Pregnancy & Paediatrics

Question 1

The first stage of the ovarian cycle is driven by which hormone?

Answer 1

FSH

Question 2

The third phase of the ovarian cycle is driven by which hormone?

Answer 2

LH

Question 3

The follicle is an important source of which hormone?

Answer 3

Oestradiol

Question 4

All follicles will produce progesterone, true or false?

Answer 4

False - only if it develops into the corpus luteum (luteal phase) if implanted

Question 5

What do pregnancy tests measure?

Answer 5

Human Chorionic Gonadotrophin

Question 6

What effect do progesterone & hCG have on blood sugar/ diabetes?

Answer 6

They induce insulin resistance (physiological as this makes more glucose available to the foetus)

Question 7

Gestational diabetes usually occurs in the first trimester, true or false?

Answer 7

False - usually in the third

Question 8

Gestational diabetes requires a predisposition to develop, true or false?

Answer 8

True

Question 9

Foetal organogensesis begins at which week of development?

Answer 9

Week 5

Question 10

What effect does hyperglycaemia have on a developing foetus?

Answer 10

Congenital malformations (e.g. ancephaly, spina bifida), prematurity, neonatal complications (e.g. ARDS, hypoglycaemia)

Question 11

ACEi and statins are recommended for hypertensive diabetics in pregnancy, T/F?

Answer 11

False - strictly avoided

Question 12

Gestational diabetics should aim to have their BG below what 2-hours post meal?

Answer 12

<7mmol/L

Question 13

What’s the ideal target for pre-meal BG in gestational diabetes?

Answer 13

4.5-5.0mmol/L

Question 14

Diabetics with MODY can be treated with which drug? (1)

Answer 14

-Glibenclamide (a SUR)

Question 15

How is gestational diabetes differentiated from T2DM?

Answer 15

Give an OGTT 6 weeks post-natally; if not resolved they have T2DM, not G-DM.

Question 16

What % of patients with gestational diabetes will go onto develop T2DM?

Answer 16

50% (80% if obese)

Question 17

Acarbose can be used to reduce chance of developing T2DM in G-DM. How does it work?

Answer 17

It inhibits glucose hydrolases at the brush-border of intestine, limiting glucose uptake

Question 18

Maternal thyroxine is particularly important for what aspect of foetal development?

Answer 18

Myelinogenesis

Question 19

If a patient on thyroxine falls pregnant, how much should their thyroxine dose be adjusted by immediately?

Answer 19

25mcg increase

Question 20

How often should TFTs be checked in pregnancy? (2)

Answer 20

1) Monthly for the first 20 weeks

2) 2-monthly after

Question 21

Hypothyroidism has been associated with which pregnancy complications? (3)

Answer 21

1) Abortion
2) Pre-eclampsia
3) Abruption

Question 22

The thyroid should increase in size in pregnancy, true or false?

Answer 22

True - to accommodate an increased production of thyroid hormones

Question 23

hCG has what effect on thyroid hormones?

Answer 23

• Increases fT4

- Lowers TSH

Question 24

hCG is thought to be responsible for which common side-effect of pregnancy?

Answer 24

Hyperemesis gravidarum

Question 25

Hyperthyroidism in pregnancy needs to be differentiated from what other condition?

Answer 25

hCG-induced thyrotoxicosis

Question 26

How can gestational hCG associated thyrotoxicosis be differentiated from hyperthyroidism? (3)

Answer 26

1) Gestational hCG wil have a raised hCG and low TSH 2) No TRAb antibody present (important remember as TRAb antibodies will pass placenta) 3) Gestational will resolve within 20 weeks

Question 27

Graves' Disease is often worsened by pregnancy, true or false?

Answer 27

False - it often settles

Question 28

Graves' Disease can be managed with which medications safely in pregnancy (2)?

Answer 28

1) Beta-blockers | 2) Low-dose ATDs (PTU in 1st trimester as carbimazole risks cutis aplasia, with carbimazole in 2nd and 3rd)

Question 29

What's the main "risk" of using PTU?

Answer 29

Liver toxicity

Question 30

Thyroiditis can occur up to how long after pregnancy?

Answer 30

1 year

Question 31

What is the incidence of T1DM in children?

Answer 31

1:450

Question 32

Around which % of T1DMs will present with DKA?

Answer 32

25%

Question 33

C-peptide is often undetectable in the first presentation of T1DM, T/F?

Answer 33

False - it is often residual but dwindles after

Question 34

A random glucose over what is WHO criteria for T1DM?

Answer 34

>11.0mmol/L

Question 35

A fasting glucose over what is WHO criteria for T1DM?

Answer 35

>7.0mmol/L

Question 36

What are the symptoms/ signs of DKA? (3)

Answer 36

1) Vomiting, abdominal pain 2) pH <7.3, urine ketones +++ 3) Acute dehydration

Question 37

What are the key differences between management of DKA in children versus adults? (3)

Answer 37

1) Guidance says NOT to give any fluids unless shock is present (due to risk of cerebral oedema) 2) Insulin should be commenced 1 hour after IV fluids 3) Treatments based upon weight

Question 38

Why is it important to stress the potential danger of misusing insulin, particularly in adolescents?

Answer 38

Insulin triggers weight gain (lipogenesis) and some patients may run their sugars high as a weight-loss strategy

Question 39

A continuous insulin infusing pump can remain in place for how long?

Answer 39

3 days

Question 40

What is insulin sensitivity?

Answer 40

The ratio by which 1 unit of insulin will lower BG (e.g. 1:2 = 1 unit will lower by 2mmol/L)

Question 41

What is a carb ratio in insulin dosing?

Answer 41

The amount of insulin that must be administered for a given amount of carbs (e.g. 1:10 = 1 unit of insulin every 10 carbs)

Question 42

Thyroid status must be controlled within which period in pregnant mothers? Why?

Answer 42

Ideally within 2 weeks, but up to 2/3 months. After this cretinism can develop (permanent)

Question 43

Which test screens for congenital thyroid status?

Answer 43

Guthrie heel prick test at day 5

Question 44

Hyperthyroidism is likely to persist permanently in the young, T/F?

Answer 44

False - usually will spontaneously resolve within 2-3 years

Question 45

Absence of CYP21A2 hydroxylase leads to which condition?

Answer 45

Congenital adrenal hyperplasia (leads to Addisonian crisis)