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WorksheetsDiabetes 2
Total questions: 28
Worksheet time: 14mins
What does in utero exposure to hyperglycemia lead
to?
increase fetal fat cells
fetal hyperinsulinemia
insulin resistance in adolescence
all of the above
A 34 year old woman was diagnosed with diabetes at the age of 20. Her initial prenatal care labs return with a 24-hr urine protein of 250mg. She has benign retinopathy on ophthalmologic exam. What White classification does her pregnancy carry?
C
D
F
R
Which of the following findings are considered diagnostic for overt diabetes in pregnancy?
hemoglobin A1C >6%
glucosuria on urine dip
fasting plasma glucose > or equal to 120mg/dL
random plasma glucose > or equal to 200mg/dL
Fetuses of overtly diabetic mothers have an increased risk for which of the following?
preterm delivery
spontaneous abortion
congenital malformation
all of the above
How does diminished fetal growth occur in pregestational diabetes?
substrate deprivation
fetal hyperinsulinemia
altered lipid metabolism
all of the above
Compared to women without diabetes, which fetal condition occurs more often in the setting of pregestational diabetes?
stillbirth
perinatal death
postpartum hemorrhage
gestational hypertension
Which of the following are considered reasons for unexplained fetal demise in women requiring insulin during pregnancy?
nonketotic acidosis
elevated lactic acid levels
decreased fetal hematocrit
none of the above
Which of the following is a reasonable explanation for hydramnios in a pregnancy complicated by diabetes?
maternal endothelial leak caused by hyperglycemia
glucose reabsorption by the fetal glomerular collecting system
osmotic gradient created by high glucose concentrations in the amniotic fluid
all of the above
What is the most likely cause for the increased incidence of respiratory distress syndrome in the neonates of diabetic mothers?
indicated preterm delivery
delayed maturation of type II pneumocytes
decreased production of surfactant in a hyperglycemic environment
all of the above
Which of the following statements regarding cardiomyopathy in infants of diabetic mothers is true?
is reversible after birth
ventricular hypertrophy is due to insulin excess
in severe cases may lead to pulmonary hypertension
in the first trimester systolic dysfunction is already present
All except which of the following statements
regarding hypocalcemia in the newborn is accurate?
Defined as <9 mg/dL
Etiology is unexplained
May be related to preterm birth
Seen more often with strict glucose control
Maternal mortality in women with type 1 diabetes results from which of the following?
infection
hypertension
diabetic ketoacidosis
all of the above
The first and most common visible retinal lesions in diabetes are small micro aneurysms followed by blot hemorrhages. This describes which of the following conditions?
proliferative retinopathy
nonproliferative retinopathy
is irreversible with improved control
the etiology of cotton wool exudates
What is the most important component of diabetic ketoacidosis in pregnancy?
restore euglycemia
provide IV hydration
provide IV potassium repletion
provide IV bicarbonate to correct acidosis
Which of the following infections is increased in pregnant women with overt diabetes?
pyelonephritis
respiratory infections
wound infection after cesarean delivery
all of the above
The most difficult aspect of preconceptional control in women with diabetes is which of the following?
resistance to insulin therapy
unpredictable insulin requirements
half of pregnancies in the US are unplanned
all of the above
Women with type 1 diabetes should achieve glycemic control with which of the following during pregnancy?
insulin
diet alone
insulin and diet
oral hypoglycemic agents
Which of the following is associated with fasting blood glucose levels >120 mg/dL?
preeclampsia
cesarean delivery
birth weight >90th percentile
all of the above
Which of the following is true concerning management of overt maternal diabetes in the second trimester?
should undergo amniocentesis
should undergo a fetal echocardiogram
have higher rates of chromosomal abnormalities
should be offered genetic screening if >35 years of age
ACOG recommends which of the following regarding the management of women with overt diabetes during labor?
morning dose of long acting be held
IV infusion of normal saline
regular IV insulin administered at a rate of 1.25 U/hr if glucose levels exceed 100 mg/dL
all of the above
Concerning screening and diagnosis of gestational DM during pregnancy, which of the following statements is true?
the HAPO study supports the 1-step approach
ACOG recommends a 2-step approach
identifying the 10% of women in the 1-step approach who should not be screened would add unnecessary complexity to the diagnosis of gestational diabetes
all of the above
Which of the following concerning the HAPO study research group are true?
Blood glucoses were measured fasting and then in 2 hours
the reference group for plasma fasting glucose was < or equal to 80 mg/dL
findings supported that increasing plasma glucose levels were associated with increasing adverse outcomes
all of the above
Which of the following factors has been implicated in fetal macrosomia?
leptin
c-peptide
insulin-like growth factor
all of the above
What is the most correct distribution of nutritional intake concerning caloric intake as endorsed by ACOG?
30% fat
30% protein
40% carbohydrates
all of the above
ACOG recommends which of the following concerning exercise in pregnancy for diabetics?
weight lifting is contraindicated
30 min per day of aerobic exercise is recommended
NY Heart Association Class I and II should participate in active aerobic programs
regular physical activity that incorporates aerobic and strength conditioning exercise is recommended during pregnancy
Which of the following statements regarding treatment of gestational DM is accurate?
insulin is the preferred medication in pregnancy
diet and exercise alone should not be used in pregnancy
a trial of oral hypoglycemics can be used prior to initiating insulin therapy
the starting dose of insulin in 0.6-1.0 mg/kg/day in divided doses if insulin is needed
A multigravida with no prenatal care presents to
labor and delivery at 39 weeks' gestation. Her last
baby was born with forceps-assisted vaginal delivery,
weighed 4200 grams, and she had a third-degree
perineal laceration repaired. Her random glucose
is 257 mg/dL and urinalysis reveals 3+ glycosuria.
Bedside ultrasound reveals an estimated fetal weight
of 4634 grams. On exam her cervix is 1 cm dilated.
What course of action do you recommend?
induction of labor
return to clinic in 1 week
amniocentesis for fetal lung maturity
begin insulin and proceed with cesarean delivery
A 29-year-old primigravida with class B diabetes
at 39 weeks' gestation presents to clinic. She has
received parental care throughout pregnancy and her
diabetes is under good control on split dose insulin.
Her fetal anatomy ultrasound and echocardiogram
were normal. The current estimated fetal weight is
4163 grams and her cervix is 1 cm dilated. What
course of action do you recommend?
Cesarean delivery
induction of labor
return to clinic in 1 week
amniocentesis for fetal lung maturity
