Vignette 1

A 36-year-old G2P1A0 woman at 12 weeks’ gestation presents to clinic for routine prenatal visit.
She reports her nausea has resolved and denies vaginal bleeding. Her pregnancy has been
uncomplicated. Her prior pregnancy 2 years ago was complicated by the diagnosis of Gestational
Hipertension that led to an induction of labor and cesarean delivery. She has no other medical
history. On examination her BP is 138/84 mm Hg, her body mass index (BMI) is 36 kg/m, and a
urine dip shows trace protein.
1. Given her history of gestational hypertension (GH) and the BP today, what diagnosis is most
likely?

a. Gestational diabetes
b. Gestational Hipertension
c. Preeclampsia
d. Chronic hypertension
e. HELLP syndrome

2. Which of the following laboratory tests should be ordered today?

a. Quad screen
b. 24-hour urine protein collection
c. HgbA1c
d. LDL
e. HSV titer

3. Which of the following pregnancy complications is not associated with chronic hypertension?
a. Superimposed preeclampsia
b. Placental abruption
c. Placenta previa
d. Preterm delivery
e. Intrauterine growth restriction

Vignette 2
A 17-year-old G1P0 woman presents at 25 weeks’ gestation complaining of headache for the
past 36 hours. She has had regular prenatal visits going back to her first prenatal visit at 8 weeks’
gestation. A 20- week ultrasound redated her pregnancy by 2 weeks as it was 15 days earlier than
her LMP dating. She has a BP of 155/104 mm Hg.

4. Which of the following is the most important question to ask on history?

a. Do you have heartburn?
b. Do you have low back pain?
c. Are you constipated?
d. Do you have pain in your right upper abdomen?
e. Do you have urinary frequency?
5. Which of the following would NOT help to determine her diagnosis?
a. Baseline or prepregnancy BP
b. Bilirubin levels
c. Urine dip for protein
d. CBC
e. AST and ALT

6. You review her medical record and determine that she does not have chronic hypertension.
The patient denies having RUQ pain but because of your high suspicion of severe preeclampsia
you order a CBC, liver enzymes, renal function test, and a 24-hour
urine protein collection. Her laboratory test results reveal a normal platelet count and liver
enzymes but a slightly elevated creatinine and proteinuria of 550 mg in 24 hours. Her headache
has resolved after a dose of acetaminophen. What is the next best step in her management?
a. Give her a prescription for labetalol and have her follow-up in clinic in 2 weeks
b. (a) plus bed rest
c. Hospitalization for further evaluation and treatment
d. Immediate delivery
e. Begin induction of labor

Vignette 3
A patient has a blood pressure of 110/72 mm Hg on her first prenatal visit at 8 weeks’ gestation.
She develops hypertension in the third trimester, and at delivery, her blood pressure is 148/94
mm Hg. Urine protein by dipstick is trace, her creatinine level is 0.76 mg/dL, and her
hypertension has resolved by the time of her hospital discharge.
7. What is her correct diagnosis?
a. Preeclampsia
b. Chronic hypertension
c. Gestational hypertension
d. Superimposed preeclampsia
e. Impending eclampsia

8. Which of the following antihypertensive drugs can indicated for pregnancy with severe
hypertension ?
a. Nifedipine
b. Methyldopa
c. Hydralazine
d. nicardipine
e. all of the above

9. A patient came to RSMH and diagnosed with impending eclampsia. Which of the following
statement is indicated as sign and symptoms of impending eclampsia?
a. severe headache
b. epigastrial pain
c. vomiting
 d. only A and B
e. A, B, and C

10. All EXCEPT which of the following increase a woman’s predisposition to develop
preeclampsia syndrome?
a. Obesity
b. Smoking
c. Nulliparity
d. Multiple gestation