Medical Disease

Question 1

how does congenital hypothyroidism present?

Answer 1

low birth weight and neuropsychological impairment

Question 2

what will labs reveal in hypothyroidism

Answer 2

high TSH

low T4

Question 3

treatment for hypothyroid

Answer 3

levothyroxine

Question 4

changes in pregnancy associated with thyroid

Answer 4

more RBCs, increased estrogen and thyroglobulin proteins

Question 5

why do the changes in thyroid hormones matter?

Answer 5

euthyroid non-pregnant women with thyroid disease become relatively hypothyroid as she gets more and more pregnant

Question 6

important considerations in hypothyroidism in pregnancy

Answer 6

may require increasing levothyroxine in pregnancy

• usually requires 25% increase
• requires TSH to be assessed regularly (q4-6wks)

Question 7

how to diagnose hypothyroidism in pregnancy

Answer 7

TSH and free T4
Ultrasound
NO RADIOACTIVE IODINE ABLATION (RAIU)

Question 8

labs in hyperthyroidism

Answer 8

low TSH

high free T4

Question 9

diagnosis of hyperthyroid in pregnancy

Answer 9

TSH and free T4
surgery in 2nd trimester
PTU in pregnancy

Question 10

treatment of hyperthyroidism prior to pregnancy

Answer 10

surgical resection or radioactive iodine ablation

Question 11

considerations for hyperthyroid diagnosis in pregnancy

Answer 11

nothing radioactive can be used

• surgery can still be performed in the 2nd trimester and only in extreme cases
• PTU in pregnancy

Question 12

mechanism of action of propylthiouracil (PTU)

Answer 12

partially blocks conversion of T4->T2

Question 13

treatment of hypothyroid disease in pregnancy

Answer 13

frequent TSH assessment

adjust dose of levothyroxine based on TSH

Question 14

valproate in pregnancy

Answer 14

cardiac abnormalities, neural tube defects, craniofacial abnormalities

Question 15

what epileptic drugs to avoid in pregnancy?

Answer 15

valproate, phenytoin, and carbamazapine

Question 16

what are phenytoin and carbamazapine associated with in pregnancy

Answer 16

cleft palate/craniofacial abnormalities, cardiac abnormalities, and developmental delay

Question 17

what med is a reasonable choice in pregnancy?

Answer 17

levetiracetam

Question 18

what should every pregnant patient on anticonvulsants receive?

Answer 18

folate supplementation

Question 19

asymptomatic screen of bacteriuria

Answer 19

YES

Question 20

are pregnant patients with asymptomatic bacteriuria treated?

Answer 20

YES

Question 21

first line treatment for asymptomatic bacteriuria

Answer 21

empiric coverage of UTIs:

- oral amoxicillin OR IV ceftriaxone

Question 22

back-up treatment for asymptomatic bacteriuria if penicillin allergy?

Answer 22

nitrofurantoin

Question 23

what is found in asymptomatic bacteriuria

Answer 23

leukocyte esterase positive
nitrite positive
WBCs
bacteria
no symptoms

Question 24

treat asymptomatic bacteriuria

Answer 24

oral abx

Question 25

what is found in cystitis

Answer 25

urgency, frequency, and dysuria leukocyte esterase positive nitrite positive

Question 26

treatment of cystitis

Answer 26

amoxicillin

Question 27

what is found in pyelonephritis

Answer 27

urgency, frequency, and dysuria, high fevers, and costovertebral angle tenderness leukocyte esterase positive nitrite positive WBC casts

Question 28

treatment of pyelonephritis

Answer 28

IV ceftriaxone | obtain ultrasound to rule out abscess

Question 29

meds that are not safe in pregnancy

Answer 29

ACE inhibitors (-prils) ARBs (-artan) lithium retinoic acid oral diabetes medications (metformin may be ok) anticonvulsants (valproate, phenytoin, carbamazapine)

Question 30

meds that are almost always safe

Answer 30

``` α-methyl-dopa labetalol hydralazine insulin amoxicillin ceftriaxone nitrofurantoin ```

Question 31

what is pregnancy safety category A

Answer 31

no risk in controlled human studies

Question 32

what is pregnancy safety category B

Answer 32

no risk in animal studies, but no human data OR risk in animal studies, but no risk in human studies

Question 33

what is pregnancy safety category C

Answer 33

risk not ruled out, benefits may outweigh risk

Question 34

what is pregnancy safety category D

Answer 34

evidence of risk in humans, but still might be worth it if the thing they treat is really bad

Question 35

what is pregnancy safety category X

Answer 35

never use in pregnancy

Question 36

what is pregnancy safety category N

Answer 36

not classified

Question 37

what med to select for HTN pregnancy

Answer 37

α-methyldopa

Question 38

what med to select for HTN in pregnancy if α-methyldopa is not available

Answer 38

hydralazine or labetalol

Question 39

first line treatment for diabetes in patients looking to become pregnant

Answer 39

dietary modification and lifestyle modifications | - meet with a nutritionist

Question 40

mainstay of therapy of DM in pregnancy

Answer 40

insulin

Question 41

what are birth defects associated with GDM mom?

Answer 41

macrosomia, premature delivery, transposition of the great vessels