Pregnancy & Paediatrics Flashcards
The first stage of the ovarian cycle is driven by which hormone?
FSH
The third phase of the ovarian cycle is driven by which hormone?
LH
The follicle is an important source of which hormone?
Oestradiol
All follicles will produce progesterone, true or false?
False - only if it develops into the corpus luteum (luteal phase) if implanted
What do pregnancy tests measure?
Human Chorionic Gonadotrophin
What effect do progesterone & hCG have on blood sugar/ diabetes?
They induce insulin resistance (physiological as this makes more glucose available to the foetus)
Gestational diabetes usually occurs in the first trimester, true or false?
False - usually in the third
Gestational diabetes requires a predisposition to develop, true or false?
True
Foetal organogensesis begins at which week of development?
Week 5
What effect does hyperglycaemia have on a developing foetus?
Congenital malformations (e.g. ancephaly, spina bifida), prematurity, neonatal complications (e.g. ARDS, hypoglycaemia)
ACEi and statins are recommended for hypertensive diabetics in pregnancy, T/F?
False - strictly avoided
Gestational diabetics should aim to have their BG below what 2-hours post meal?
<7mmol/L
What’s the ideal target for pre-meal BG in gestational diabetes?
4.5-5.0mmol/L
Diabetics with MODY can be treated with which drug? (1)
-Glibenclamide (a SUR)
How is gestational diabetes differentiated from T2DM?
Give an OGTT 6 weeks post-natally; if not resolved they have T2DM, not G-DM.
What % of patients with gestational diabetes will go onto develop T2DM?
50% (80% if obese)
Acarbose can be used to reduce chance of developing T2DM in G-DM. How does it work?
It inhibits glucose hydrolases at the brush-border of intestine, limiting glucose uptake
Maternal thyroxine is particularly important for what aspect of foetal development?
Myelinogenesis
If a patient on thyroxine falls pregnant, how much should their thyroxine dose be adjusted by immediately?
25mcg increase
How often should TFTs be checked in pregnancy? (2)
1) Monthly for the first 20 weeks
2) 2-monthly after
Hypothyroidism has been associated with which pregnancy complications? (3)
1) Abortion
2) Pre-eclampsia
3) Abruption
The thyroid should increase in size in pregnancy, true or false?
True - to accommodate an increased production of thyroid hormones
hCG has what effect on thyroid hormones?
- Increases fT4
- Lowers TSH
hCG is thought to be responsible for which common side-effect of pregnancy?
Hyperemesis gravidarum
Hyperthyroidism in pregnancy needs to be differentiated from what other condition?
hCG-induced thyrotoxicosis
How can gestational hCG associated thyrotoxicosis be differentiated from hyperthyroidism? (3)
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
Graves’ Disease is often worsened by pregnancy, true or false?
False - it often settles
Graves’ Disease can be managed with which medications safely in pregnancy (2)?
1) Beta-blockers
2) Low-dose ATDs (PTU in 1st trimester as carbimazole risks cutis aplasia, with carbimazole in 2nd and 3rd)
What’s the main “risk” of using PTU?
Liver toxicity
Thyroiditis can occur up to how long after pregnancy?
1 year
What is the incidence of T1DM in children?
1:450
Around which % of T1DMs will present with DKA?
25%
C-peptide is often undetectable in the first presentation of T1DM, T/F?
False - it is often residual but dwindles after
A random glucose over what is WHO criteria for T1DM?
> 11.0mmol/L
A fasting glucose over what is WHO criteria for T1DM?
> 7.0mmol/L
What are the symptoms/ signs of DKA? (3)
1) Vomiting, abdominal pain
2) pH <7.3, urine ketones +++
3) Acute dehydration
What are the key differences between management of DKA in children versus adults? (3)
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
Why is it important to stress the potential danger of misusing insulin, particularly in adolescents?
Insulin triggers weight gain (lipogenesis) and some patients may run their sugars high as a weight-loss strategy
A continuous insulin infusing pump can remain in place for how long?
3 days
What is insulin sensitivity?
The ratio by which 1 unit of insulin will lower BG (e.g. 1:2 = 1 unit will lower by 2mmol/L)
What is a carb ratio in insulin dosing?
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)
Thyroid status must be controlled within which period in pregnant mothers? Why?
Ideally within 2 weeks, but up to 2/3 months. After this cretinism can develop (permanent)
Which test screens for congenital thyroid status?
Guthrie heel prick test at day 5
Hyperthyroidism is likely to persist permanently in the young, T/F?
False - usually will spontaneously resolve within 2-3 years
Absence of CYP21A2 hydroxylase leads to which condition?
Congenital adrenal hyperplasia (leads to Addisonian crisis)
