Pregnancy with Pre-existing Medical Illness Exam Review, Free CME Quiz
A free sample Pregnancy with Pre-existing Medical Illness question included below. The full Pregnancy with Pre-existing Medical Illness CME quiz is free online for a limited time. You can earn AMA CME credit - and now you can earn ANCC contact hours as well! Play now.
Here's this week's sample CME board review question on pregnancy with pre-existing medical illness:
A 21-year-old insulin dependent diabetic is found comatose at home. She is 17 weeks pregnant and is found to have a serum glucose of 386 mg/dl (normal: 70-110 mg/dl).
The most accurate statement regarding diabetic ketoacidosis (DKA) in pregnancy is...
The correct answer is:
Hyperemesis is one of the most common precipitants.
Discuss common etiologies of coma during pregnancy due to diabetic ketoacidosis.
Hyperemesis and noncompliance or errors in insulin dosage are the most common precipitants of diabetic ketoacidosis in the pregnant patient. Admission is often indicated to correct dehydration and more carefully adjust glucose control.
The serum pH may be deceptively normal in the pregnant patient, because the initial pH tends to be higher in pregnancy due to physiologic hyperventilation. DKA is rare in patients with gestational diabetes, and serum glucose may be only moderately elevated because the fetus continues to secrete insulin and use glucose.
The rate of congenital malformations in patients with diabetes is increased threefold or fourfold compared with the nondiabetic population, with anomalies being more likely in pregnant women with poor glycemic control. Preeclampsia and placental infarction secondary to vascular disease may result in impaired fetal development and stillbirth
Maternal mortality is rare in appropriately treated DKA. Fetal mortality rates are relatively high, ranging from 10 to 35%.
Gorgas DL. Cooper R. Comorbid Medical Emergencies During Pregnancy (Chapter 179) In: Walls R, et al., Rosen's Emergency Medicine: Concept and Clinical Practice. 9th ed. 2018: 2259-2276.e4
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