Diabetes in Pregnancy MCQs

Prolactinoma: (>200) Clinical features: Amenorrhoea Galactorrhoea Infertility Compressive symptoms: B/L TEMPORAL HEMIANOPIA. DOC: CABERGOLINE - FOR ALL CASES BROMOCRIPTINE- IF PREGNANCY IS DESIRED. Reference : Harrison's Principles of Internal Medicine 21 st edition Page 2912

Polyuria, polydipsia with large volume of hypoosmolar urine suggest the diagnosis of Diabetes insipidus. Among the following, Lithium therapy causes nephrogenic diabetes. Other drugs causing Diabetes Insipidus: Lithium, Demeclocycline, Methoxyflurane, Amphotericin B, Aminoglycosides, Cisplatin, Rifampin, Foscarnet. Lithium causes DI by entering the Collecting Duct via the ENaC, where it down regulates the Aquaporin channels. Lithium also causes Chronic Tubulointerstitial Disease. Amiloride can be used to prevent and treat Lithium induced Diabetes Insipidus. Reference: Harrison's Principles of Internal Medicine, Ch: 316, Pg: 2363.

It is recommended that an FPG( Fasting plasma glucose) value in early pregnancy ≥5.1 mmol/l (92 mg/dl) should also be classified as Gestational Diabetes Mellitus. International Association of Diabetes and Pregnancy Study Groups Consensus Panel; Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiller JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy.

This lady's fasting plasma glucose levels are appropriate, but taking a BD mixed insulin regime is probably not appropriate to her lifestyle where her mealtimes and portion sizes may be slightly irregular given the fact that she has two other children to manage. A basal bolus regime would give her more flexibility in varying insulin dose. The coexistence of Addison's is unlikely and increasing the size of her meals would only promote more excess weight gain and worsening insulin resistance. Reference: ADA Standards of Diabetes Care - 2023

The screening for Diabetes mellitus should be performed in women at the first prenatal visit First trimester screening is performed for high risk women according to ADA while ACOG advocates universal screening for all women The diagnosis of Gestational Diabetes mellitus is made if either one of the following is satisfied: Fasting blood glucose > 92 mg/dl 1 hr post OGTT > 180 mg/dl 2 hr post OGTT > 153 mg/dl If fasting blood glucose is more than 126 mg/dl or 2-hour post glucose load value is > 200 mg/dl, the diagnosis of overt diabetes mellitus is made Reference: ADA Standards of Medical Care in Diabetes 2023

Clues pointing towards hemochromatosis: Dark skinned-> bronzing of skin Polyuria, polydipsia-> Diabetes mellitus Destructive arthropathy in typical location The characteristic feature of haemochromatotic arthropathy is involvement of the second and third metacarpals. The arthropathy can lead to extensive joint destruction. These patients may have episodes of acute, inflammatory pseudogout from such deposition. Arthropathy and hypogonadism do not respond to Iron lowering therapy. Reference: Harrison's Principles of Internal Medicine 21 st edition Ch: 374, Pg: 2871

Intervals between NST testing The interval between tests is arbitrarily set at 7 days. According to ACOG, more frequent testing is advocated for women with post term pregnancy, type I diabetes mellitus, IUGR or gestational hypertension. In these circumstances some investigators recommend twice weekly (i.e. after 72 hours) with additional testing performed for maternal or fetal deterioration regardless of the time elapsed since the last test. Generally daily NST is recommended with severe preeclampsia remote from term. Reference: Williams Obs. 23/e, p 339

Risk factors for Candida (Monilla) Vaginitis Promiscuity Immunosuppression (like HIV) Pregnancy Steroid therapy Following long-term broad spectrum antibiotic therapy Oral contraceptive pills Diabetes mellitus Poor personal hygiene Obesity Reference: Shaw 15th/ed p 146.