HIPERTENSION IN PREGNANCY

Questions 1 through 5 apply to the following patient:

A 28-year-old G2P0 at 39 weeks is in early labor. She is 2 cm dilated and 90% effaced, with contractions
every 4 to 5 minutes. The fetal heart tones are reassuring. Her nurse steps out for a moment and
returns to find her having a seizure

1. The nurse administers a 4-g magnesiumbolus. The seizure stops. The fetal heart tone variability
is flat, but there are no decelerations. What would your next therapies be aimed at?
(A) reducing edema with diuretics
(B) giving hypotensive agents until the blood pressure is 110/70 mmHg
(C) giving 3 g of magnesiumsulfate every 3 hours
(D) prepare for immediate delivery by cesarean section
(E) keeping the patient free of convulsions, coma, and acidosis

2. Which of the following would be the most common warning sign/symptomof her eclamptic
seizure?
(A) proteinuria
(B) severe headache
(C) facial edema
(D) increased blood pressure >160/120 mmHg
(E) epigastric pain

3. This patient is most at risk for mortality fromwhich of the following complications?
(A) infection
(B) uremia
(C) congestive heart failure
(D) fever
(E) cerebral hemorrhage

4. This patient and other women with severe preeclampsia, when compared with pregnant
women without preeclampsia, will have a decrease in which of the following?
(A) response to pressor amines
(B) plasma volume
(C) total body sodium
(D) uric acid
(E) serumliver functions

5. If this patient were to have a renal biopsy, what would the most likely pathologic finding be?
(A) glomerular endothelial swelling
(B) pyelonephritis
(C) hydroureter
(D) cortical necrosis
(E) acute tubular necrosis

Questions 6 through 7 apply to the following patient:

6. You should do which of the following while waiting for the magnesiumsulfate bolus to arrive
fromthe labor and delivery department?
(A) obtain an ultrasound to rule out molar pregnancy
(B) prepare to performan emergency cesarean delivery
(C) give intravenous (IV) phenytoin
(D) protect the patient fromself-harm
(E) obtain a chest film

7. After she awakes fromher seizure and the postictal state, she complains of blurry vision. What is
the most likely finding upon fundoscopic examination?
(A) exudates and hemorrhage
(B) loss of corneal curvature
(C) retinal edema
(D) arteriolar spasm
(E) macular degeneration

8. patient and her husband are extremely anxious about your suggestion that she be given
magnesium sulfate for seizure prophylaxis. In assuring her about the safety of the drug, you can
emphasize which of the following?
(A) The drug is rapidly excreted via the kidney.
(B) It is a mild smooth-muscle constrictor and thus safe for the infusion.
(C) The drug has a narrow margin of safety so that we start off with a lower dose in preeclamptics,
and administer it by an IV pump.
(D) As a central nervous system (CNS) stimulant it should not deprive her of the awareness of her
delivery, unlike barbiturates.
(E) The drug does not cross the placenta and thus should not affect her fetus/infant.

9. In eclampsia, which of the following is one of several unfavorable prognostic signs?

(A) tachycardia
(B) 2+ proteinuria
(C) urine output greater than 100 cc/h
(D) more than one but less than three convulsions
(E) swelling of the tongue

10. A 24-year-old woman (gravida 1, para 0) at 37 weeks’ gestation was noted to have a 6-1b
weight gain and an increase in blood pressure from100/60 to 130/80 mmHg in the past week.
She also has 1+ proteinuria. The examination was repeated 6 hours later and the same results
were obtained. Which of the following is the best diagnosis?
(A) normal pregnancy
(B) preeclampsia
(C) eclampsia
(D) pregnancy-induced hypertension
(E) transient hypertension of pregnancy

11. A 14-year-old girl is seen for her first prenatal visit at 34 weeks’ gestation by menstrual history.
On examination her BP is 148/96 mmHg and her fundus measures 33 cm. Her urine dipstick is
1+ positive for protein. Which of the following is the most likely diagnosis?
(A) hypertensive disease with superimposed preeclampsia
(B) mild eclampsia
(C) third-trimester pregnancy
(D) preeclampsia
(E) chronic hypertension

12. In developed countries (western societies) what is the most common cause of direct maternal
mortality?
(A) hemorrhage
(B) congenital cardiac disease
(C) infection
(D) hypertension
(E) amniotic fluid embolism

13.A 16-year-old woman at 37 weeks’ gestation with a BP of 145/105, 2+ proteinuria, and

pulmonary edema
(A) mild preeclampsia
(B) severe preeclampsia
(C) chronic hypertensive disease
(D) eclampsia
(E) chronic renal disease
(F) lupus nephritis