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What does the patient want to know?Tap a term: its definition, what you can do with it, and how often the exam asks it.
Definition: a mood stabiliser with about a 1 in 10 major malformation risk across pregnancy.
You can: Tell valproate from lithium by how long the exposure lasted for the 1 in 10 risk.
Definition: a mood stabiliser with up to a 1 in 10 malformation risk across the first trimester.
You can: Tell lithium from valproate by the shorter first-trimester exposure.
Definition: a mood stabiliser with a 0.5 to 1% neural tube defect risk.
You can: Tell carbamazepine from valproate by the lower neural tube defect risk of 0.5 to 1%.
Definition: a rare tricuspid valve defect starting at about 1 in 20,000 births.
You can: Tell Ebstein's anomaly after lithium from a common defect by its base rate of 1 in 20,000.
Definition: the SSRI linked to atrial and ventricular septal defects.
You can: Tell paroxetine from other SSRIs by its link to heart wall defects.
Definition: a benzodiazepine linked to oral cleft and Ebstein's anomaly in early pregnancy.
You can: Tell diazepam from lithium by the oral cleft that comes with Ebstein's anomaly.
Definition: the 2 to 4% of live births with a major malformation and no drug.
You can: Name the background malformation rate when a risk is quoted for a pregnancy with no drug.
Each card is one term. The grey line is what the patient says, which is what the question stem gives.
Summary
About 2 to 4% of live births have a spontaneous major malformation with no drug exposure at all.
About 2 to 4% of live births have a spontaneous with no drug exposure at all. Pregnancy counts give a slightly lower figure of 2 to 3%. A drug is suspected to be a teratogen when exposure raises the rate above this background.
Lithium's malformation risk is higher than the general-population rate. Clinicians obtain a pregnancy test before starting lithium, carbamazepine or valproate. A major malformation is a serious structural birth defect. Candidates treat any quoted risk as caused by the drug.
A drug risk counts only where the figure rises above 2 to 4%.
6 more sections on Teratogen risk in pregnancy: valproate, lithium, carbamazepine, paroxetine and diazepam
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