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Self-Assessment Questions


Hypertensive Disease of Pregnancy: Review Questions

Ursula C. Brewster, MD

Dr. Brewster is an assistant professor of medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT.

Choose the single best answer for each question.

Questions 1 and 2 refer to the following case.

A 27-year-old woman who is 30 weeks pregnant presents to her obstetrician/gynecologist for routine follow-up and has a blood pressure of 150/105 mm Hg. She was previously normotensive. Urinalysis reveals a specific gravity of 1.020 with 1+ proteinuria and no cells. Serum uric acid level is 5.0 mg/dL. Platelet count and liver function tests are normal. Analysis of a 24-hour urine collection shows 1.1 g of protein.

1. Which of the following does this patient most likely have?
  1. Chronic hypertension
  2. Gestational hypertension
  3. Normal blood pressure for pregnancy
  4. Preeclampsia
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2. The patient is placed on bed rest, and antihypertensive medications are started. Which of the following medications would be used as a first-line agent?

  1. Captopril
  2. High-dose lasix
  3. Intravenous (IV) magnesium sulfate
  4. Methyldopa
  5. No medications are safe in pregnancy
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3. A woman who is 36 weeks pregnant presents complaining of mid-epigastric tenderness, nausea, and vomiting. She looks unwell. Her blood pressure is 146/100 mm Hg. Results of laboratory testing reveal normal renal function, a platelet count of 98 × 103/µL, and schistocytes visible on a blood smear. The serum aspartate aminotransferase (AST) level is 80 IU/L. The patient is diagnosed with HELLP (hemolysis with a microangiopathic blood smear, elevated liver enzymes, and a low platelet count) syndrome. Which of the following is the most important initial therapeutic intervention for this patient?
  1. Bedrest until fetal age reaches 40 weeks
  2. Immediate delivery
  3. Platelet infusion to prevent bleeding
  4. Right upper quadrant ultrasound
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4. A 38-year-old woman who is 36 weeks pregnant presents for routine follow-up. She has had hypertension since age 34 years, which requires antihypertensive therapy. Prior to her pregnancy, the patient’s blood pressures averaged 130/70 mm Hg on amlodipine. During her first trimester, her blood pressure averaged 120/60 mm Hg but has risen in recent weeks to 150/95 mm Hg on the same therapy. The patient’s only complaint is of worsening lower extremity edema. A 24-hour urine collection reveals 1500 mg of protein. Serum laboratory values, including electrolytes, liver function tests, and platelet count, are normal. What is this patient’s diagnosis?

  1. Chronic essential hypertension
  2. Eclampsia
  3. HELLP syndrome
  4. Preeclampsia
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