Weight gain recommendations — MCQs

You have been entrusted with the task of finding the causes of low birth weight in infants born in the health jurisdiction for which you are responsible. In 2017, there were 1,500 live births and, upon further inspection of the birth certificates, 108 of these children had a low birth weight (i.e. lower than 2,500 g), while 237 had mothers who smoked continuously during pregnancy. Further calculations have shown that the risk of low birth weight in smokers was 14% and in non-smokers, it was 7%, while the relative risk of low birth weight linked to cigarette smoking during pregnancy was 2%. In other words, women who smoked during pregnancy were twice as likely as those who did not smoke to deliver a low-weight infant. Using this data, you are also asked to calculate how much of the excess risk for low birth weight, in percentage terms, can be attributed to smoking. What is the attributable risk percentage for smoking leading to low birth weight?

A 24-year-old primigravida presents to her physician for regular prenatal care at 31 weeks gestation. She has no complaints and the antepartum course has been uncomplicated. Her pre-gestational history is significant for obesity (BMI = 30.5 kg/m2). She has gained a total of 10 kg (22.4 lb) during pregnancy, and 2 kg (4.48 lb) since her last visit 4 weeks ago. Her vital signs are as follows: blood pressure, 145/90 mm Hg; heart rate, 87/min; respiratory rate, 14/min; and temperature, 36.7℃ (98℉). The fetal heart rate is 153/min. The physical examination shows no edema and is only significant for a 2/6 systolic murmur best heard at the apex of the heart. A 24-hour urine is negative for protein. Which of the following options describe the best management strategy in this case?

A 21-year-old primigravid woman comes to the physician at 10 weeks' gestation because of progressive fatigue for the past 3 weeks. She reports that she has had a 3.2-kg (7-lb) weight loss after conceiving despite an increase in appetite. She has become increasingly anxious and has trouble falling asleep. There is no personal or family history of serious illness. Medications include folic acid and a multivitamin. She is 165 cm (5 ft 5 in) tall and weighs 55 kg (120 lb); BMI is 20 kg/m2. Her temperature is 37.4°C (99.4°F), pulse is 120/min, respirations are 18/min, and blood pressure is 150/70 mm Hg. The globes of the eyes are prominent. The thyroid gland is firm and diffusely enlarged. Neurologic examination shows a fine resting tremor of the hands. There is a midsystolic click at the apex and a grade 2/6 early systolic murmur at the upper left sternal border. Serum thyroid-stimulating hormone concentration is 0.1 μU/mL. An ECG is normal except for sinus tachycardia. Which of the following is the most appropriate next step in management?

A 65-year-old man presents to the diabetes clinic for a check-up. He has been successfully managing his diabetes through diet alone, and has not experienced any complications related to retinopathy, neuropathy, or nephropathy. He recently started a new exercise regimen and is eager to see whether his weight has declined since his last visit. The nurse measures his height to be 170 cm and his weight to be 165 lb (75 kg). What range does this patient’s body mass index currently fall into?

A 38-year-old woman, gravida 4, para 3, at 20 weeks' gestation comes to the physician for a prenatal care visit. She used fertility enhancing treatment for her current pregnancy. Her other children were born before 37 weeks' gestation. She is 170 cm (5 ft 7 in) tall and weighs 82 kg (180 lb); BMI is 28.4 kg/m2. Her vital signs are within normal limits. The abdomen is nontender, and no contractions are felt. Ultrasonography shows a cervical length of 22 mm and a fetal heart rate of 140/min. Which of the following is the most likely diagnosis?

A 21-year-old female presents to her primary care doctor for prenatal counseling before attempting to become pregnant for the first time. She is an avid runner, and the physician notes her BMI of 17.5. The patient complains of chronic fatigue, which she attributes to her busy lifestyle. The physician orders a complete blood count that reveals a Hgb 10.2 g/dL (normal 12.1 to 15.1 g/dL) with an MCV 102 µm^3 (normal 78 to 98 µm^3). A serum measurement of a catabolic derivative of methionine returns elevated. Which of the following complications is the patient at most risk for if she becomes pregnant?

A 37-year-old woman comes to the physician because of irregular menses and generalized fatigue for the past 4 months. Menses previously occurred at regular 25- to 29-day intervals and lasted for 5 days but now occur at 45- to 60-day intervals. She has no history of serious illness and takes no medications. She is 155 cm (5 ft 1 in) tall and weighs 89 kg (196 lb); BMI is 37 kg/m2. Her temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 146/100 mm Hg. Examination shows facial hair as well as comedones on the face and back. There are multiple ecchymotic patches on the trunk. Neurological examination shows weakness of the iliopsoas and biceps muscles bilaterally. Laboratory studies show: Hemoglobin 13.1 g/dL Leukocyte count 13,500/mm3 Platelet count 510,000/mm3 Serum Na+ 145 mEq/L K+ 3.3 mEq/L Cl- 100 mEq/L Glucose 188 mg/dL Which of the following is the most likely diagnosis?

A 42-year-old man presents with palpitations, 2 episodes of vomiting, and difficulty breathing for the past hour. He says he consumed multiple shots of vodka at a party 3 hours ago but denies any recent drug use. The patient denies any similar symptoms in the past. Past medical history is significant for type 2 diabetes mellitus diagnosed 2 months ago, managed with a single drug that has precipitated some hypoglycemic episodes, and hypothyroidism diagnosed 2 years ago, well-controlled medically. The patient is a software engineer by profession. He reports a 25-pack-year smoking history and currently smokes 1 pack a day. He drinks alcohol occasionally but denies any drug use. His blood pressure is 100/60 mm Hg, pulse is 110/min, and respiratory rate is 25/min. On physical examination, the patient appears flushed and diaphoretic. An ECG shows sinus tachycardia. Which of the following medications is this patient most likely taking to explain his symptoms?

A 29-year-old G1P0 presents to her obstetrician for her first prenatal care visit at 12 weeks gestation by last menstrual period. She states that her breasts are very tender and swollen, and her exercise endurance has declined. She otherwise feels well. She is concerned about preterm birth, as she heard that certain cervical procedures increase the risk. The patient has a gynecologic history of loop electrosurgical excision procedure (LEEP) for cervical dysplasia several years ago and has had negative Pap smears since then. She also has mild intermittent asthma that is well controlled with occasional use of her albuterol inhaler. At this visit, this patient’s temperature is 98.6°F (37.0°C), pulse is 69/min, blood pressure is 119/61 mmHg, and respirations are 13/min. Cardiopulmonary exam is unremarkable, and the uterine fundus is just palpable at the pelvic brim. Pelvic exam reveals normal female external genitalia, a closed and slightly soft cervix, a 12-week-size uterus, and no adnexal masses. Which of the following is the best method for evaluating for possible cervical incompetence in this patient?

A 26-year-old woman presents to the women’s health clinic with a 9-week delay in menses. The patient has a history of grand mal seizures, and was recently diagnosed with acute sinusitis. She is prescribed lamotrigine and amoxicillin. The patient smokes one-half pack of cigarettes every day for 10 years, and drinks socially a few weekends every month. Her mother died of breast cancer when she was 61 years old. The vital signs are stable during the current office visit. Physical examination is grossly normal. The physician orders a urine beta-hCG that comes back positive. Abdominal ultrasound shows an embryo consistent in dates with the first day of last menstrual period. Given the history of the patient, which of the following would most likely decrease congenital malformations in the newborn?