{"id":1916,"date":"2023-04-12T14:42:00","date_gmt":"2023-04-12T14:42:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1916"},"modified":"2025-10-01T11:40:32","modified_gmt":"2025-10-01T19:40:32","slug":"usmle-step-1-question-of-the-day-isotretinoin","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Isotretinoin"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\/#B_Urine_%EA%9E%B5-hCG_test\" >B. Urine \ua7b5-hCG test<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\/#A_Pulmonary_function_test\" >A. Pulmonary function test<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\/#C_Eye_examination\" >C. Eye examination<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\/#D_International_normalized_ratio\" >D. International normalized ratio<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\/#E_Purified_protein_derivative_test\" >E. Purified protein derivative test<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 19-year-old who comes to the office because of worsening acne. She has had multiple bouts of acne affecting her shoulders, chest, and face. Her acneiform lesions have increased in size, transforming into nodules, thereby affecting her appearance. She is sexually active with her boyfriend and uses condoms consistently. She does not use tobacco, alcohol, or illicit drugs. Which of the following laboratory investigations should be performed before initiating this drug?&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 19-year-old woman comes to the office because of worsening acne. &nbsp;She has had multiple bouts of acne affecting her shoulders, chest, and face. The acne was treated with topical benzoyl peroxide and oral antibiotics with a slight improvement over the past three months. She is concerned because recently, her acneiform lesions have increased in size, transforming into nodules, thereby affecting her appearance. The patient immigrated from India with her family ten years ago. Past medical history is noncontributory. She is sexually active with her boyfriend and uses condoms consistently. She does not use tobacco, alcohol, or illicit drugs. After performing a complete physical examination, a decision to start oral isotretinoin is made. Which of the following laboratory investigations should be performed before initiating this drug?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Pulmonary function test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Urine \ua7b5-hCG test<\/strong><strong>C. Eye examination<br><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. International normalized ratio<\/strong><strong>E. Purified protein derivative test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Urine_%EA%9E%B5-hCG_test\"><\/span><strong>B. Urine \ua7b5-hCG test<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Pulmonary_function_test\"><\/span>A. Pulmonary function test<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Baseline pulmonary function testing is recommended before the initiation of amiodarone as it has a high tendency to cause pulmonary toxicity. Isotretinoin is not reported to affect the lung parenchyma.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Eye_examination\"><\/span>C. Eye examination<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Hydroxychloroquine, a medication used to treat systemic lupus erythematosus, is typically a well-tolerated and safe drug; however, there is a small risk of retinal toxicity in patients with prolonged use. Therefore, patients should have a baseline ophthalmologic evaluation with periodic assessment. &nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_International_normalized_ratio\"><\/span>D. International normalized ratio<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>A baseline international normalized ratio (INR) should be obtained prior to warfarin administration to monitor its activity and prevent unwanted bleeding diathesis. Isotretinoin does not affect INR level.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Purified_protein_derivative_test\"><\/span>E. Purified protein derivative test<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:\u00a0<\/strong>A purified protein derivative (PPD) test is recommended before administering immunosuppressive drugs like infliximab, an anti-TNF agent, to prevent the reactivation of underlying latent tuberculosis. Isotretinoin does not compromise the immune system.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_0105c5.png\" alt=\"The most powerful platform for learning medicine and the health sciences Osmosis sign up ad\" class=\"wp-image-1919\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_0105c5.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_0105c5.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Acne vulgaris<\/strong>, an inflammatory skin condition with multifactorial etiology (<strong>follicular hyperkeratinization, increased sebum production<\/strong>, and&nbsp;<strong>infection by Cutibacterium acnes<\/strong>), can present with&nbsp;<strong>inflammatory papules, pustules, or nodules<\/strong>. Treatment options depend on the severity and include&nbsp;<strong>retinoids, benzoyl peroxide, antibiotics, and isotretinoin<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This patient suffering from&nbsp;<strong>nodulocystic acne<\/strong>&nbsp;needs treatment with&nbsp;<strong>oral isotretinoin<\/strong>. Isotretinoin is a known&nbsp;<strong>teratogen<\/strong>, and pregnancy should be actively ruled out by measuring&nbsp;<strong>serum or urine beta-hCG levels<\/strong>&nbsp;twice. Sexually active patients should be started on two different types of contraception before its initiation. Other standard pretreatment tests include a&nbsp;<strong>liver function test<\/strong>&nbsp;and&nbsp;<strong>lipid panel&nbsp;<\/strong>(serum triglyceride and cholesterol levels).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Isotretinoin<\/strong>, a retinoid, is a last resort for treating&nbsp;<strong>severe (nodulocystic acne with scarring) or unresponsive&nbsp;<\/strong>acne vulgaris. It acts by&nbsp;<strong>shrinking the sebaceous glands&nbsp;<\/strong>(reducing sebum production),&nbsp;<strong>inhibiting the growth<\/strong>&nbsp;of&nbsp;<em>Cutibacterium acnes<\/em>, and preventing the formation of comedones. It has several adverse effects, including&nbsp;<strong>teratogenicity<\/strong>&nbsp;(craniofacial, cardiac, thymic, and central nervous system malformations), cheilitis,&nbsp;<strong>xerosis<\/strong>, conjunctivitis, pruritus,&nbsp;<strong>photosensitivity<\/strong>, and hypertriglyceridemia. It can also cause decreased bone mineral density, hepatotoxicity, fatigue, and lethargy.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Isotretinoin<\/strong>, a retinoid, treats&nbsp;<strong>severe or unresponsive<\/strong>&nbsp;acne. It acts by decreasing sebum production,&nbsp;<strong>inhibiting the growth<\/strong>&nbsp;of&nbsp;<em>Cutibacterium acnes<\/em>, and preventing comedogenesis. Significant adverse effects include&nbsp;<strong>teratogenicity<\/strong>, cheilitis,<strong>&nbsp;xerosis<\/strong>, conjunctivitis, pruritus,&nbsp;<strong>photosensitivity<\/strong>, and hypertriglyceridemia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vallerand, I. A., Lewinson, R. T., Farris, M. S., Sibley, C. D., Ramien, M. L., Bulloch, A. G. M., &amp; Patten, S. B. (2018).&nbsp;<em>Efficacy and adverse events of oral isotretinoin for acne: a systematic review. British Journal of Dermatology<\/em>, 178(1), 76-85.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Layton, A. (2009).\u00a0<em>The use of isotretinoin in acne. Dermato-endocrinology,<\/em>\u00a01(3), 162-169.\u00a0<em><strong>_________________________<\/strong><br><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your\u00a0<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_889345.png\" alt=\"The ultimate guide to the USMLE step 1: Everything you need to know\" class=\"wp-image-1921\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_889345.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_889345.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><br><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 19-year-old who comes to the office because of worsening acne. She has had multiple bouts of acne affecting her shoulders, chest, and face. Her acneiform lesions have increased in size, transforming into nodules, [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1917,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1369,44],"tags":[],"class_list":["post-1916","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Isotretinoin - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-isotretinoin\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Isotretinoin - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 19-year-old who comes to the office because of worsening acne. She has had multiple bouts of acne affecting her shoulders, chest, and face. 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