Teratogens

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This is any agent that causes a structural abnormality following fetal exposure during pregnancy.

Teratogen

T/F. An increased prevalence of a particular birth defect is usually what leads to the discovery of a teratogenic agent.

True

Methyl mercury was found to be a teratogen when it was dumped into the bay from a local factor (Chisso) and mother's ate the contaminated fish during pregnancy. It lead to increased incidence of birth defects that lead to an investigation. What was the name of this disease?

Minamata Disease

In what trimester is a baby most vulnerable to teratogens?

1st

This is a known teratogen that is used to treat skin problems and nausea. It was originally given for nausea during pregnancy, but it caused face and limb abnormalities.

Thalidamide

This is a known teratogen that was a therapeutic (antibiotic) that caused damage to developing LONG BONES and dental tissue.

Tetracycline

T/F. Alcohol, nicotine, crack, methamphetamine, LCD, or PCP are NOT known teratogens.

False, they are

This is an infectious agent also known as the German Measles that can cause deafness and microcephaly.

Rubella

This is an infectious agent (VIRUS) that is a known teratogen to cause hearing loss.

CMV

Name four other infectious agents that are important fetal teratogens.

HIV
Syphilis
Toxoplasmosis
Herpes Simplex

Name three maternal diseases (mother has them) that can be fetal teratogens.

AIDS
DM
Phenylketonuria

T/F. Environmental agents such as organic compounds, mercury, PCB, herbices, and solvents are all important fetal teratogens.

True

When a fetus is exposed to a tertaogen, what two things are often the determining factor for the severity and the type of defect?

Time they were exposed (what trimester)
Dose of exposure

Dose Response: The greater the dose the _________ the effect.

Greater

Certain stages of development are more vulnerable than others. In general, which is the more vulnerable trimester?

1st

Repeat: This antibiotic causes irreversible tooth defects and diminished growth of LONG BONES.

Tetracycline

Repeat: This anti-nausea drug causes limb deformities and CVD (cardiovascular disease).

Thalidamide

Streptomycin is known to cause?

Deafness

Warfarin (anticoagulant) is known to cause mental retardation and what eye problem?

Optic Atrophy

T/F. Trimethadione and Phenytoin (Seizure meds) are known to cause IUGR (inuteral growth retardation), MR, and CV defects.

True

T/F. Accutane is not known to cause microphthlamia, brain and heart defects.

False, it is!

Mercury can cause CNS defects, MR, and ______.

Blindness

True/Flase. Lithium can cause congenital cardiac/large vessel abnormalities.

True

Nicotine is known to cause IUGR and this eye problem!

Strabismus

What syndrome are oral contraceptives known to cause?

Vacteryl Syndrome (Mermaid syndrome)

T/F. Alcohol cannot cause FAS, IUGR, or MR.

False, it can

What is the relationship of the following to the incidence of strabismus?

1. Coffee
2. Tea
3. Alcohol
4. Smoking

1. Coffee: No relationship
2. Tea: No relationship
3. Alcohol: INVERSE relationship
4. Smoking: DIRECT relationship

What is the greatest risk to fetus from 2nd hand smoke? (i.e. What does it cause?)

Premature birth

Patients taking this acne medicine are required to take a pregnancy test before Rx is given (and monthly thereafter), pledge that they will not get pregnant during time of use, and have proof of contraception during use.

Accutane

Repeat: What is the main issue for second hand smoke?

Prematurity

T/F. Non-smoking women ofter the age of 30 living with a smoker had much greater chance of delivering a premature baby.

True

What are two consequences of premature birth (socially)?

Expensive
May be hard on child later

About how many pregnancies could be affected by second hand smoke?

30,000

Fetal Alcohol Syndrome: Patient can develop IUGR (slow fetal growth), MR, _______, small _____ _____ (width, not height), and _______. They may also have no philtrum, a thin ______ lip and BEHAVIORAL problems.

Microcephaly (Small head)
Small Palpebral Fissures
Strabismus
Upper

What are the six main malformations caused by the VACTERL syndrome (due to oral contraceptive use during pregnancy).

Vertebral Malformation
Anal Malformation
Cardiac Malformation
Tracheal Malformation
Esophogeal Malformation
Renal Malformation
Limb Malformation

Name the five TORCH infectious diseases.

Toxoplasmosis
Others (Syphilis, HIV)
Rubella
Cytomegalovirus
Herpes

What is the most common cause of posterior uveitis?

Toxoplasmosis

If a child is infected with toxoplasmosis in the first trimester, what is the result?

Infant death

What are two ways a pregnant individual can contract toxoplasmosis?

Cat Litter
Handling/Consuming Contaminated Meat

What is the most common ocular sign of toxoplasmosis infection? Is it bilateral or unilateral? Is it peripheral or posterior pole?

Chorioretinitis (posterior uveitis)
Bilateral, posterior pole

Congenital Toxoplasmosis Syndrome: Patients may have ocular signs that include _____, cataract, and ______. They may present with systemic intracranial calcifications, seizures, hydrocephalus, _____, and deafness.

Chorioretinitis (****)
Microphthalmia
Microcephaly

When should we be concerned with a fetus contracting syphalis from the mother?

After the 18 week (before that it is not problematic)

Congenital Syphilis: Ocular signs include chorioretinits, _______ _____, and optic atrophy. Patient may also present systemically with _____ abnormalities, deafness, hydrocephalus, MR, nasal abnormalities and this pathongnomic sign (specific). Patient may also have a _________ ______ found on the soles of feet, trunk and palms.

Interstitial Keratopathy
Skeletal
Hutchinson's teeth (****)
Maculopapular Rash

What is the prevalence of congenital syphilis among live births?

1/10,000

What organism is responsible for congenital syphilis?

Treponema Pallidum

What are three main modes of transmission of congenital HIV?

Placenta
Milk
Blood

T/F. HIV is found in tears (but infection from tears has not been reported).

True

Congenital HIV: Ocular signs include HIV _________, CMV retinitis, _____, _______ sclera, and long palpebral fissures. Systemically the child may have a failure to thrive and be open to opportunistic infections.

Retinitis
Hypertelorism (Wide Telocanthus)
Blue Sclera

What is the incidence of congenital HIV among live births?

1/2,700

Rubella: Also called what? It may produce the following ocular signs: _____, _____, rubella retinopathy, and corneal and chorioretinits. Systemically the child may have heart defects, cerebral calcifications, MR, deafness, maculopapular rash, and ______ and ______.

German Measles
GLC
CAT
Thrombocytopenia
Hepatosplenomegaly

Wat is the incidence of rubella among live births?

1/1,000,000 (very rare)

When rubella is contracted in the 1st trimester it has an 85% chance of leading to what? (Rubella-specific IgM persists in these infants).

CRS (Congenital Rubella Syndrome)

When CRS (congenital rubella syndrome) occurs in an infant and they develop cataracts are these usually bilateral or unilateral?

75% Bilateral
(25% unilateral with microphthalmos)

T/F. A very young infant with CRS and large hazy corneas may develop glaucoma (10%). What is the treatment for this?

True
Surgery

What is the incidence of the cytomegalovirus among live births?

2.5% (rare)

Cytomegalovirus (CMV): Patient may have keratitis, chorioretinits, or be _______. What is unique about this disease in terms of ocular signs? Systemically the patient may have IUGR, cerebral calcification, MR, deafness, and _____.

Blind
Ocular damage is rare
Microcephaly

How does a fetus contract herpes simplex virus?

Mother must have genital herpes simplex infection.

T/F. Herpes simplex produces more ocular morbidity than other child keratitis infections.

True

Herpes Simplex: Child may have acute ___________, HSV _____, chorioretinits, CAT, and microphthalmos. Systemically they may have a skin rash, _____ or _____.

Conjunctivitis
Keratitis
Hepatitis
Encephalitis

What is the pathognomonic sign for Herpes simplex in a fetus? Should you treat it with steroids?

Dendritic lesions on the cornea
NO!

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