drdg
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A 22-year-old woman G2P1 at 12 w gestation comes to the physician for her 3 rd prenatal check-up. Her pregnancy has been uncomplicated. She has no history of serious illness. Her previous pregnancy was uncomplicated. She does not use tobacco, alcohol or drugs. She has no family-history of DM. BP 135/80. Physical exam is normal. Urine dipstick shows glycouria, without proteinuria. Which of the following is the next most appropriate step in management ?
A. Reassurance and repeat follow-ups
B. Obtain fasting urine samples.
C. Obtain 1 hr 50 g oral glucose tolerance test
D. Obtain 3 hr 100 g glucose tolerance test
E. Start diabetic diet and insulin.
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| hanialkhadher
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i will go with C
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| hopefor
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its B
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| me007
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http://findarticles.com/p/articles/mi_m0689/is_11...
Results Glycosuria is found at some point in about 50% of pregnant women; it is believed to be due to an increased glomerular filtration rate. The renal threshold for glucose is highly variable and may lead to a positive test result for glycosuria despite normal blood sugar. High intake of ascorbic acid or high urinary ketone levels may result in false-positive results. Four published studies assessed the value of glycosuria as a screen for gestational diabetes. All used urine dipsticks. Three of the 4 most likely overestimate the sensitivity of glycosuria for predicting gestational diabetes.
My guess is A.
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| hanialkhadher
Forum Elite
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if glycosuria is detetected then a casual timed plasma venous glucose estimation should be performed and interpreted as below
a 75 g oral glucose tolerance test (OGTT)
http://www.gpnotebook.co.uk/simplepage.cfm?ID=-11...
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"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
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| me007
Forum Guru
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that is UK recomendations, questionable use for USMLE 
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| drdg
Forum Senior
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I am waiting more replies from kamsi, titly and kpmle2 and then put the correct answer soon. Thank you.
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| hanialkhadher
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Thank you drdg for this notification so we know you didn't forget about us.
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"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
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| titly
Forum Elite
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C.
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we spend our days waiting for the ideal path to appear in front of us, but, what we forget is paths are made by walking, not by waiting. keep walking................................
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| drdg
Forum Senior
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The correct answer is B.
Benign glycosuria is a very common finging in pregnant women because of decreased renal threshold. However, causes of glycosuria besides decreased renal threshold have to be ruled out first, which is best done with fasting glucose measurement. A positive result may be an early sign of gestional diabetes, and therefore, a 1-hour glucose tolerance test has to be carried out.
Diebetes screenings is also mandated in all pregnant women between 24-28 w gestation. At this stage of pregnancy, the pregnant woman is at higher risk of developing gestational diabetes because of sufficient amounts of hPL hormone.
The presence of glycosuria could be an early sign of gestational diabetes, and therefore, this condition has to be ruled out (A). Treatment can be instituted after the diagnosis confirmed.(E)
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| hanialkhadher
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Thanks
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"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
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| dr.roh
Forum Guru
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the fasting urine sample...has to be greater than what value to carry out a 1 hour 50g OGTT ?
---Is it > 126 and is it one reading or 2 readings > 126 ??
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| titly
Forum Elite
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Posts: 323
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2 reading more than 125
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we spend our days waiting for the ideal path to appear in front of us, but, what we forget is paths are made by walking, not by waiting. keep walking................................
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| GOGETA
Trying to get in PGY1
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good stuff to bump
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