Medical Conditions in Pregnancy (Wootton)

Question 1

Screening for Gestational Diabetes is done between weeks __1__.

50 gm one hour oral load glucose challenge test are considered abnormal if values are greater than a range of __2__.

Answer 1

1) 24-28

2) 130-140

Question 2

What are some maternal complications associated with Gestational Diabetes?

Answer 2

1) Increased risk of gestational hypertension
2) Increased risk of preeclampsia
3) Greater risk of cesarean delivery
4) Increase risk of developing diabetes later in life

Question 3

What are some fetal complications associated with Gestational Diabetes?

Answer 3

1) Macrosomia
2) Neonatal hypoglycemia
3) Hyperbilirubinemia

Question 4

There is a direct link between birth defects and increasing ____ levels in the period of embryogenesis, sixfold increase risk of congenital anomalies.

Answer 4

Glycosylated hemoglobin levels (HgBA1C)

Question 5

There are 2 classes of gestational diabetes:

Class A1: gestational diabetes is __1__ controlled.

Class A2: gestational diabetes is __2__ controlled .

Answer 5

1) Diet

2) Insulin or oral meds

Question 6

In the management of diabetes, good glycemic control is determined by fasting levels less than __1__ mg/dL.

Along with two hour postprandial levels less than __2__ mg/dL.

Answer 6

1) 95 mg/dL

2) 120 mg/dL

Question 7

Delivery options depends on estimated fetal weight and glycemic control, at what estimated fetal weight is C-section chosen?

Answer 7

Greater than 4500 gm

Question 8

Maternal hyperthyroidism diagnosis is made by elevated__1__ and suppressed __2__.

Answer 8

1) Free T4

2) TSH

Question 9

In the treatment of maternal hyperthyroidism, what is contraindicated?

Answer 9

Radioactive iodine

Question 10

In the treatment of maternal hyperthyroidism, __1__ is used in 2nd and 3rd trimester (can cause aplasia cutis and choanal atresia in 1st trimester).

__2__ increases risk of liver toxicity so only used in 1st trimester.

Answer 10

1) Methimazole

2) Propylthiouracil (PTU)

Question 11

____ can occur due to infection, labor, cesarean delivery and noncompliance with medication with signs/symptoms of hyperthermia, tachycardia, perspiration, and high output cardiac failure.

Answer 11

Thyroid storm

Question 12

What beta blocker is used to treat thyroid storm?

What is used to block the secretion of thyroid hormones?

What is used to stop synthesis of thyroid hormones?

What is used to halt peripheral conversion of T4 to T3?

Answer 12

1) Propranolol
2) Sodium iodide
3) PTU
4) Dexamethasone

Question 13

If ____ is treated appropriately anticipate normal pregnancy outcome. However if untreated it can increase the risk of spontaneous abortion, preeclampsia, abruption, low birth weight infants, stillbirth, or lower intelligence levels.

Answer 13

Hypothyroidism

Question 14

You want to treat Hypothyroidism with thyroid replacement such as?

Answer 14

Levothyroxine

Question 15

What is due to transplacental transfer of thyroid stimulating antibodies and is transient (lasting 2-3 months)?

Answer 15

Neonatal thyrotoxicosis

Question 16

Neonatal hypothyroidism due to thyroid dysgenesis, inborn errors of thyroid function, or drug induced can result in generalized ____.

Answer 16

Developmental retardation

Question 17

__1__ disease has a high risk of developing heart failure, subacute bacterial endocarditis and thromboembolic disease.

__2__ is the most common lesion is.

Answer 17

1) Rheumatic heart disease

2) Mitral stenosis

Question 18

Atrial and ventricular septal defects, primary pulmonary hypertension, tetralogy of Fallot, and transposition of the great vessels are all examples of?

Answer 18

Congenital heart disease

Question 19

Primary pulmonary hypertension is a contraindication to pregnancy due to decompensation during pregnancy and a high mortality rate, __1__ anesthesia is preferred and __2__ delivery may be an option for these patients.

Answer 19

1) Epidural

2) Vaginal

Question 20

What are the most frequent cardiac arrhythmias seen and are usually benign?

What arrhythmia is more worrisome for underlying cardiac disease?

Answer 20

1) Supraventricular tachycardia

2) Atrial fibrillation/flutter

Question 21

__1__ develops typically within last weeks of pregnancy or within 6 months postpartum and women with preeclampsia, hypertension, and poor nutrition are at risk for developing.

The mortality rate is about __2__ percent.

Answer 21

1) Postpartum cardiomyopathy

2) 10%

Question 22

All pregnant cardiac patients should be on a __1__ diet.

Encourage rest in the __2__ position.

Answer 22

1) Low sodium

2) Left lateral

Question 23

What condition is characterized by immunoglobulins attaching to maternal platelets?

Answer 23

Immune Idiopathic Thrombocytopenia

Question 24

What steroid is given for Immune Idiopathic Thrombocytopenia treatment?

Answer 24

Prednisone

Question 25

Preterm delivery, fetal growth restrictions, stillbirth, and miscarriage are all fetal complications of what autoimmune disorder?

Answer 25

SLE

Question 26

Treat the SLE flares with?

Answer 26

Prednisone

Question 27

There is a 10% risk for neonatal lupus-passive transfer of __1__ or __1__.

Answer 27

anti-Ro/SSA or anti-La/SSB

Question 28

The presence of lupus anticoagulant and or anticardiolipin antibody is diagnostic of?

Answer 28

Antiphospholipid Syndrome

Question 29

With antiphospholipid syndrome there is an increased risk of developing?

Answer 29

Preeclampsia

Question 30

Treated antiphospholipid syndrome during pregnancy with __1__ and __2__.

Answer 30

1) Heparin/low molecular weight heparin | 2) Low-dose aspirin

Question 31

Acute Renal Failure is due to preexisting renal disease or pregnancy induced and there are three types of it. Which type is seen with acute blood or fluid loss? Which type is there usually a preexisting disease (lupus nephritis) or hypercoagulable state? Which type is there rare, urologic obstructive lesions such as kidney stones?

Answer 31

1) Pre-renal 2) Renal 3) Post-renal

Question 32

Using different mechanics to remove the obstruction such as a urethral catheter is the treatment for which type of Acute Renal Failure? Treatment such as diuretic therapy and hemodialysis is directed at preventing further damage for which type of Acute Renal Failure? Volume restoration is the treatment for which type of Acute Renal Failure?

Answer 32

1) Post-renal 2) Renal 3) Pre-renal

Question 33

Chronic Renal Failure with serum ____ greater the 1.5 to 2 worsens the prognosis.

Answer 33

Creatinine

Question 34

__1__ is more e likely to lead to cystitis and pyelonephritis in pregnant women. __2__ is the most common cause.

Answer 34

1) Asymptomatic bacteriuria | 2) E. coli

Question 35

Fever, costovertebral tenderness, malaise, elevated WBC is the presentation of __1__. 20% of these patients have increased __2__ activity and can result in __3__.

Answer 35

1) Pyelonephritis 2) Uterine 3) Preterm labor

Question 36

What do 50-80% of women complain of during the first 8-12 weeks of pregnancy and is treated with vitamin B6, doxylamine, and promethazine?

Answer 36

Nausea and vomiting

Question 37

Persistent nausea and vomiting associated with >5% loss of pre-pregnancy weight, ketonuria, and dehydration is characteristic of?

Answer 37

Hyperemesis gravidarum

Question 38

What GI condition occurs in 70% of pregnant women and treatment involves small meals, avoiding lying down after meals, elevate head when sleeping, antacids, and H2 blockers?

Answer 38

Reflux Esophagitis (GERD)

Question 39

What GI condition may pregnancy actually improve the condition of? Antibiotic therapy is targeted at?

Answer 39

1) Peptic ulcer | 2) H. pylori

Question 40

Pregnant women with ____ syndrome are at greater risk due to delayed gastric emptying and increased intraabdominal/intragastric pressure which can result in adult respiratory syndrome.

Answer 40

Mendelson’s Syndrome aka acid aspiration syndrome

Question 41

There can be increase ____ risk if Inflammatory Bowel Diseases (Crohn’s disease and ulcerative colitis) is active at the time of conception.

Answer 41

Miscarriage

Question 42

Cholestasis and pruritis in second half of pregnancy along with an increased risk of meconium stained amniotic fluid and fetal demise is characteristic of?

Answer 42

Intrahepatic Cholestasis of pregnancy

Question 43

With Intrahepatic Cholestasis of pregnancy what is a common presentation? Labs reveal what serum levels to be elevated?

Answer 43

1) Itching without abdominal pain or rash | 2) Bile acids

Question 44

__1__ is an obstetric emergency characterized by maternal liver dysfunction and/or failure that can lead to maternal and fetal complications, including death. __2__ must be done in order to save the mothers life.

Answer 44

1) Acute fatty liver of pregnancy | 2) Termination of pregnancy

Question 45

The most common reason for anemia in pregnancy is?

Answer 45

Iron deficiency

Question 46

Because pregnancy is a hypercoagulable state there is up to 5 fold increase in ____ and the greatest risk is the first 5 weeks postpartum.

Answer 46

Venous thrombosis

Question 47

What thromboembolic disorder is most common in patients with varicose veins, obesity and little physical activity and are most common in calf, will not result in pulmonary emboli?

Answer 47

Superficial thrombophlebitis

Question 48

What thromboembolic disorder presents with pain the calf with dorsiflexion and is more common in the left leg than the right and it has incidence of 1 in 2000 patients antepartum and 1 in 700 postpartum?

Answer 48

Deep venous thrombosis (DVT)

Question 49

____ therapy for DVT is used for 6 weeks postpartum but not during pregnancy due to risk of fetal hemorrhage or teratogenesis.

Answer 49

Coumadin

Question 50

What complication of DVT can lead to maternal mortality?

Answer 50

Pulmonary Embolism

Question 51

What is the most common pulmonary disease in pregnancy?

Answer 51

Asthma

Question 52

What is the most common type of headache for pregnant women? Treat with?

Answer 52

1) Tension type | 2) Acetaminophen

Question 53

What neurologic disorder most often improve during pregnancy?

Answer 53

Migraines

Question 54

The episodes of Multiple sclerosis are __1__ during pregnancy. They may __2__ postpartum.

Answer 54

1) Fewer and less severe | 2) Exacerbate

Question 55

__1__ should not be used during pregnancy as it is more teratogenic than other antiepileptics. Most commonly used medications are __2__ and __2__.

Answer 55

1) Valproate | 2) Lamotrigine and levetiracetam

Question 56

Women on anti-epileptics should be on 0.4 mg of ____ per day before and during pregnancy.

Answer 56

Folic acid

Question 57

The use of antidepressants should try to be avoided in the ___ trimester.

Answer 57

First

Question 58

The diagnosis of baby blues is changed to postpartum depression after ___ weeks.

Answer 58

Two weeks