Antiepileptics: practice question

A Pharmacology 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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Pharmacology · Antiepileptics

Sample item

A woman with idiopathic generalised epilepsy planning pregnancy is on sodium valproate. Which fetal risk is most characteristic, and which supplementation is advised?

AGingival hyperplasia in the neonate, with vitamin CBNeural tube defects, with high-dose folic acid before conceptionCEbstein's anomaly, with vitamin B6DCleft lip alone, with vitamin D

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

The answer and the reasoning

B. Neural tube defects, with high-dose folic acid before conception

Valproate is a major teratogen causing neural tube defects, other malformations and neurodevelopmental impairment. Where it cannot be avoided, high-dose folic acid is given before conception, and an alternative agent such as lamotrigine or levetiracetam is generally preferred.

Option by option

A. Gingival hyperplasia in the neonate, with vitamin C
Gingival hyperplasia is an adverse effect of phenytoin in the user and not a neonatal malformation.
B. Neural tube defects, with high-dose folic acid before conception (correct)
Correct. Neural tube defects are the classical valproate malformation.
C. Ebstein's anomaly, with vitamin B6
Ebstein's anomaly is linked to lithium exposure in pregnancy.
D. Cleft lip alone, with vitamin D
Cleft lip alone is not the characteristic valproate effect, and vitamin D does not prevent it.

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.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Neural tube defects, with high-dose folic acid before conception. Valproate is a major teratogen causing neural tube defects, other malformations and neurodevelopmental impairment.

Why is "Gingival hyperplasia in the neonate, with vitamin C" not the answer?

Gingival hyperplasia is an adverse effect of phenytoin in the user and not a neonatal malformation.

Why is "Ebstein's anomaly, with vitamin B6" not the answer?

Ebstein's anomaly is linked to lithium exposure in pregnancy.

Why is "Cleft lip alone, with vitamin D" not the answer?

Cleft lip alone is not the characteristic valproate effect, and vitamin D does not prevent it.

What concept does this question test?

It tests Antiepileptics in Pharmacology. Where it cannot be avoided, high-dose folic acid is given before conception, and an alternative agent such as lamotrigine or levetiracetam is generally preferred.

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 Antiepileptics?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.