MCQ Obstetrics Answer 34

The correct answer is C.

Patients with a history of gestational diabetes have a high likelihood for eventually developing overt diabetes. These women should therefore be extensively counseled regarding the importance of diet and exercise. Along with counseling, testing is necessary to determine which patients actually do develop overt diabetes.

Testing should be performed in the first few months following the delivery. This testing may be a 75-g, 2-hour, oral glucose tolerance test. Diabetes is diagnosed if the fasting glucose level exceeds 140 mg/dL, or two post-glucose measurements exceed 200 mg/dL. Patients should then undergo fasting glucose testing every 3 years.

This patient, given her history of gestational diabetes, needs to have regular testing.

Chest x-ray every 3 years (choice A) is not recommended as a screening test for this patient. Although the number of deaths from lung cancer surpasses that of breast cancer, and lung cancer is the leading cause of cancer death in women, routine chest x-ray is not used as a regular screening test.

Coronary angiography every 3 years (choice B) would not be recommended for this patient. This is an invasive procedure that currently is not used as a regular screening test in the general population.

Mammography every 3 years (choice D) would not be recommended for this patient. At 33 years of age, she does not yet require routine mammography. She should have a mammogram every 1-2 years starting at age 40, and then annually starting at age 50.

Pap testing every 3 years (choice E) would not be recommended for this patient. Pap testing should be performed annually starting at age 18, or with the initiation of sexual intercourse. Some recommend that the interval can be increased at the physician's discretion in a low-risk patient with three normal Pap tests in a row. Others dispute this, arguing that annual Pap tests should be performed on all women.

In any event, this patient, with her history of Chlamydia and gonorrhea, is not low risk and therefore needs annual Pap testing.

Category: Obstetrics MCQs