Endocrine, Physiology, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Endocrine, Physiology, USMLE Step 1 - Full Vignette with Extended Explanations

A term newborn, large for gestational age, is born to a mother with late-pregnancy insulin-treated hyperglycemia and multiple autoimmune conditions. Shortly after birth, the infant displays low blood glucose but remains vigorous and stable on exam. What prevention-focused strategies should be considered for managing hypoglycemia risk in this well-appearing, at-risk term neonate? Which clinical factors guide optimal monitoring and interventions in the newborn nursery? VIDEO INFO Category: Endocrine, Physiology, USMLE Step 1 Difficulty: Hard - Advanced level - Challenges experienced practitioners Question Type: Prevention - Preventive measures and screening Case Type: Tricky Findings Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A term female neonate is born at 39 weeks 1 day by spontaneous vaginal delivery to a 28-year-old G2P2 mother with insulin-treated hyperglycemia in late pregnancy. Maternal conditions include Sjo gren s syndrome and rosacea. Medications in the third trimester were prenatal vitamins, low-dose aspirin 81 mg daily, insulin glargine at bedtime, pre-meal lispro, and topical azelaic acid; she used loratadine intermittently.... OPTIONS A. Administer 40% oral dextrose gel at 200 mg/kg (0.5 mL/kg) massaged into the buccal mucosa in the newborn nursery, immediately initiate breastfeeding or expressed human milk, recheck capillary glucose in 30 minutes, and repeat a single gel dose if still below target while continuing skin-to-skin c... B. Administer 40% oral dextrose gel 0.5 mL/kg in the nursery but defer breastfeeding for 1 hour to reduce rebound; recheck a glucose in 60 minutes and avoid an immediate feed until two values normalize. C. Give 40% oral dextrose gel 1.0 mL/kg (400 mg/kg) once without an immediate feed, recheck a glucose after 2 hours, and proceed to additional gel doses only if the second value remains low. D. Begin a prophylactic intravenous D10W infusion at 4-6 mg/kg/min and hold enteral feeds until euglycemia is documented on two checks; reserve oral dextrose gel for recurrent symptomatic episodes. CORRECT ANSWER A. Administer 40% oral dextrose gel at 200 mg/kg (0.5 mL/kg) massaged into the buccal mucosa in the newborn nursery, immediately initiate breastfeeding or expressed human milk, recheck capillary glucose in 30 minutes, and repeat a single gel dose if still below target while continuing skin-to-skin care. EXPLANATION At-risk, otherwise well term infants of diabetic mothers should be managed with noninvasive, nursery-based measures that prevent progression to symptomatic hypoglycemia and NICU transfer. The best prevention-focused strategy is to give 40% oral dextrose gel 200 mg/kg (0.5 mL/kg) rubbed into the buccal mucosa, immediately feed human milk, and recheck capillary glucose in 30 minutes, repeating a single gel dose if still below target while maintaining skin-to-skin care. This approach, supported by randomized trials and pediatric endocrine guidance, rapidly raises glucose, preserves rooming-in, decreases IV dextrose use and NICU admission, and supports breastfeeding. It pairs a precisely dosed, high-concentration glucose bolus with substrate delivery from the feed; 40% gel provides 400 mg/mL, so 200 mg/kg equals 0.5 mL/kg. Deferring breastfeeding for an hour undermines the synergistic effect of gel plus feed and delays substrate delivery.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------