A pregnant patient at 6 months gestation who is 37 years old complains of urinary frequency,thirst,increased appetite,and candida vaginitis that is refractory to treatment.The patient has a history of vaginal delivery of a 10-pound neonate 3 years ago.On physical examination,vital signs are T 98.6,pulse 88,resps 18/min,BP 120/70.On physical examination,heart has regular rate and rhythm at 88 beats/min,no S3,no murmurs.Lungs are clear to auscultation.Abdominal examination is negative.Uterus fundus is above umbilicus.Ankles: no edema.Dorsalis pedis pulses +2/4 bilaterally.Urine dipstick is negative for protein,+ for glucose and + for ketones. The clinician should:

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Quizplus · Accepted Answer

The patient is presenting with classic symptoms of gestational diabetes, including urinary frequency, increased thirst, and increased appetite. The fact that the patient is 37 years old and had a previous neonate weighing 10 pounds also puts her at higher risk for gestational diabetes. A 3-hour glucose tolerance test is the best option to diagnose gestational diabetes at this point in the pregnancy. A fasting serum glucose or Hgb A1c may not be sensitive enough to detect gestational diabetes, and a 24-hour urine collection is not necessary for diagnosis.

A Pregnant Patient at 6 Months Gestation Who Is 37