During normal pregnancy, thyroid function is associated with an increase in:
Correct Answer D:
TSH does not cross the placenta in significant amounts, but T4 transfer in early gestation may have a protective role in the early neural development of the fetus. Thyroid-binding globulin levels are increased, leading to an increase in the amount of bound thyroid hormone (choice D). Free thyroid hormone stays in the normal range, and total thyroid hormone levels are elevated. The T3 resin uptake is inversely proportional to the hormone binding capacity, so it decreases in normal pregnancy.
→ Free triiodothyronine (T3) (choice A) stays essentially unchanged.
→ Basal metabolic rate (choice B) increases moderately. Some researches show that energy needs are different for each trimester. An increase of 5%, 10% and 25% of pre-pregnancy Basal Metabolic Rate is the agreed figure.
→ TSH (choice C) does not cross the placenta in significant amounts.
→ The T3 resin uptake (choice E) decreases since the percent of thyroid hormone that is bound has increased.
Which of the following maternal serum concentrations is increased during normal pregnancy?
Correct Answer E:
Albumin will decrease due to dilutional effects. Bicarbonate decreases due to increased renal excretion to correct for the respiratory alkalosis (blowing off more CO2). Due to the 50% rise in GFR, the serum creatinine falls. Insulin levels are higher both in the fasting and postprandial states. By comparison, fasting glucose concentrations are 10 to 20% lower during pregnancy. Plasma levels of lipids (choice E) increase during the latter part of pregnancy, the most marked rises occurring with triglycerides, cholesterol, and free fatty acids.
→ Fasting glucose concentrations (choice A) are 10 to 20% lower during pregnancy due to: increased storage of tissue glycogen, increased peripheral glucose utilization, decreased hepatic glucose production, glucose consumption by the fetus (especially in late pregnancy).
→ Serum albumin levels (choice B) fall due to dilutional effects.
→ Creatinine (choice C) falls due to a 50% increase in glomerular filtration rate. This occurs as early as 12 weeks’ gestation.
→ Bicarbonate (choice D) decreases as the kidney excretes more the compensate for the drop in CO2 levels (due to increase in minute ventilation; renal compensation for a respiratory alkalosis).
During a routine urinalysis in pregnancy, which of the following is most likely to be a normal finding?
Correct Answer A:
Due to the increase in glomerular filtration rate by 50%, the transport maximum for glucose can be reached at a much lower serum concentration. Occasional spillage of glucose in the urine is a normal finding in pregnancy.
B. Routine urinalysis should not have the presence of blood.
C. Routine urinalysis should not show evidence of infection.
D. Routine urinalysis should not show evidence of infection.
E. True proteinuria is abnormal in pregnancy and may either represent preeclampsia or an underlying renal abnormality.
During a routine prenatal visit, a patient at 28 weeks gestation describes a worsening pain in her lower back and pelvic area. She is averse to analgesics but is eager to try exercise to relieve the pain. Additional patient history and an examination confirm that the pain is not due to underlying medical problems.
Which one of the following would be the most appropriate exercise prescription for this patient?
Correct Answer C:
Low back pain and pelvic pain are commonly encountered in pregnancy, a time when medication or physical modality use may prove undesirable or difficult. A properly prescribed exercise program is a generally safe and effective method to treat this pain. The most appropriate exercises for pregnancy- related pelvic pain and low back pain target the low back, trunk, and abdominal muscles to increase core stability. Examples of such exercises include Pilates, back extension exercises, and abdominal crunches. Isometric and isotonic exercises work muscle groups against either an external force or opposing muscle groups, and are best suited for the development of muscle tone, strength, and conditioning in the extremities. Likewise, concentric and closed kinetic chain exercises involve working muscles against resistance, and are best suited for rehabilitating and strengthening the extremities.
A woman develops severe post partum hemorrhage. 6 weeks later she presents with fatigue and an inability to breast feed.
All of the following hormones could be decreased, except:
Sheehan's syndrome is a rare complication of childbirth. Sheehan's syndrome typically develops because of excessive blood loss and shock during childbirth, which results in partial destruction of the pituitary gland. Symptoms include fatigue, loss of pubic and underarm hair, and inability to produce breast milk.
The pituitary hormones will be affected and they include FSH, LH, ACTH, TSH, prolactin and growth hormone. Remember the mnemonic ‘FLAT PiG’ for the anterior pituitary hormones.
Aldosterone is produced by the adrenal gland. In particular the zona glomerulosa part of the adrenal cortex.
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