her discovery that she was pregnant, she had symptoms of palpitations, heat intolerance, and weight loss. She was diagnosed with Graves disease and prescribed methimazole by her endocrinologist. During her pregnancy, she missed several routine prenatal appointments and inadvertently continued taking many of the same medications that she had been taking prior to her pregnancy, including methimazole. 
Introduction
  • Overview
    • teratogens are agents that can cause abnormal fetal development and birth defects
      • effects vary depending on timing of fetal exposure to the teratogen
        • weeks 1-3 of gestation
          • "all-or-none" effects 
            • the embryo either dies or survives without any complications
        • weeks 3-8 of gestation
          • embryonic period
          • most susceptible time period due to organogenesis
        • week 8 of gestation until birth
          •  growth and function of organs are affected
 
Teratogens
Substance Abuse
Teratogen Effects on Fetus
Alcohol
  • Fetal alcohol sydrome 
Cocaine
  • Low birth weight
  • Preterm birth
  • Intrauterine growth retristriction
  • Placental abruption
Nicotine
  • Low birth weight
  • Preterm labor
  • Placental problems
  • Sudden infant death syndrome
  • ADHD
Medications
ACE inhibitors (i.e., lisinopril)
  • Renal damage
    • renal dysplasia
Alkylating agents (i.e., cyclophosphamide)
  • Absence of digits
  • Cleft palate
  • Renal agenesis
Aminoglycosides (i.e., gentamicin)
  • Ototoxicity
Antiepileptic drugs (i.e., phenytoin)
  • Neural tube defects
  • Cardiac defects
  • Cleft lip and palate
Diethylstilbestrol
  • Vaginal clear cell adenocarcinoma
  • Congenital cervical, ovarian, and uterine abnormalities
Folate antagonists (i.e., methotrexate)
  • Neural tube defects
    • meningomyelocele  
Isotretinoin
  • Multiple severe birth defects (i.e., cleft palate, microphthalmia, and congenital heart defects)
Lithium
  • Ebstein anomaly  
Methimazole
  • Aplasia cutis congenita
Tetracyclines (i.e., doxycycline)
  • Discolored teeth
  • Inhibited bone growth
Thalidomide
  • Limb defects
Warfarin
  • Bone deformities
  • Fetal hemorrhage
  • Abortion
  • Ophthalmologic abnormalities
 

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Questions (4)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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(M1.EB.14.70) 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? Review Topic | Tested Concept

QID: 106476
1

Maternal hyperthyroidsim

5%

(12/241)

2

Uncontrolled maternal diabetes mellitus

43%

(104/241)

3

Maternal use of tetracyclines

20%

(48/241)

4

Maternal use of lithium

15%

(37/241)

5

Maternal use of nicotine

14%

(33/241)

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