Drugs in pregnancy: isotretinoin: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Drugs in pregnancy: isotretinoin

Sample item

A 22-year-old woman with severe nodulocystic acne is being started on oral isotretinoin. What counselling is essential?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Effective contraception before, during and for a month after treatment because of severe teratogenicity

Isotretinoin causes craniofacial, cardiac, thymic and central nervous system malformations, so pregnancy must be excluded before starting and prevented throughout treatment and for a month after. It is absorbed systemically even though it is used for skin disease. Exposure at any stage of pregnancy carries risk.

Option by option

  • A. Effective contraception before, during and for a month after treatment because of severe teratogenicity (correct)

    Correct. Reliable contraception and a negative pregnancy test are mandatory.

  • B. Treatment is safe to continue if she conceives after the first trimester

    Risk is highest in early organogenesis, and later exposure does not make it safe.

  • C. No contraception is needed because it acts locally on the skin

    The drug is systemic and crosses the placenta, so skin-directed action is irrelevant.

  • D. Only barrier methods during menstruation are required

    Intermittent barrier use is not reliable enough for a major teratogen.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Effective contraception before, during and for a month after treatment because of severe teratogenicity. Isotretinoin causes craniofacial, cardiac, thymic and central nervous system malformations, so pregnancy must be excluded before starting and prevented throughout treatment and for a month after.

Why is "Treatment is safe to continue if she conceives after the first trimes…" not the answer?

Risk is highest in early organogenesis, and later exposure does not make it safe.

Why is "No contraception is needed because it acts locally on the skin" not the answer?

The drug is systemic and crosses the placenta, so skin-directed action is irrelevant.

Why is "Only barrier methods during menstruation are required" not the answer?

Intermittent barrier use is not reliable enough for a major teratogen.

What concept does this question test?

It tests Drugs in pregnancy: isotretinoin in OBG. It is absorbed systemically even though it is used for skin disease. Exposure at any stage of pregnancy carries risk.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Drugs in pregnancy: isotretinoin?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.