Hypertensive Disorders in Pregnancy (Wootton)

Question 1

__1__ Hypertension presents before or recognized during first half of pregnancy.

__2__ Hypertension is recognized after 20 weeks gestation.

__3__ occurs after 20 weeks gestation and coexists with proteinuria.

__4__ is new onset seizure activity associated with preeclampsia.

__5__ occurs in women who have been diagnosed with chronic high blood pressure before pregnancy, but then develop worsening high blood pressure and protein in the urine.

Answer 1

1) Chronic
2) Gestational
3) Preeclampsia
4) Eclampsia
5) Chronic hypertension with superimposed preeclampsia

Question 2

What is the most common type of chronic HTN?

Answer 2

Essential HTN (Idiopathic)

Question 3

What labs/tests should you order during evaluation of chronic HTN during pregnancy in order to assess for maternal end-organ damage?

Answer 3

1) CBC
2) Glucose
3) CMP
4) 24 hour urine collection for total protein
5) EKG
6) Echo

Question 4

In the management of mild chronic HTN (BP less than 160/110 mmHg) you should begin __1__ therapy at 81 mg daily at 12 weeks till delivery.

Answer 4

Aspirin

Question 5

In the management of severe chronic HTN (BP greater than 160/110 mmHg) you should begin antihypertensive therapy with?

Answer 5

1) Methyldopa
2) Labetalol
3) Nifedipine

Question 6

In the management of severe chronic HTN, what antihypertensive medications are absolutely contraindicated as they can increase the risk of malformations (renal dysgenesis, calvarial hypoplasia and fetal growth restriction)?

Answer 6

1) ACE inhibitors (drugs end in -pril)

2) Angiotensin receptor blockers (drugs end in -sartan)

Question 7

Gestational HTN occurs without any features of __1__.

It occurs after __2__ weeks gestation.

It also can occur within 48-72 hours after __3__.

It resolves by __4__ weeks postpartum.

Answer 7

1) Preeclampsia
2) 20 weeks
3) Delivery
4) 12 weeks

Question 8

What common findings of preeclampsia are diagnostic?

Answer 8

1) HTN
2) Proteinuria
3) Edema

Question 9

Symptoms of preeclampsia include?

Answer 9

1) Blurred vision
2) Epigastric and/or RUQ pain
3) Headache

Question 10

Is multiparity or nulliparity a risk factor for preeclampsia?

What abnormal uterine growth is a risk factor?

Answer 10

1) Nulliparity

2) Hydatidiform mole

Question 11

What does preeclampsia cause that results in headaches?

What manifestation to the lung does preeclampsia cause?

What does preeclampsia cause that results in the RUQ pain?

Preeclampsia causes swelling and enlargement of glomerular capillary endothelial cells which leads to?

Answer 11

1) Cerebral edema
2) Pulmonary edema
3) Hepatic hemorrhage
4) Proteinuria

Question 12

__1__ Preeclampsia is characterized as BP > 140/90 but less than 160/110 at least 4 hours apart.

The proteinuria is __2__ mg/24 hour or a single specimen urine protein:creatinine ratio of __3__ mg/dL or a urine dipstick reading of __4__.

Answer 12

1) Mild
2) > 300 mg/24 hour
3) 0.3 mg/dL
4) 2+

Question 13

__1__ Preeclampsia is characterized as BP systolic >160 or diastolic >110 (2 occasions 4 hours apart).

Urine production is described as __2__.

__3__ enzymes are twice the upper limits of normal.

Answer 13

1) Severe
2) Oliguria (less than 500 ml in 24 hours)
3) Liver enzymes

Question 14

What symptoms are noted with severe preeclampsia?

Answer 14

1) Visual disturbances
2) Pulmonary edema
3) Epigastric or right upper quadrant pain
4) Thrombocytopenia

Question 15

A physical examination of preeclampsia can reveal?

Answer 15

1) Brisk reflexes

2) Clonus

Question 16

What lab findings are increased with preeclampsia?

Answer 16

1) Hematocrit
2) LDH
3) AST, ALT
4) Uric acid

Question 17

What lab finding is decreased with preeclampsia?

Answer 17

Thrombocytopenia (low platelets)

Question 18

Between ____ weeks gestation in a patient with mild preeclampsia you should begin induction at time of diagnosis at this gestational age.

Answer 18

37-40 weeks

Question 19

In the management of blood pressure with antihypertensives what should be given for severe preeclampsia?

Answer 19

1) Labetalol
2) Nifedipine
3) Hydralazine

Question 20

What is the MOA of hydralazine?

What is the MOA of labetalol?

What is the MOA of nifedipine?

Answer 20

1) Direct vasodilator
2) Nonselective alpha-1 and beta-1 blocker
3) Calcium channel blocker

Question 21

__1__ should be administered for seizure prophylaxis in preeclampsia patients.

4 gm bolus is given as the __2__ dose.

2 gm/hr is given as the __3__ dose.

The therapeutic value is between __4__ to __4__ mg/dL.

Answer 21

1) Magnesium sulfate
2) Loading
3) Maintenance
4) 5-9 mg/dL

Question 22

Eclampsia is defined as new onset __1__ seizures.

__2__ is the first line treatment.

__3__ is indicated if it is persistent.

Answer 22

1) Tonic clonic
2) Magnesium sulfate
3) Lorazepam

Question 23

HELLP syndrome is a variant of?

It stands for?

Answer 23

1) Preeclampsia

2) Hemolysis, Elevated Liver Enzymes, and Low Platelets

Question 24

What symptoms are common with HELLP syndrome?

Answer 24

1) RUQ pain

2) N/V

Question 25

What is found on labs for HELLP syndrome?

Answer 25

1) LDH greater than 600 IU/L
2) AST/ALT elevated twice the upper limit of normal
3) Platelets less than 100,000

Question 26

What should be done with HELLP syndrome in regards to the delivery?

Answer 26

Immediate delivery