Pregestational diabetes — MCQs

A 31-year-old G1P0000 presents to her obstetrician for her first prenatal visit after having a positive home pregnancy test one week ago. She states that her last menstrual period was 8 weeks ago. The patient has a past medical history of type I diabetes mellitus since childhood and is on insulin. Her hemoglobin A1c two weeks ago was 13.7%. At that time, she was also found to have microalbuminuria on routine urinalysis, and her primary care provider prescribed lisinopril but the patient has not yet started taking it. The patient’s brother is autistic, but family history is otherwise unremarkable. At this visit, her temperature is 98.6°F (37.0°C), blood pressure is 124/81 mmHg, pulse is 75/min, and respirations are 14/min. Exam is unremarkable. This fetus is at increased risk for which of the following?

A 21-year-old gravida 1, para 0 woman presents to the family medicine clinic for her first prenatal appointment. She states that she has been taking folic acid supplements daily as directed by her mother. She smokes a few cigarettes a day and has done so for the last 5 years. Pediatric records indicate the patient is measles, mumps, and rubella non-immune. Her heart rate is 78/min, respiratory rate is 14/min, temperature is 36.5°C (97.7°F), and blood pressure is 112/70 mm Hg. Her calculated BMI is approximately 26 kg/m2. Her heart is without murmurs and lung sounds are clear bilaterally. Standard prenatal testing is ordered. Which of the following is the next best step for this patient’s prenatal care?

A 31-year-old G1P0 woman at 26 weeks gestation presents to the clinic for evaluation of an abnormal glucose tolerance test. She denies any symptoms, but states that she was given 50 g of oral glucose 1 week earlier and demonstrated a subsequent venous plasma glucose level of 156 mg/dL 1 hour later. The vital signs are: blood pressure, 112/78 mm Hg; pulse, 81/min; and respiratory rate, 16/min. Physical examination is within normal limits. Which of the following is the most appropriate next step in management?

A 23-year-old G1P0 primigravid woman at 28 weeks estimated gestational age presents for a prenatal checkup. She says she has been having occasional headaches but is otherwise fine. The patient says she feels regular fetal movements and mild abdominal pain at times. Her past medical history is unremarkable. Current medications are a prenatal multivitamin and the occasional acetaminophen. Her blood pressure is 148/110 mm Hg today. On her last visit at 24 weeks of gestation, her blood pressure was 146/96 mm Hg. On physical exam, the fundus measures 28 cm above the pubic symphysis. Laboratory findings are significant for the following: Serum Glucose (fasting) 88 mg/dL Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum Creatinine 0.9 mg/dL Blood Urea Nitrogen 10 mg/dL Alanine aminotransferase (ALT) 18 U/L Aspartate aminotransferase (AST) 16 U/L Mean Corpuscular Volume (MCV) 85 fL Leukocyte count 4,200/mm3 Reticulocyte count 1% Erythrocyte count 5.1 million/mm3 Platelet count 95,000mm3 Urinalysis show: Proteins 2+ Glucose negative Ketones negative Leucocytes negative Nitrites negative Red Blood Cells (RBCs) negative Casts negative Which of the following medications would be the next best step in the treatment of this patient?

A 25-year-old woman presents to the emergency department with intermittent uterine contractions. She is 39 weeks pregnant and experienced a deluge of fluid between her legs while she was grocery shopping. She now complains of painful contractions. She is transferred to the labor and delivery floor and a healthy male baby is delivered. He has a ruddy complexion and is crying audibly. Laboratory values demonstrate a hemoglobin of 22 g/dL and electrolytes that are within normal limits. Which of the following is the best description for the cause of this neonate's presentation?

A 27-year-old Hispanic G2P1 presents for a routine antepartum visit at 26 weeks gestation. She has no complaints. The vital signs are normal, the physical examination is within normal limits, and the gynecologic examination corresponds to 25 weeks gestation. The oral glucose tolerance test (OGTT) with a 75-g glucose load is significant for a glucose level of 177 mg/dL at 1 hour and 167 mg/dL at 2 hour. The fasting blood glucose level is 138 mg/dL (7.7 mmol/L), and the HbA1c is 7%. Which of the following represents the proper initial management?

A newborn whose mother had uncontrolled diabetes mellitus during pregnancy is likely to have which of the following findings?

A 26-year-old woman comes to the physician for evaluation of nausea and fatigue. Her last menstrual period was 8 weeks ago. She has a history of bipolar disorder controlled by a drug known to sometimes cause hypothyroidism and nephrogenic diabetes insipidus. She does not smoke cigarettes or drink alcohol. A urine pregnancy test is positive. An ultrasound of the pelvis shows a viable intrauterine pregnancy. The fetus is most likely at increased risk for which of the following anomalies?

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

A 36-year-old primigravida presents to her obstetrician for antenatal care. She is at 24 weeks of gestation and does not have any current complaint except for occasional leg cramps. She does not smoke or drink alcohol. Family history is irrelevant. Her temperature is 36.9°C (98.42°F), blood pressure is 100/60 mm Hg, and pulse of 95/minute. Her body mass index is 21 kg/m² (46 pounds/m²). Physical examination reveals a palpable uterus above the umbilicus with no other abnormalities. Which of the following screening tests is suitable for this patient?