UW htn

Question 1

table. Chronic HTN definition?

Answer 1

sAKS >=140 and/or dAKS >=90 prior to conception or 20 weeks gestation

Question 2

table. gestational HTN definition?

Answer 2

new onset elevated BP at >= 20 weeks gestation

NO PROTEINURIA or end-organ damage

Question 3

table. preeclampsia. definition?

Answer 3

new onset elevated BP at >= 20 weeks gestation
AND
proteinuria OR end-organ damage

Question 4

table. eclampsia. definition?

Answer 4

preeclampsia AND new onset grand mal seizures

Question 5

table. chronic HTN with superimposed preeclampsia. definition?

Answer 5

chronic HTN AND one of the following:
a) new onset proteinuria or worsening of exiting proteinuria at >=20 weeks gestation
b) sudden worsening of HTN
c) signs of end-organ damage

Question 6

notes. chronic HTN maternal complications.

Answer 6

Superimposed preeclampsia, Postpartum hemorrhage, Gestational diabetes, Abruption placentae, Cesarean delivery

Question 7

notes. chronic HTN fetal complications.

Answer 7

Fetal: Fetal growth restriction, Perinatal mortality, Preterm delivery (incr. SVR 1. and arterial stiffness  placental dysfunction), Oligohydramnios (Note: poorly controlled diabetes leads to polyhydramnios)

Question 8

table preeclampsia. risk factors? 5

Answer 8

Nulliparity
Obesity
Preexisting medical condition (eg SLE, chronic HTN)
Multiple gestation
Advanced maternal age

Question 9

table preeclampsia. again definition.

Answer 9

New onset HTN (sAKS >=140 and/or dAKS >=90) at >20 weeks gestation
AND
Proteinuria OR signs/symptoms of other end organ damage

Question 10

table preeclampsia. severe features. BP?

Answer 10

Severe HTN (sAKS >=140 and/or dAKS >=90).

Question 11

table preeclampsia. severe features. PLT?

Answer 11

<100k.

Question 12

table preeclampsia. severe features. liver?

Answer 12

Elevated transaminases (2x upper limit of normal)

Question 13

table preeclampsia. severe features. pulmonary?

Answer 13

pulmonary edema

Question 14

table preeclampsia. severe features. CNS?

Answer 14

visual or cerebral symptoms (eg headache)

Question 15

table preeclampsia. Mx. If <37 weeks and no severe features?

Answer 15

expectant

Question 16

table preeclampsia. Mx. If >=37 weeks (or >= 34 weeks with severe features)?

Answer 16

delivery

Question 17

table preeclampsia. Mx. Severe range BP?

Answer 17

iv labetalol, iv hydralazine, PO nifedipine

Question 18

table preeclampsia. Mx. seizures prophylaxis?

Answer 18

MgSO4

Question 19

Preeclampsia prevention. definition?

Answer 19

new onset HTN and proteinuria and/or end organ damage at >20 weeks gestation

Question 20

Preeclampsia prevention. high risk factors? 6

Answer 20

Prior preeclampsia
CKD
chronic HTN
DM
multiple gestation
Autoimmune disease

Question 21

Preeclampsia prevention. moderate risk factors? 3

Answer 21

obesity
advanced maternal age
nullparity

Question 22

Preeclampsia prevention. prevention?

Answer 22

low-dose aspirin at 12 weeks gestation

Question 23

Stroke due to preeclampsia. notes. mechanism nr1. coagulation system.

Answer 23

Activation of coagulation system, plt aggregation and vascular microthrombi formation –> cerebral vessel occlusion (ischemic stroke)

Question 24

Stroke due to preeclampsia. notes. mechanism nr 2. blood floow

Answer 24

dysregulated cerebral blood flow –> inappropriate cerebral vasospasm –> incr. perfusion pressure –> rupture of intracerebral vessels (hemorrhagic stroke)

Question 25

Stroke due to preeclampsia. notes. what about CT?

Answer 25

most patients with preeclampsia do not require CT scan but those with FOCAL NEUROLOGIC DEFICITS require a CT SCAN OF THE HEAD to evaluate for possible stroke and help guide management.

Question 26

eclampsia table. CP?

Answer 26

HTN, typically severe (ie SBP>=160 or DBP >= 110)
Seizures, typically tonic-clonic with postictal phase
severe headache
visual disturbances (ie scotoma)
hyperreflexia
proteinuria

Question 27

eclampsia table. Dx? 2

Answer 27

mainly clinical
Bilateral frontal lobe edema on CT scan of head

Question 28

eclampsia table. Mx? 3

Answer 28

Mg infusion
antihypertensive agent for severe hypertension
delivery

Question 29

algorithm of patho of pulmonary embolism in pre/eclampsia. mechanism

Answer 29

generalized arterial vasospasm (systemic HTN) –> incr. afterload against which the heart is pumping -> incr. pulmonary capillary pressure –> pulmonary edema

Question 30

algorithm of patho of pulmonary embolism in pre/eclampsia. other 3 mechanisms?

Answer 30

decr. albumin
decr. renal function
incr. vascular permeability

Question 31

notes. postpartum preeclampsia. onset?

Answer 31

preeclampsia can present in postpartum patients up to 6 weeks after delivery

Question 32

notes. postpartum preeclampsia. CP?

Answer 32

severe headache in bilateral occipital or frontal regions (most common presentation). this headache does not improve with paracetamol or NSAIDs

Question 33

anti-HTN drugs during pregnancy. first line drugs? 4

Answer 33

BAB (labetalol)
CCB (nifedipine)
hydralazine
methyldopa

Question 34

anti-HTN drugs during pregnancy. second line? 2

Answer 34

clonidine
thiazine diuretics

Question 35

anti-HTN drugs during pregnancy. what contraindicated? 5

Answer 35

ACEI
ATII blockers
direct renin inhibitors
nitroprusside
mineralcorticoid receptor antagonists (spironolactone)