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Discussions on "silentobserver's" ques - triplehelix
#1
Please, be assured that I am posting to clear my confusion.
This is not to offend anybody or to argue the correct answer that hs been posted.
Please help me to understand what CMDT says. Thank you !


this is the Q:

A 26 y/o lady comes to your office with c/o early morning nause and vomiting. you check her urine pregnancytest and that is positive. As a part of routine prenatal testing which of the following is not required

A. Blood Sugar
B. Cervical Swab for Gonnorhea
C. Atypical Ab titer
D. Rubella Ab titer
E. HbsAg serum

and silentobserver giave the answer is B

Now, this is what is said in CMDT, 2008
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The first prenatal visit should occur as early as possible after the diagnosis of pregnancy and should include the following: history, physical examination, laboratory tests, advice to patients, and tests and procedures.

Height, weight, and blood pressure should be measured, and a general physical examination should be done. Abdominal and pelvic examination should include the following: (1) estimate of uterine size or measure fundal height; (2) evaluation of bony pelvis for symmetry and adequacy; (3) evaluation of cervix for structural anatomy, infection, effacement, dilation; (4) detection of fetal heart sounds by Doppler device after 10 weeks or fetoscope after 18 weeks.


Urinalysis, culture of a clean-voided midstream urine sample, complete blood count with red
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cell indices, serologic test for syphilis, rubella antibody titer, history of varicella infection,
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blood group, Rh type, atypical antibody screening, and hepatitis B surface antigen (HBsAg)
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evaluation. HIV screening should be offered to all pregnant women. Cervical cultures are
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usually obtained for Neisseria gonorrhoeae and chlamydia, along with a Papanicolaou smear
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of the cervix.
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All black women should have sickle cell screening. Women of African, Asian, or Mediterranean ancestry with anemia or low mean corpuscular volume (MCV) values should have hemoglobin electrophoresis performed to identify abnormal hemoglobins (Hb S, C, F, -thalassemia, -thalassemia). Tuberculosis skin testing is indicated for high-risk immigrant and local populations. Genetic counseling with the option of chorionic villus sampling or genetic amniocentesis should be offered to all women who will be 35 years of age or older at delivery and those who have had prior offspring with chromosomal abnormalities. Noninvasive first trimester screening for Down syndrome by ultrasonographic nuchal translucency and serum levels of PAPP-A (pregnancy-associated plasma protein A) and free subunit of hCG can also be offered. Blood screening for Tay-Sachs and Canavan disease is offered to Jewish women with Jewish partners (especially those of Ashkenazi descent), and couples of French-Canadian or Cajun ancestry should also be screened as possible Tay-Sachs carriers. Screening for cystic fibrosis is offered to all pregnant women. Hepatitis C antibody screening should be offered to pregnant women who are at high risk for infection.

Pregnant women who work in medical-dental health care or the police and fire departments and those who are household contacts of a hepatitis B virus carrier or a hemodialysis patient and are HBsAg-negative at prenatal screening are at high risk for acquiring hepatitis B. They should be vaccinated during pregnancy.

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#2
I AGREE, ANSWER HAS TO BE AAAA, BC GONORHEA CHLAMYDIA CERVIX IS DONE , ACCORDING TO KAPLAN CK

AND BLOOD SUGAR GCT DONE IF FEMALE AT HIGH RISK
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#3
hi goodnews
I saw your explanation about gonococcus screen during first prenatal visit.
You mentioned that you saw it in UW CCS and that is CCS #4.

I know mirt was also making his question from UW, exactly what silentobserver1 did today....I am not saying that they have connection (does not matter what I believe)...

Now, UW did not say that you do not do gonococcus/chlamydia screen, it said additonal test for at-risk (not high-risk) individual, and it gave the indication when to do blood glucose at first visit.

Now, if I look at CMDT, I decided to stick with CMDT.
Moreoever, from my personal experience, I know that in US hospital they do not do blood glucose at first visit, but they do chlamydia/gonococcus screen.

The reason I had to write again because the explanation does not mirror the principles of practice. last time, I think my discussion with mirt was inconclusive ...and mirt decided to be silent...and I decided not to answer to "self-made" questions, but I made the same mistake here...now I know how to refrain myself from next threads...

The only reason I do this because in step 2 CK, I found at least 10 question in my test whick was exactly same as I saw in the forum...so, I just wanted to make sure that I learn from the forum so that I get those questions correct in the test...but ....I am afraid ....
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#4
Good discussion tripple.................how about what SO posted .....I mean this......www.nlm.nih.gov/medlineplus/ency/article/000896.htm - 24k
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#5
this Q didn't ask specifically about 'gestational diabetes' but about 'routine prenatal testing'...

I think that may be the confusion...
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#6
very nice to see you mirt, thanks GOD that you responded to our request.

Thank yo also for giving this link, now in that link, it says:

Exams and Tests Return to top
Gestational diabetes is usually diagnosed during the 24th - 28th weeks of pregnancy. All pregnant women should receive an oral glucose tolerance test during this time period to screen for the condition.

It did not say that alpregnant women should get GTT at first visit.

If you talk about risk factor part, then this is what it says:
Risk factors for gestational diabetes include:

African or Hispanic ancestry
Being over age 25 when pregnant
Birth defect in a previous child
Obesity
Giving birth to a previous baby who weighed more than 9 pounds
Recurrent infections
Unexplained miscarriage or death of a newborn


So, this patient's age is 26, and she has risk for GDM, and of course we will do GTT for her (but before GTT, we will do her blood glucose too), but we will do it during the 24-28 weeks.

Do not you agree ?
Of if you see this Q in real test, what will you choose as your answer ?
A or B?

Until now, I can say that I will choose A (unless somebody gives us any strong reference with clear guidelines that is considered better than CMDT)...wel, that is my personal opinion.

I hope you do not get irritated, bro...this is just about learning, not anything at personal level.

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#7
I am not irritated at all...............and why should I be.....There is nothing personal about it.....We are all here to learn......And I strongly believe that you guys are doing a fantastic job. Honestly I would go with the answer you picked if I see this question in real test but we should also look at things differently sometimes and may be .......may be this is one of those questions........We know that people who are at high risk for GDM are tested early and people who are not are tested routinely at 24 to 28 wks GA.....Now is Age that important a factor that we do it during first visit that needs to seen..............if age > 25 is a risk factor then I think we should do it in first visit.....what do you say.................Keep up with your fantastic job........I am really enjoying being part of your discussion team and am really learning...how effective it is going to be that I will know after a month or so.................Good Luck
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#8
I totally agree with you mirt...and i assume (based on my CK experience) that we will see uestions from this forum....and in fact, I think few members already mentioned that when they got their results on April 30, they said they saw some very similar Qs in their test that we all are doing in this forum.

About this question issue:
I leave the whole thing to any Gyn-Obs resident, and I will follow what they suggest....because I know that they know much better than I do.

Please stay with our discussion, mirt, we enjoy your participation. Thank you.
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