NORCET 8 Prelims-2025
Pharmacology
Easy
Which of the following drugs can cause the congenital malformation in the arms and legs of babies shown in the image?
Appeared in: NORCET 8 Prelims-2025
Explanation
- The image shows an infant with phocomelia, a condition where the long bones of the limbs are absent or underdeveloped, causing the hands and feet to be attached close to the body.
- This specific type of limb reduction defect is the classic, hallmark sign of teratogenicity caused by the drug Thalidomide.
- Exposure to Thalidomide during the critical period of limb development in pregnancy (approximately 24 to 36 days after fertilization) is known to cause phocomelia.
Why Other Options Were Wrong
- Option A: Isotretinoin is a potent teratogen but causes a different set of malformations known as retinoic acid embryopathy.
- Option B: Warfarin is a teratogen that causes Fetal Warfarin Syndrome, which does not include phocomelia.
- Option C: Ethambutol is an antituberculosis medication and is not associated with causing major limb malformations like phocomelia.
Related Visual
- Visual 1: Infographic: A comparative chart showing the hallmark defects of different teratogens (Thalidomide, Warfarin, Isotretinoin, Valproic Acid) with representative images or icons for each syndrome (phocomelia, nasal hypoplasia, microtia, neural tube defect).
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Teratogenic effects of medications during pregnancy as background academic context rather than a clinical decision trigger.
- This question underscores the critical importance of a thorough medication history and review for all women of childbearing potential, not just those who are already pregnant.
- The thalidomide tragedy led to major reforms in drug testing and regulation, emphasizing the need for rigorous evaluation of medications for teratogenic potential before they are approved for use.
- Thalidomide is used today under strict Risk Evaluation and Mitigation Strategy (REMS) programs to treat conditions like multiple myeloma and erythema nodosum leprosum, requiring stringent contraception and regular pregnancy testing for female patients.
How to Approach the Question
- First, carefully analyze the image to identify the specific congenital malformation. The image clearly shows an infant with extremely short or absent limbs, with hands and feet close to the trunk.
- Recognize this condition as phocomelia, or 'seal limbs'.
- Next, review the options provided, which are all drugs.
- Recall or use your knowledge of pharmacology and teratology to link each drug to its known teratogenic effects.
- Match the identified condition (phocomelia) with the drug known to cause it. Thalidomide is famously and uniquely associated with phocomelia.
- Eliminate the other options by recalling their different teratogenic profiles: Isotretinoin (craniofacial/cardiac defects), Warfarin (nasal hypoplasia), and Ethambutol (not a major teratogen for limb defects).
Concept Tested & Keywords
- Concept Tested: Teratogenic effects of medications during pregnancy
- Stem keywords: congenital malformation, arms and legs, babies, image
- Lead-in keywords: Which
- Clinical cues: The image showing an infant with phocomelia (severely shortened or absent limbs) is the key clinical cue.
Question ID
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