{"id":3171,"date":"2021-02-03T13:52:00","date_gmt":"2021-02-03T13:52:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3171"},"modified":"2025-10-01T11:45:05","modified_gmt":"2025-10-01T19:45:05","slug":"usmle-step-1-question-neural-tube-defects","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-neural-tube-defects","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Neural Tube Defects"},"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-neural-tube-defects\/#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><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-neural-tube-defects\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><\/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-neural-tube-defects\/#Correct_answer_explanation\" >Correct answer explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-neural-tube-defects\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-neural-tube-defects\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a two-hour-old baby who was born with a defect and can&#8217;t move his lower extremities. The mother is worried and wants to know if this could occur again if she has more children in the future. Can you help figure out what might have caused this birth defect?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 2-hour-old boy is being evaluated in the nursery. He was born via spontaneous vaginal delivery to a 27-year-old woman who had inconsistent prenatal care. The mother\u2019s medical history includes generalized seizures managed with carbamazepine. She took routine prenatal vitamins throughout the pregnancy. The mother has smoked 1 pack of cigarettes daily for the past 10 years, she does not use alcohol, and she used cocaine 1\u20132 times per month during the pregnancy. &nbsp;A physical examination of the patient shows a newborn male in no acute distress. The patient moves the upper extremities freely but not the lower extremities. There is a red, fleshy swelling present on the lower back. Stroking the skin around the anus does not produce a contraction of the anal sphincter. Which of the following interventions could have prevented this neonate\u2019s abnormalities?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Cessation of cocaine use &nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Smoking cessation&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Changing carbamazepine to valproate &nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Increasing the dose of prenatal vitamins<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">&nbsp;Scroll down to find the answer!&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Everybody loves Osmosis.org\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/kizbJZ9cdLg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><u><em><strong>\u2192 Reinforce your understanding with more self-assessment items on Osmosis.<\/strong><\/em><\/u><\/a><\/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<p class=\"wp-block-paragraph\"><strong>D. Increasing the dose of prenatal vitamins&nbsp;<\/strong>This neonate is presenting with an abnormal lesion on the lower back, paraplegia, and loss of anal sphincter tone\u2014a presentation consistent with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/High_Yield:_Congenital_neurological_malformations\" target=\"_blank\" rel=\"noreferrer noopener\">meningomyelocele.<\/a>&nbsp;<\/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<p class=\"wp-block-paragraph\"><strong>A. Cessation of cocaine use&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Cocaine is a potent vasoconstrictor, and therefore, it can cause fetal and placental injury, leading to&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Placental_abruption\" target=\"_blank\" rel=\"noreferrer noopener\">placental abruption<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Miscarriage\" target=\"_blank\" rel=\"noreferrer noopener\">spontaneous abortion<\/a>, prematurity, and fetal death. Neural tube defects, as seen in this patient, are not associated with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cocaine_dependence\" target=\"_blank\" rel=\"noreferrer noopener\">cocaine use<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Smoking cessation&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Tobacco_dependence\" target=\"_blank\" rel=\"noreferrer noopener\">Tobacco use<\/a>&nbsp;negatively affects both maternal and fetal health and continues over into the postnatal period. Tobacco use is associated with neonatal death, reduction in birth weight, placental abruption,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Placenta_previa\" target=\"_blank\" rel=\"noreferrer noopener\">placenta previa<\/a>, and preterm birth. It is also associated with specific congenital malformations such as cleft lip with&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Gastroschisis\" target=\"_blank\" rel=\"noreferrer noopener\">gastroschisis<\/a>, cardiac defects, digital anomalies, bilateral&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Renal_agenesis\" target=\"_blank\" rel=\"noreferrer noopener\">renal agenesis<\/a>, and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Clinical_Reasoning:_Anal_conditions\" target=\"_blank\" rel=\"noreferrer noopener\">anal atresia<\/a>&nbsp;but not neural tube defects.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Changing carbamazepine to valproate &nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Both valproate and carbamazepine, as well as other folate antagonists (e.g., methotrexate), are associated with neural tube defects. Therefore, changing to valproate is unlikely to change the prognosis.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"http:\/\/osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_fe318c.png\" alt=\"The most powerful platform for learning medicine. Try it free today button.\" class=\"wp-image-3173\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_fe318c.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_fe318c.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Correct_answer_explanation\"><\/span><a href=\"http:\/\/osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a>Correct answer explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/learn\/High_Yield:_Congenital_neurological_malformations\" target=\"_blank\" rel=\"noreferrer noopener\">Open neural tube defects (NTDs)<\/a>&nbsp;are congenital anomalies that develop when the neural tube fails to close normally during the third and fourth weeks of gestation. NTDs may be open (e.g., myelomeningocele, meningocele, encephalocele, and anencephaly) or closed (e.g.,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Spina_bifida\" target=\"_blank\" rel=\"noreferrer noopener\">spina bifida<\/a>&nbsp;occulta).&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Risk factors for developing closed or open neural tube defects include&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Folate_(Vitamin_B9)_deficiency\" target=\"_blank\" rel=\"noreferrer noopener\">folic acid deficiency<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Diabetes_insipidus\" target=\"_blank\" rel=\"noreferrer noopener\">gestational diabetes<\/a>, maternal obesity, and certain medications (e.g., valproate, carbamazepine). Most isolated NTDs appear to be caused by folate deficiency, probably in combination with genetic or environmental risk factors. Folate deficiency may arise from inadequate oral intake, malabsorption, use of folic acid antagonists, or genetic causes of abnormal folate metabolism. Folic acid supplementation is recommended for all women during preconception and the first trimester periods; 0.4 mg daily of folic acid is recommended for all women, beginning before conception and continuing through pregnancy. For women taking carbamazepine or valproate or those with a prior infant with an NTD or with an NTD affecting either parent, a higher folic acid dose of 4 mg daily is recommended.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"1024\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1a.png?w=1024\" alt=\"\" class=\"wp-image-4629\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1a.png 1080w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1a.png?resize=150,150 150w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1a.png?resize=300,300 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1a.png?resize=768,769 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1a.png?resize=1024,1024 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"1024\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1b.png?w=1024\" alt=\"\" class=\"wp-image-4630\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1b.png 1081w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1b.png?resize=150,150 150w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1b.png?resize=300,300 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1b.png?resize=768,768 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Step_1_QOTD_-_Neural_Tube_Defects_Answer1b.png?resize=1024,1024 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\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\">Neural tube defects are associated with folic acid deficiency, gestational diabetes, maternal obesity, and certain medications (e.g., valproate and carbamazepine). Women at risk should take an increased dose of folic acid before conception and throughout the pregnancy.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23790957\/\" target=\"_blank\" rel=\"noreferrer noopener\">Neural tube defects: recent advances, unsolved questions, and controversies.&nbsp;<\/a>&nbsp;<\/li>\n\n\n\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15151734\/\" target=\"_blank\" rel=\"noreferrer noopener\">Risk of fetal exposure to folic acid antagonists.<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>_________________________<\/em><\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_fe318c.png?w=700\" alt=\"The most powerful platform for learning medicine. Try it free today button.\" class=\"wp-image-3173\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_fe318c.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_fe318c.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>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.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a two-hour-old baby who was born with a defect and can&#8217;t move his lower extremities. The mother is worried and wants to know if this could occur again if she has more children in the [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3172,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,44],"tags":[],"class_list":["post-3171","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","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: Neural Tube Defects - 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-neural-tube-defects\" \/>\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: Neural Tube Defects - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a two-hour-old baby who was born with a defect and can&#8217;t move his lower extremities. 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