OB BM4 LONG EXAM 1-Diabetes Mellitus, Endocrine Disorders, Hematologic Disorders, Connective Tissue Disorders Flashcards
Which genetic syndrome belongs to the other types of diabetes mellitus according to MODY?
Edward syndrome
Klinefelter syndrome
Marfan syndrome
Noonan syndrome
Klinefelter syndrome
Which statement is true regarding incidence of Pregestational diabetes?
a. overt DM incidence is similar to obesity
b. >3000 new cases are diagnosed each year
c. women with type 2 DM have undiagnosed GDM
d. 15% of GDM are found to have diabetes after birth
a. overt DM incidence is similar to obesity
The diagnosis of pregestational diabetes is based on which criteria?
a. random plasma glucose level >200 mg/dL and history of unexplained fetal loss
b. fasting glucose level >125mg/dL plus polydipsia
c. hemoglobin A1c of at least 6.5% plus plasma glucose of mmol/L
d. random plasma glucose of at least 11.1 mmol/L plus persistent glucosuria
a. random plasma glucose level >200 mg/dL and history of unexplained fetal loss???
One of which is the fetal effects of Overt diabetes with HbA1c concentrations >12%
cardiomyopathy
hyperglycemia
hypercalcemia
oligohydramnios
cardiomyopathy
Incidence of macrosomia rises significantly when mean maternal blood glucose concentrations chronically exceed what level?
115 mg/dL
120 mg/dL
125 mg/dL
130 mg/dL
130 mg/dL
This statement is true regarding the maternal effect of diabetes mellitus?
a. microalbuminuria which is more than 300 mg/24 hours develops in patients destined to have end-stage renal disease
b. diabetic nephropathy commonly regreses due to improved glucose control
c. neovascularization begins on the vitreous and out into the retinal surface in response to ischemia
d. Peripheral symmetrical sensorimotor diabetic neuropathy is common in diabetic pregnant women
b. diabetic nephropathy commonly regreses due to improved glucose control
What is the maintenance dose of low dose IV insulin in the management of ketoacidosis?
2-8 U/hour
4-6 U/hour
2-10 U/hour
4-12 U/hour
2-10 U/hour
Which long acting insulin is commonly used in pregnant women with diabetes?
Lispro (short-acting)
Regular (short-acting)
Aspart (short-acting)
Glargine
Glargine
How do we manage overt diabetes during third trimester and delivery?
a. according to ACOG fetal surveillance should start at 28-32 weeks AOG
b. fetal kick counts should be done starting 34 weeks AOG
c. labor induction and delivery is planned at 39 weeks gestation (planned at 38 weeks)
d. reducing dose of long-acting insulin to be given on the day of delivery
d. reducing dose of long-acting insulin to be given on the day of delivery
According to ACOG, screening and diagnosis of gestational diabetes should be a two-step approach. Which is the recommended threshold value for its diagnosis?
a. FBS = 5.1 mmol/L
b. 1hour OGTT = 150 mg/dL (180 mg/dL)
c. FBS = 95 mg/dL (92 mg/dL)
d. 2hour OGTT = 9 mmol/L (8.5 mmol/L)
a. FBS = 5.1 mmol/L
Screening with 50g OGCT should be performed at what AOG?
12 weeks AOG
20 weeks AOG
24 weeks AOG
30 weeks AOG
24 weeks AOG
According to the Fifth International Workshop Conference on Gestational, screening strategy for high risk patients should include
Strong family history of type 2 diabetes
One-step procedure: diagnostic 100-g OGTT performed on all subjects
Age < 25 years
Member of an ethnic group with prevalence of GDM
Strong family history of type 2 diabetes
Which proinsulin like polypeptide is a risk factor for fetal macrosomia in GDM?
epidermal growth factor
fibroblast growth factor
platelet-derived growth factor
insulin-like growth factor
insulin-like growth factor
What is the recommended treatment of GDM with insulin according to ACOG?
a. insulin is considered if 1-hour postprandial levels persistently exceed 130 md/dL
b. insulin crosses placenta and is safe during pregnancy
c. insulin is added if fasting levels persistently exceed 95 mg/dL
d. regular insulin is helpful in postprandial glucose management
c. insulin is added if fasting levels persistently exceed 95 mg/dL
One of the side effects of metformin when given in pregnancy is:
PROM
phototherapy
stillbirth
5-minute Apgar score ≤ 5
phototherapy
What is the effect of thyroid disorders on pregnancy?
increased preterm birth
increased prenatal morbidity
increased postpartum thyroiditis
increased GDM
increased postpartum thyroiditis
Which hormone is structurally similar to TSH?
human chorionic gonadotropin
luteinizing hormone
follicle stimulating hormone
adrenocorticotropic hormone
human chorionic gonadotropin
At what gestational age will thyrotropin releasing hormone be detectable in the fetal serums?
12 weeks AOG
16 weeks AOG
20 weeks AOG
24 weeks AOG
20 weeks AOG
This is known to be the stem cell interchange that can lead to engraftment in several maternal tissue
autoimmune thyroid disease
fetal-to-maternal cell trafficking
thyroid peroxidase antibodies
fetal microchimerism
fetal microchimerism
Which one is a clinical finding of hyperthyroidism?
hypertension
increased T3 levels
markedly depressed TSH levels
failure to gain weight
failure to gain weight
Which condition is included in methimazole embryopathy?
choanal atresia
esophageal constrictions
fetal leucopenia
neonatal agranulocytosis
choanal atresia
This is true regarding surgical management of thyrotoxicosis in pregnancy
a. medical abortion is necessary for radioactive iodine exposure
b. pregnancy is avoided within 3 months post radioablative therapy
c. breastfeeding cessation for 3 months after irradiation surgery
d. surgery can be done anytime during pregnanc
c. breastfeeding cessation for 3 months after irradiation surgery
This perinatal complication of thyrotoxicosis is secondary to the fetal exposure to maternally administered thionamides
Goitrous thyrotoxicosis
Goitrous hypothyroidism
Nongoitrous hypothyroidism
Nongoitrous thyrotoxicosis
Goitrous hypothyroidism
This drug is given to further block peripheral conversion of T4 to T3
PTU
methimazole
dexamethasone
propranolol
dexamethasone
What is the pregnancy outcome when there is presence of autoantibodies toTPO and thyroglobulin?
greater risk of previa
increased stillbirth
increased abortion
greater risk for hypertension
increased abortion
What is the recommended daily dose of iodine intake according to institute of medicine during breastfeeding?
220 μg/d
260 μg/d
290 μg/d
320 μg/d
290 μg/d
During pregnancy, what is the source of parathyroid hormone?
parathyroid glands
placental tissue
fetal parathyroid gland
maternal bones
placental tissue
Which is an indication for parathyroidectomy in pregnancy?
serum calcium level 1.0 mg/dL
age >60 years
creatinine clearance < 50 mL/min
osteoporosis
serum calcium level 1.0 mg/dL
Which medication is given to block tubular calcium reabsorption with hyperparathyroidism?
calcitonin
furosemide
magnesium
mithramycin
furosemide
Which statement is true regarding Cushing syndrome in pregnancy?
a. most adenomas are macroadenomas measuring >1mm
b. There are more males affected than females
c. It is occasionally associated with hyperandrogenism
d. Fatigability and weakness are common symptoms during pregnancy
c. It is occasionally associated with hyperandrogenism
Which is an acquired etiology of anemia?
Thalassemia
Megaloblastic anemia
sickle-cell hemoglobinopathies
hemolytic anem
Megaloblastic anemia
Which clinical finding will confirm iron deficiency anemia?
serum ferritin levels of < 10mg/L
hemoglobin levels of < 8mg/dL
hematocrit levels of < 20%
serum iron levels of < 100mg/L
serum ferritin levels of < 10mg/L
During pregnancy vitamin B12 levels are lower than nonpregnant values because of decreased levels of which binding proteins?
cyanocobalamins
transcobalamins
calmodulin binding protein
GC globulin
transcobalamins
What is the most common complication of Paroxysmal Nocturnal Hemoglobinuria?
venous thromboses
Maternal death
hypertension
Budd-Chiari syndrome
venous thromboses
Which inherited condition can cause aplastic anemia
Thalassemia A
Fanconi anemia
Gaucher disease
G6PD deficiency
Fanconi anemia
What is the usual cause of secondary polycythemia?
gene mutation
stem cell disorder
cigarette smoking
drug interactions
cigarette smoking
What is the pathophysiology of Sickle hemoglobin?
prior sickle-cell hemoglobin C disease
substitution of glutamic acid by valine
chronic transfusion therapy
substitution of glutamic acid by lysine
substitution of glutamic acid by valine
The hallmark or the predominant symptoms of sickle cell crisis is:
high grade fever
severe anemia
hemolytic anemia
severe pain
severe pain
What drug is given to gravida with sickle cell hemoglobinopathy support rapid red blood cell turnover?
erythropoetin
hydroxyurea
ferrous fumarate
folic acid
folic acid
he common cause of severe childhood anemia in Southeast Asia due to hemoglobinopathy?
heterozygous E-β thalassemia
hemoglobin EE hemoglobinpathy
Homozygous hemoglobin E
Hemoglobin E plus Alpha thalassemia
heterozygous E-β thalassemia
Which is the genotype of a silent carrier of alpha thalassemia?
αα/α-
αα/αα
–/α-
–/αα
αα/α-
How do we diagnose Hemoglobin Bart?
by DNA analysis
by capillary electrophoresis
by Molecular genetic testing
by Targeted mutation analysis
by capillary electrophoresis
The pathophysiology of Hemoglobin H disease (β4) is?
a. heterozygous state for a0- plus α+- thalassemia with deletion of three or four alpha genes (–/-α)
b. α+- thalassemia minor in which one gene is deleted from each chromosome (-α/-α)
c. have α0-thalassemia minor inherited with both gene
d. deletions typically from the same chromosome (–/αα)
deletion of all four α-globin chain genes (–/–) characterizes homozygous α-thalassemi
a. heterozygous state for a0- plus α+- thalassemia with deletion of three or four alpha genes (–/-α)
This is known as the Homozygous β-thalassemia:
β-thalassemia minor
Cooley anemia
Hemoglobin Bart (γ4)
Thalassemia intermedia
Cooley anemia
This is characterized by lack of platelet membrane glycoprotein and causes severe dysfunction:
May-Hegglin anomaly
Idiopathic Thrombocytopenic Purpura
Bernard-Soulier syndrome
Primary or essential thrombocytopenia
Bernard-Soulier syndrome
What is the recommended treatment for Thrombocytosis in pregnancy?
aspirin
plasma transfusion
warfarin
dexamethasone
aspirin
This condition is caused by severe deficiency of factor IX and has similar genetic and clinical features with factor VIII:
Hemophilia A
Hemophilia B
von Willebrand disease
Stuart-Prower factor deficiency
Hemophilia B
Which immunologic criteria is included in the diagnosis of SLE?
thrombocytopenia (< 100,000/mm3)
Low complement C3 and C4
Leukopenia (< 3,000/mm3)
Anticardiolipin antibody (ACA)
Low complement C3 and C4
To prevent preeclampsia in patients with SLE, Aspirin is given at 50-150 mg daily. When is the recommended start of treatment?
on initial prenatal consult
12 weeks AOG
16 weeks AOG
20 weeks AOG
12 weeks AOG
The main change in the 2006 laboratory criteria recommendation for screening of APS is:
a. screening should be done at least in two or more occasions
b. IgM and IgM is done after 6 weeks
c. screening should be done at 12 weeks apart
d. confirmatory tests should show medium to high titer
screening should be done at 12 weeks apart
