Clinical Challenge Answers


February 13, 2015: Gestational Diabetes in Pregnancy

The correct answer is A. Patients with “dumping syndrome” experience palpitations, fatigue, diaphoresis, headaches and flushing due to postprandial hyperinsulimemia and hypoglycemia.  This is often spurred by high glycemic loads delivered to the small intestine and fluid shifts from the intravascular space.  Although diabetes can be diagnosed by a euglycemic clamp, it is cumbersome and expensive.  Although not fully validated, one alternative is home glucose monitoring (fasting and 2-hour postprandial blood sugar) for approximately 1 week during the 24–28 weeks of gestation.

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January 9, 2015: Menopause

BOTH D and E are correct. When postmenopausal bleeding continues even in the face of an endometrial thickness less than 4 mm, additional evaluation is necessary.  Endometrial biopsy may be sufficient.   Also appropriate is sonohysterography or hysteroscopy, which may identify intracavitary disease and enable targeted sampling. 

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December 11, 2014: Diagnosing Ectopic Pregnancy

The correct answer is C. Finding a fetal heart rate in the adnexal mass on ultrasonography is associated
with the highest likelihood of an ectopic pregnancy. Septated cysts may give the illusion of a yolk sac
and debris may suggest a fetus, which decreased reliability of the mass being a gestation.
A low serum progesterone concentration and an empty uterus at the time of B-hcg concentration above
the discriminatory zone is associated with a non-viable pregnancy but not necessarily an ectopic
pregnancy. These findings can also be found in spontaneous abortions.

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