U2 Ob - Et 17 Medical & Surgical Complications Of Pregnancy

1. A 27yo G1P1 comes to you for preconception counseling whose prior pregnancy was complicated by a neural tube defect. You inform her that increasing her folate intake is the most effective way for neural tube defects to be prevented. How much folate should she consume each day?

0.1mg

0.4mg

1.0mg

4.0mg

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Explanation

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2. A 32yo G2P1001 is newly diagnosed with gestational diabetes. Which of the following has the largest effect on blood glucose levels in this patient:

Human chorionic gonadotropin

Insulinase

Human placental lactogen

Progesterone

Human placental lactogen (hPL) has the largest effect on blood glucose levels in this patient. hPL is a hormone produced by the placenta during pregnancy. It acts as an insulin antagonist, meaning it reduces the effectiveness of insulin in lowering blood glucose levels. This leads to higher blood glucose levels in the patient. Gestational diabetes is a condition characterized by high blood glucose levels during pregnancy, and hPL contributes to this by counteracting the effects of insulin.

Explanation

Human placental lactogen (hPL) has the largest effect on blood glucose levels in this patient. hPL is a hormone produced by the placenta during pregnancy. It acts as an insulin antagonist, meaning it reduces the effectiveness of insulin in lowering blood glucose levels. This leads to higher blood glucose levels in the patient. Gestational diabetes is a condition characterized by high blood glucose levels during pregnancy, and hPL contributes to this by counteracting the effects of insulin.

3. A 28yo G2P1001 at 15wks comes to you saying she has not been feeling normal lately. After taking a thorough h&p you find she says she has not been able to sleep well and has been unexpectedly losing weight. She also reports feeling hot all the time and sweats throughout the day. On physical exam she is noted to have a BP of 145/90 and her pulse is 98. She also has a slight tremor in her hands. Which of the following is the likely cause of her symptoms:

Generalized anxiety disorder

Hyperthyroidism

Gestational Diabetes

Previously undiagnosed asthma

Normal effects of pregnancy

The patient's symptoms of weight loss, difficulty sleeping, feeling hot, and sweating throughout the day are consistent with hyperthyroidism. The elevated blood pressure, increased pulse, and slight hand tremor further support this diagnosis. Generalized anxiety disorder may cause some similar symptoms, but it is less likely to cause physical signs such as elevated blood pressure and pulse. Gestational diabetes and previously undiagnosed asthma would not explain all of the patient's symptoms. The normal effects of pregnancy would not typically cause weight loss and the other symptoms described.

Explanation

The patient's symptoms of weight loss, difficulty sleeping, feeling hot, and sweating throughout the day are consistent with hyperthyroidism. The elevated blood pressure, increased pulse, and slight hand tremor further support this diagnosis. Generalized anxiety disorder may cause some similar symptoms, but it is less likely to cause physical signs such as elevated blood pressure and pulse. Gestational diabetes and previously undiagnosed asthma would not explain all of the patient's symptoms. The normal effects of pregnancy would not typically cause weight loss and the other symptoms described.

4. A 30yo G1 with no previous health care comes to your office after finding she is pregnant. After labs are drawn you see that her creatinine is 1.9. Which of the following is this patient most likely at an increased risk of developing:

Gestational diabetes

Fetal heart defects

Pre-eclampsia

Recurrent upper respiratory infections

Pre-eclampsia is a condition characterized by high blood pressure and damage to organs, typically occurring after 20 weeks of pregnancy. It is associated with increased levels of creatinine, which is a waste product that is filtered by the kidneys. Therefore, a pregnant woman with an elevated creatinine level of 1.9 is at an increased risk of developing pre-eclampsia. Gestational diabetes, fetal heart defects, and recurrent upper respiratory infections are not directly related to creatinine levels.

Explanation

Pre-eclampsia is a condition characterized by high blood pressure and damage to organs, typically occurring after 20 weeks of pregnancy. It is associated with increased levels of creatinine, which is a waste product that is filtered by the kidneys. Therefore, a pregnant woman with an elevated creatinine level of 1.9 is at an increased risk of developing pre-eclampsia. Gestational diabetes, fetal heart defects, and recurrent upper respiratory infections are not directly related to creatinine levels.

5. A 40yo woman with two children in high school comes to your office for lower abdominal pain. Her last menstrual period was three months ago and to her surprise she is found to be 15 weeks pregnant. Two years ago she suffered a cardiac event and has since been on Aspirin, Propranolol, Atorvastatin, and Losartan. Which of the following is a possible complication to the fetus from this treatment regimen:

Cleft palate

Clear cell carcinoma

Gastroschisis

Renal failure

Masculinization

The possible complication to the fetus from this treatment regimen is renal failure. This is because the medications the woman is taking, such as Propranolol and Losartan, can have adverse effects on fetal kidney development and function. These drugs can interfere with the normal development of the fetal kidneys, leading to renal failure.

Explanation

The possible complication to the fetus from this treatment regimen is renal failure. This is because the medications the woman is taking, such as Propranolol and Losartan, can have adverse effects on fetal kidney development and function. These drugs can interfere with the normal development of the fetal kidneys, leading to renal failure.

6. On a new patient's first Ob visit she is found to be in great health with no complaints and is very excited about being pregnant. The only thing that is found in your workup is a small amount of bacteriuria. What is the most appropriate course of action?

Trimethoprim-sulfamethoxazole 160/800 BID x 7days

No treatment necessary for asymptomatic bacteriuria.

Nitrofurantoin 100mg BID x 5days

Ciprofloxacin 500mg BID x 7days

Asymptomatic bacteriuria refers to the presence of bacteria in the urine without any symptoms of a urinary tract infection. In pregnant women, it is important to treat asymptomatic bacteriuria to prevent complications such as pyelonephritis and preterm labor. Nitrofurantoin is the most appropriate choice for treatment in pregnancy due to its safety profile. The recommended duration of treatment is 5 days. Trimethoprim-sulfamethoxazole is contraindicated in pregnancy, and ciprofloxacin should be avoided due to potential adverse effects on fetal cartilage development.

Explanation

Asymptomatic bacteriuria refers to the presence of bacteria in the urine without any symptoms of a urinary tract infection. In pregnant women, it is important to treat asymptomatic bacteriuria to prevent complications such as pyelonephritis and preterm labor. Nitrofurantoin is the most appropriate choice for treatment in pregnancy due to its safety profile. The recommended duration of treatment is 5 days. Trimethoprim-sulfamethoxazole is contraindicated in pregnancy, and ciprofloxacin should be avoided due to potential adverse effects on fetal cartilage development.

7. As an intern you are the only doctor in the room because your upper level had to leave to do a stat c-section. Your patient is a 24yo G3P2103 with a history of severe asthma who just had a spontaneous vaginal delivery after a protracted labor. You are having a difficult time stopping the bleeding and are contemplating which medication to use. Which of the following should be avoided in this patient:

Methergine

Hemabate

Pitocin

Cytotec

Hemabate should be avoided in this patient because it is contraindicated in patients with severe asthma. Hemabate is a medication used to control bleeding after childbirth, but it can cause bronchospasm and worsen asthma symptoms. Since the patient has a history of severe asthma, using Hemabate could potentially lead to a severe asthma attack and further complications. Therefore, it is important to avoid using Hemabate in this patient and consider alternative medications for controlling the bleeding.

Explanation

Hemabate should be avoided in this patient because it is contraindicated in patients with severe asthma. Hemabate is a medication used to control bleeding after childbirth, but it can cause bronchospasm and worsen asthma symptoms. Since the patient has a history of severe asthma, using Hemabate could potentially lead to a severe asthma attack and further complications. Therefore, it is important to avoid using Hemabate in this patient and consider alternative medications for controlling the bleeding.

8. A 31yo G1 presents to your office after a positive pregnancy test. She has a Hemoglobin A1c of 10.0. You counsel her on the importance of proper glycemic control. Which of the following is NOT recommended for proper evaluation and management of this patient during pregnancy:

Daily monitoring of blood sugar

Increased insulin doses throughout pregnancy

26wk Glucose Tolerance Test

Urine dipstick test

Monthly Hemoglobin A1c tests

The 26-week Glucose Tolerance Test is not recommended for proper evaluation and management of this patient during pregnancy. This test is typically done between 24-28 weeks of gestation to screen for gestational diabetes, but in this case, the patient already has a diagnosis of diabetes with a high Hemoglobin A1c level. The focus should be on daily monitoring of blood sugar, increased insulin doses throughout pregnancy, urine dipstick tests, and monthly Hemoglobin A1c tests to ensure proper glycemic control during pregnancy.

Explanation

The 26-week Glucose Tolerance Test is not recommended for proper evaluation and management of this patient during pregnancy. This test is typically done between 24-28 weeks of gestation to screen for gestational diabetes, but in this case, the patient already has a diagnosis of diabetes with a high Hemoglobin A1c level. The focus should be on daily monitoring of blood sugar, increased insulin doses throughout pregnancy, urine dipstick tests, and monthly Hemoglobin A1c tests to ensure proper glycemic control during pregnancy.

9. A previously healthy 26yo G3P2002 just failed her Glucose Tolerance Test. Which of the following complications will her newborn infant be at an increased risk for:

Congenital heart defects

Stillbirth

Hyperglycemia

Renal agenesis

All of the above

A previously healthy 26-year-old woman who failed her Glucose Tolerance Test is at an increased risk for stillbirth. This means that her newborn infant will also be at an increased risk for stillbirth. The Glucose Tolerance Test is used to diagnose gestational diabetes, which is a condition where high blood sugar levels develop during pregnancy. Gestational diabetes can increase the risk of complications, such as stillbirth, for both the mother and the baby. Therefore, it is important for the woman to receive appropriate medical care and monitoring to reduce the risk of stillbirth.

Explanation

A previously healthy 26-year-old woman who failed her Glucose Tolerance Test is at an increased risk for stillbirth. This means that her newborn infant will also be at an increased risk for stillbirth. The Glucose Tolerance Test is used to diagnose gestational diabetes, which is a condition where high blood sugar levels develop during pregnancy. Gestational diabetes can increase the risk of complications, such as stillbirth, for both the mother and the baby. Therefore, it is important for the woman to receive appropriate medical care and monitoring to reduce the risk of stillbirth.

10. A 25yo G1 is who is known to have sickle cell trait. She is worried that she is going to have a difficult pregnancy because of her carrier state. Which of the following is she at an increased risk for during pregnancy:

Urinary tract infections

Fetal IUGR

Pre-eclampsia

Gestational diabetes

During pregnancy, women with sickle cell trait are at an increased risk of urinary tract infections. This is because the sickle-shaped red blood cells can block the flow of urine, leading to stasis and increased risk of infection. Other complications such as fetal IUGR, pre-eclampsia, and gestational diabetes are not directly associated with sickle cell trait.

Explanation

During pregnancy, women with sickle cell trait are at an increased risk of urinary tract infections. This is because the sickle-shaped red blood cells can block the flow of urine, leading to stasis and increased risk of infection. Other complications such as fetal IUGR, pre-eclampsia, and gestational diabetes are not directly associated with sickle cell trait.