LE4 - HTN Flashcards

Question

A 27-year-old G1P0 presents at 31 weeks gestation with generalized tonic-clonic seizures. BP is 160/105 mmHg, and urinalysis shows 3+ protein. What is the most likely diagnosis? A. Eclampsia B. Severe preeclampsia C. Chronic hypertension with superimposed preeclampsia D. Epilepsy What is the first-line treatment to control the seizures? A. Diazepam B. Magnesium sulfate C. Phenytoin D. Labetalol

Answer 1

A. Eclampsia Rationale: Eclampsia is characterized by generalized tonic-clonic seizures in a patient with preeclampsia and no other identifiable causes. B. Magnesium sulfate Rationale: Magnesium sulfate is the drug of choice for both prevention and treatment of seizures in eclampsia. Diazepam and phenytoin are not first-line treatments for eclampsia-related seizures.

Answer 2

C. Preeclampsia with severe features Rationale: Severe hypertension, new-onset cerebral symptoms (headache, visual changes), and renal insufficiency (creatinine >1.1 mg/dL) meet the criteria for preeclampsia with severe features. B. Immediate delivery after stabilizing BP and administering magnesium sulfate Rationale: For preeclampsia with severe features at ≥34 weeks, delivery is the definitive treatment. Magnesium sulfate prevents seizures, and antihypertensive therapy prevents complications such as stroke.

Answer 3

B. Postpartum eclampsia Rationale: Eclampsia can occur postpartum, typically within 48 hours but sometimes later. The presence of hypertension and proteinuria supports the diagnosis. A. Administer magnesium sulfate and continue monitoring Rationale: Magnesium sulfate is the first-line treatment for eclampsia, including postpartum cases. Brain imaging is reserved for atypical presentations or if the patient does not improve.

Answer 4

Answer: B. Chronic hypertension Rationale: Hypertension diagnosed before 20 weeks gestation is classified as chronic hypertension, even in the absence of proteinuria or systemic findings. Answer: C. Prescribe low-dose aspirin and initiate antihypertensive therapy if BP exceeds 160/105 mmHg Rationale: Chronic hypertension requires close monitoring and preventive measures, such as low-dose aspirin to reduce preeclampsia risk. Antihypertensives are initiated for severe hypertension (≥160/105 mmHg).

Answer 5

Answer: B. Chronic hypertension with superimposed preeclampsia Rationale: Chronic hypertension complicated by new-onset proteinuria, thrombocytopenia, and elevated liver enzymes meets the criteria for chronic hypertension with superimposed preeclampsia. Answer: A. Immediate delivery after stabilizing BP and administering magnesium sulfate Rationale: Chronic hypertension with superimposed preeclampsia and severe features requires immediate delivery if gestational age is ≥34 weeks or maternal-fetal condition worsens. Magnesium sulfate is administered for seizure prophylaxis.

Answer 6

Answer: C. Gestational hypertension Rationale: Hypertension diagnosed after 20 weeks gestation in a previously normotensive woman, without proteinuria or systemic features, is classified as gestational hypertension. Answer: B. Continue monitoring BP and fetal well-being Rationale: Gestational hypertension without severe features is managed expectantly with regular monitoring of BP and fetal well-being. Antihypertensives are only indicated for severe hypertension (≥160/105 mmHg).

Answer 7

Answer: A. Severe gestational hypertension Rationale: Hypertension ≥160/110 mmHg without proteinuria or systemic findings is classified as severe gestational hypertension, which requires close monitoring to differentiate from preeclampsia. Answer: B. Initiate antihypertensive therapy and close monitoring Rationale: Severe hypertension (≥160/110 mmHg) requires antihypertensive therapy to reduce maternal risks, such as stroke, even in the absence of preeclampsia. Delivery is not indicated unless maternal or fetal conditions worsen.

Answer 8

Answer: B. HELLP syndrome Rationale: The patient meets the laboratory criteria for HELLP syndrome, including thrombocytopenia (<100,000/mm³), elevated liver enzymes (ALT >70 U/L, LDH >600 U/L), and hemolysis (abnormal peripheral smear and reticulocytosis). The presence of right upper quadrant pain and mild hypertension supports this diagnosis. Answer: C. Immediate delivery after stabilizing maternal condition Rationale: At 36 weeks gestation, delivery is the cornerstone of therapy for HELLP syndrome. Maternal stabilization with antihypertensives, magnesium sulfate, and platelet transfusion (if necessary) should precede delivery.

Answer 9

Answer: C. Hemolysis on peripheral smear Rationale: Hemolysis is a hallmark of HELLP syndrome that differentiates it from preeclampsia. Elevated liver enzymes and thrombocytopenia are shared features, but hemolysis is unique to HELLP syndrome. Answer: B. Administer betamethasone and delay delivery for 24-48 hours Rationale: At 32 weeks, delivery can be delayed by 24-48 hours if maternal and fetal conditions are stable. Betamethasone is administered to promote fetal lung maturity.

Answer 10

Answer: C. HELLP syndrome Rationale: HELLP syndrome can occur postpartum, typically within 48 hours of delivery. Laboratory findings of thrombocytopenia, elevated liver enzymes, and hemolysis (LDH >600 U/L) confirm the diagnosis. Answer: B. Platelet transfusion to maintain platelets ≥40,000 cells/μL Rationale: Platelet transfusion is indicated in HELLP syndrome to stabilize platelet counts, particularly if invasive procedures are necessary. Dexamethasone and plasma exchange are not recommended for HELLP syndrome.

Answer 11

Answer: D. All of the above Rationale: HELLP syndrome shares overlapping features with other conditions, such as viral hepatitis, AFLP, and TTP. A thorough history, physical exam, and additional testing are necessary to confirm the diagnosis. Answer: B. Blood glucose levels Rationale: AFLP often presents with hypoglycemia, which is not a feature of HELLP syndrome. Blood glucose levels can help differentiate these conditions.

Answer 12

Answer: A. Complete HELLP syndrome Rationale: The patient meets the criteria for complete HELLP syndrome with thrombocytopenia (<100,000/mm³), elevated AST (>70 U/L), and elevated LDH (>600 U/L). Answer: B. Immediate delivery after stabilizing maternal condition Rationale: At 34 weeks gestation, delivery is the definitive treatment for complete HELLP syndrome. Maternal stabilization with magnesium sulfate for seizure prophylaxis and antihypertensive therapy is essential before delivery.

Answer 13

Answer: B. Partial HELLP syndrome (EL) Rationale: The patient meets the criteria for partial HELLP syndrome with elevated liver enzymes (AST >70 U/L) and LDH >600 U/L but does not meet the platelet threshold (<100,000/mm³) for complete HELLP syndrome. Answer: A. Delay delivery for 24-48 hours with betamethasone administration Rationale: If maternal and fetal conditions are stable, delivery can be delayed to allow for betamethasone administration, which promotes fetal lung maturity. This is particularly important at 32 weeks gestation

Answer 14

Answer: B. Partial HELLP syndrome (HEL) Rationale: The patient demonstrates hemolysis, elevated liver enzymes, and low platelets (though >100,000/mm³). This fits the criteria for partial HELLP syndrome (HEL). Answer: C. Magnesium sulfate and close monitoring Rationale: Postpartum HELLP syndrome requires supportive care, including seizure prophylaxis with magnesium sulfate and close monitoring of maternal condition. Platelet transfusion is not indicated unless platelet count is <40,000/mm³ or delivery is planned.

Answer 15

Answer: C. 86-100% Rationale: Proteinuria is a common feature of HELLP syndrome and is present in 86-100% of cases, distinguishing it from some conditions in the differential diagnosis. Answer: B. Immediate delivery after maternal stabilization Rationale: At 36 weeks gestation, delivery is the definitive treatment for HELLP syndrome. Stabilization of maternal condition with antihypertensives and magnesium sulfate should precede delivery.

Answer 16

Answer: C. Home management with close maternal and fetal monitoring Rationale: This patient has preeclampsia without severe features at <34 weeks gestation, making her eligible for home management. Regular BP monitoring, weekly lab tests, and antenatal testing (e.g., NST) are required. Answer: B. Perform daily fetal kick counts and report any decreased movements Rationale: Patients on home management should monitor BP at least twice daily, perform daily fetal kick counts, and promptly report symptoms such as severe headache, visual changes, or decreased fetal movements.

Answer 17

Answer: A. Initiate magnesium sulfate and plan for immediate delivery Rationale: The patient has preeclampsia with severe features, including severe hypertension, headache, visual changes, thrombocytopenia, and elevated liver enzymes. Immediate delivery is indicated after maternal stabilization with magnesium sulfate and antihypertensives.

Answer 18

Answer: A. Immediate delivery Rationale: At 36 weeks, delivery is the preferred management for preeclampsia, even in the absence of severe features, as fetal lungs are mature and the risks of continuing pregnancy outweigh the benefits. Answer: B. Monitor for seizure prophylaxis with magnesium sulfate Rationale: Seizure prophylaxis with magnesium sulfate is indicated for patients with preeclampsia to prevent progression to eclampsia. Delivery timing is not dependent on NST results if preeclampsia is confirmed.

Answer 19

B. Admit to the hospital for evaluation and monitoring Rationale: New symptoms such as headache and decreased fetal movements warrant hospital admission for further evaluation and monitoring, as they may indicate progression to preeclampsia with severe features.

Answer 20

A. At 34 weeks gestation Rationale: Delivery is recommended at 34 weeks gestation for preeclampsia, even without severe features, as fetal lung maturity is expected and maternal/fetal risks increase with prolonged pregnancy.

Answer 21

Answer: A. Admit the patient for stabilization and immediate delivery Rationale: The patient has severe preeclampsia with features such as severe hypertension, headache, visual disturbances, thrombocytopenia, and elevated liver enzymes. Immediate delivery is indicated for maternal and fetal safety as the gestational age is >34 weeks. Answer: A. Administer magnesium sulfate for seizure prophylaxis and initiate antihypertensives Rationale: Stabilizing maternal condition with magnesium sulfate and antihypertensives is essential to reduce the risk of seizures and prevent hypertensive complications like stroke before delivery.

Answer 22

Answer: B. Expectant management with frequent maternal and fetal monitoring Rationale: At <34 weeks gestation, expectant management may be acceptable if maternal and fetal conditions are stable. Close monitoring, including NSTs, Doppler studies, and maternal labs, is critical. Delivery is indicated if deterioration occurs. Answer: B. Daily NSTs and biweekly Doppler studies Rationale: Daily NSTs and frequent Doppler studies are essential for monitoring fetal well-being during expectant management in severe preeclampsia, especially when fetal growth restriction and oligohydramnios are present.

Answer 23

Answer: C. Fetal growth restriction (FGR) Rationale: Fetal growth restriction is the most common fetal morbidity in preeclampsia due to uteroplacental insufficiency, often detected through abnormal Doppler velocimetry. Answer: A. Admit for continuous monitoring until delivery at 34 weeks Rationale: Abnormal Doppler findings in preeclampsia warrant inpatient management with close maternal and fetal monitoring. Delivery is typically recommended at 34 weeks to minimize risks.

Answer 24

B. Immediate delivery via cesarean section Rationale: Severe preeclampsia with abnormal fetal surveillance (late decelerations, low BPP) requires immediate delivery to prevent further maternal and fetal compromise. Cesarean delivery is indicated due to non-reassuring fetal status.

Answer 25

B. Delivery is recommended immediately if maternal condition deteriorates Rationale: Severe preeclampsia at <34 weeks may warrant expectant management if maternal and fetal conditions are stable. Immediate delivery is required if there is any maternal or fetal deterioration.

Answer 26

Answer: B. Maintain BP in the range of 140-150/90-100 mmHg Rationale: The goal of antihypertensive therapy in preeclampsia is not to normalize BP but to achieve a safe target range of 140-150/90-100 mmHg to reduce the risk of maternal complications without compromising uteroplacental blood flow. Answer: C. Oral labetalol Rationale: Oral labetalol is a preferred first-line antihypertensive due to its efficacy and safety profile. Sublingual nifedipine is avoided as it can cause a rapid BP drop and compromise uteroplacental blood flow. Magnesium sulfate is used for seizure prophylaxis, not BP management.

Answer 27

Answer: A. Fetal hypoxia due to uteroplacental insufficiency Rationale: Rapid BP reduction with hydralazine can cause maternal hypotension and reduced uteroplacental blood flow, leading to fetal hypoxia. Gradual dose adjustments are critical to avoid such complications. Answer: C. Switch to IV labetalol Rationale: IV labetalol is an effective alternative for acute BP control in cases where hydralazine is insufficient. Sublingual nifedipine is contraindicated due to the risk of rapid BP drops.

Answer 28

Answer: B. Monitor BP without initiating antihypertensives Rationale: Antihypertensive therapy is not indicated for mild/moderate hypertension (BP <160/110 mmHg) in the absence of severe features. Close monitoring is sufficient in such cases. Answer: A. To prevent hypotension and decreased uteroplacental blood flow Rationale: Excessive lowering of BP can compromise uteroplacental blood flow, leading to fetal hypoxia or distress. Therapy is reserved for severe hypertension.

Answer 29

A. Continue labetalol and monitor closely for rebound hypertension Rationale: Gradual BP reduction to the target range of 140-150/90-100 mmHg is appropriate. Antihypertensive therapy should not be discontinued abruptly, and rebound hypertension must be prevented.

Answer 30

C. Decreased uteroplacental perfusion leading to fetal hypoxia Rationale: Excessive BP lowering can reduce uteroplacental blood flow, causing fetal hypoxia or distress. Gradual reduction of BP to the target range minimizes this risk.

Answer 31

C. IV labetalol Rationale: IV labetalol is effective for rapid BP control in hypertensive emergencies during pregnancy. Sublingual nifedipine is contraindicated due to the risk of a sudden BP drop, which can compromise uteroplacental blood flow. Oral hydralazine is less commonly used. B. Gradually reduce BP to a target range of 140-150/90-100 mmHg Rationale: The goal of antihypertensive therapy in severe preeclampsia is to achieve a safe BP range of 140-150/90-100 mmHg, preventing complications such as stroke while maintaining uteroplacental perfusion.

Answer 32

Answer: C. Avoid sublingual administration to prevent fetal distress Rationale: Sublingual nifedipine causes a rapid BP drop, increasing the risk of fetal distress due to reduced uteroplacental blood flow. Oral administration ensures gradual BP reduction and maintains fetal safety. Answer: D. Less frequent dosing required for maintenance Rationale: Oral nifedipine is effective for maintenance therapy with less frequent dosing compared to hydralazine, making it suitable for sustained BP control in preeclampsia.

Answer 33

Answer: C. Maternal hypotension Rationale: Hydralazine can cause maternal hypotension if not carefully titrated, which may reduce uteroplacental perfusion and result in fetal hypoxia. Answer: B. Administer IV fluids and titrate the dose upward Rationale: Volume depletion in preeclampsia may exacerbate hypotension during hydralazine therapy. Administering IV fluids and carefully titrating the dose helps maintain uteroplacental perfusion.

Answer 34

C. Continue IV labetalol and monitor for rebound hypertension Rationale: Gradual reduction of BP to the target range should be maintained. Rebound hypertension is a concern, and IV labetalol should be continued with close monitoring before transitioning to oral therapy.

Answer 35

B. 10-20 mg IV bolus, then increase to 20-80 mg IV every 20-30 minutes Rationale: IV labetalol is initiated with a bolus of 10-20 mg and titrated every 20-30 minutes as needed. It is the preferred first-line agent for severe hypertension due to its rapid onset and safety profile. C. 300 mg Rationale: The maximum dose of IV labetalol is 300 mg. Beyond this, other antihypertensives such as hydralazine or nicardipine may be considered if BP remains uncontrolled.

Answer 36

A. 5 mg IV/IM, then 5-10 mg every 20-40 minutes Rationale: The recommended dose for hydralazine is 5 mg IV or IM initially, followed by 5-10 mg every 20-40 minutes as needed, with a maximum dose of 20 mg IV. B. Maternal hypotension and reflex tachycardia Rationale: Hydralazine can cause maternal hypotension, which may reduce uteroplacental blood flow, and reflex tachycardia. Gradual dose titration is necessary to minimize these risks.

Answer 37

B. 10-20 mg orally, repeat after 30 minutes if needed Rationale: Oral nifedipine is administered at an initial dose of 10-20 mg, with a repeat dose after 30 minutes if BP remains elevated. Sublingual administration is avoided due to the risk of rapid BP drops and fetal distress. C. Ensure gradual BP reduction to prevent fetal hypoxia Rationale: Gradual BP reduction with oral nifedipine minimizes the risk of fetal hypoxia and uteroplacental insufficiency, especially in preeclampsia.

Answer 38

C. 10 gtts/min, titrate hourly by 1 mg/hr increments Rationale: IV nicardipine is typically started at 10 gtts/min, with hourly titration by 1 mg/hr increments to a maximum dose of 10 mg/hr, ensuring controlled BP reduction. B. In refractory severe hypertension requiring rapid BP control Rationale: IV nicardipine is preferred in severe, refractory hypertension when rapid BP control is required, especially in critical situations where other agents have failed.

Answer 39

C. IV furosemide Rationale: Furosemide is indicated for managing pulmonary edema in preeclampsia to relieve fluid overload. It is not routinely used for BP control due to potential hypokalemia and volume depletion.

Answer 40

C. Methyldopa Rationale: Methyldopa is the safest and most commonly used oral antihypertensive for long-term BP control in pregnancy. It is particularly effective for mild/moderate hypertension. Labetalol oral formulation is not available in the Philippines, and thiazides are only indicated for pulmonary edema. A. 500 mg/day in divided doses Rationale: Methyldopa is typically started at 500 mg/day in divided doses and can be titrated to a maximum of 3 g/day depending on the patient’s response.

Answer 41

A. 30-120 mg/day orally using slow-release preparations Rationale: Slow-release oral nifedipine is preferred for outpatient management or long-term control of mild to moderate hypertension in pregnancy. Sublingual administration is contraindicated due to the risk of sudden BP drops. B. It reduces the risk of fetal hypoxia from abrupt BP changes Rationale: Slow-release nifedipine ensures gradual BP reduction, minimizing the risk of maternal hypotension and fetal hypoxia, which are associated with rapid BP changes seen in immediate-release formulations.

Answer 42

C. 3 g/day Rationale: Methyldopa is prescribed at a dosage of 0.5-3 g/day in divided doses. The maximum daily dose is 3 g, titrated based on the patient’s response and tolerance. C. Central alpha-adrenergic agonism Rationale: Methyldopa is a centrally acting alpha-adrenergic agonist that reduces sympathetic outflow, thereby lowering BP.

Answer 43

C. Thiazide diuretics Rationale: Thiazide diuretics are reserved for managing pulmonary edema in preeclampsia but are not used for routine BP control due to risks of hypokalemia and volume depletion. A. IV furosemide Rationale: Pulmonary edema in preeclampsia is treated with IV furosemide to manage fluid overload. Antihypertensives like methyldopa or nifedipine address BP control but do not directly resolve pulmonary edema.

Answer 44

B. Switch to methyldopa for BP control Rationale: ACE inhibitors, such as enalapril, are contraindicated during pregnancy due to teratogenic effects and risks of fetal renal dysgenesis, oligohydramnios, and neonatal morbidity. Methyldopa is a safe alternative for BP control in pregnancy. B. Renal dysgenesis and oligohydramnios Rationale: ACE inhibitors can cause fetal renal dysgenesis, oligohydramnios, and growth restriction, along with neonatal morbidity and mortality.

Answer 45

D. Losartan Rationale: Angiotensin receptor blockers (ARBs), such as losartan, are contraindicated in pregnancy due to similar risks to ACE inhibitors, including fetal renal damage and oligohydramnios. D. Chronic hypertension requiring long-term BP control Rationale: Losartan can be safely reintroduced postpartum for the long-term management of chronic hypertension.

Answer 46

A. Furosemide Rationale: Diuretics, such as furosemide, are reserved for specific indications like pulmonary edema in pregnancy. Other diuretics and drugs like enalapril and losartan are contraindicated due to fetal risks. C. Reduced uteroplacental blood flow Rationale: Diuretics can lead to volume depletion and reduced uteroplacental blood flow, increasing the risk of fetal hypoxia and distress.

Answer 47

A. Enalapril Rationale: ACE inhibitors, such as enalapril, are safe postpartum and effective for managing chronic or postpartum hypertension. Methyldopa is less effective postpartum and is typically used during pregnancy. B. Initial BP normalization followed by increases after 24 hours Rationale: BP often normalizes in the first 12-24 hours postpartum but then increases due to hemodynamic adjustments, requiring close monitoring and management.

Answer 48

A. Restart losartan postpartum Rationale: Losartan can be safely restarted postpartum for chronic hypertension, as it is no longer contraindicated after delivery. Methyldopa and nifedipine are more commonly used during pregnancy.

Answer 49

A. Betamethasone 12 mg IM every 24 hours for 2 doses Rationale: Betamethasone at 12 mg IM every 24 hours for 2 doses is a standard regimen for enhancing fetal lung maturity. Dexamethasone is also an option, administered as 6 mg IM every 12 hours for 4 doses. C. 24-48 hours after the last dose Rationale: Delivery is ideally timed 24-48 hours after completing corticosteroid administration to maximize its effects on fetal lung maturity and reduce neonatal complications.

Answer 50

B. Administer corticosteroids and plan delivery in 24-48 hours Rationale: Antenatal corticosteroids can still be beneficial between 34 and 36 weeks, reducing neonatal complications like cerebrovascular hemorrhage and necrotizing enterocolitis. Delivery should occur 24-48 hours after completing the regimen if possible. C. Decreasing the incidence of RDS, cerebrovascular hemorrhage, and NEC Rationale: While the primary benefit of corticosteroids at <34 weeks is lung maturity, in late preterm gestations, they help reduce complications like RDS, cerebrovascular hemorrhage, and NEC.

Answer 51

B. Administer the second dose 24 hours after the first Rationale: Betamethasone is given as two doses 24 hours apart to optimize fetal lung maturity. Weekly repeat doses are not routinely recommended.

Answer 52

B. 6 mg IM every 12 hours for 4 doses Rationale: Dexamethasone is administered as 6 mg IM every 12 hours for 4 doses to enhance fetal lung maturity and reduce neonatal complications.

Answer 53

A. Respiratory distress syndrome (RDS) Rationale: Antenatal corticosteroids significantly reduce the risk of RDS, as well as other complications like NEC and cerebrovascular hemorrhage. Neonatal sepsis is not directly prevented by corticosteroids.

Answer 54

B. To prevent progression to eclampsia Rationale: Magnesium sulfate is the drug of choice for preventing seizures in patients with preeclampsia with severe features, reducing the risk of progression to eclampsia. A. 4 g IV over 5-10 minutes Rationale: The standard loading dose for magnesium sulfate is 4 g IV administered slowly over 5-10 minutes. This may be followed by maintenance doses via IV infusion or IM injections.

Answer 55

B. No, it is not indicated for preeclampsia without severe features Rationale: Magnesium sulfate is not routinely administered in preeclampsia without severe features due to the risks of toxicity and side effects. It is reserved for cases with severe features or eclampsia. A. Antihypertensive therapy to control BP Rationale: In preeclampsia without severe features, controlling BP with antihypertensives is the priority to prevent complications. Magnesium sulfate is not indicated unless severe features develop.

Answer 56

A. 4 g IV over 5-10 minutes Rationale: The standard loading dose for treating eclampsia is 4 g IV over 5-10 minutes. This can be followed by maintenance doses via IV infusion or IM injections. B. Administer calcium gluconate 10 mL of 10% solution IV Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity and should be administered immediately if signs of toxicity are observed.

Answer 57

A. 2 g/hour infusion after a 4 g IV loading dose Rationale: The standard maintenance dose for magnesium sulfate is 2 g/hour after a 4 g IV loading dose.

Answer 58

B. Administer calcium gluconate 10 mL of 10% solution IV Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity and should be administered immediately to reverse neuromuscular blockade and respiratory depression.

Answer 59

B. Diazepam Rationale: Diazepam is the drug of choice for acute convulsions due to its rapid onset of action (1 minute), which is critical for immediate seizure control. Magnesium sulfate, while effective in preventing recurrent seizures, has a slower onset and is not suitable for acute seizure management. B. 10 mg IV over 2 minutes Rationale: The loading dose of diazepam for acute seizure control is 10 mg IV administered over 2 minutes to ensure rapid seizure termination.

Answer 60

B. Phenytoin Rationale: Phenytoin is an alternative to diazepam for managing acute seizures and is effective when seizures recur. It works by blocking sodium channels in neurons to reduce excitability. B. 1 g IV infused slowly over 20 minutes Rationale: The loading dose of phenytoin is 1 g IV infused over 20 minutes to prevent further seizures. Slow infusion is critical to avoid complications such as hypotension.

Answer 61

B. Magnesium sulfate Rationale: Magnesium sulfate is the drug of choice for preventing seizure recurrence in patients with eclampsia. It works peripherally to block calcium channels and reduce neuromuscular excitability. B. 2 g/hour IV infusion after a 4 g IV loading dose Rationale: After a 4 g IV loading dose, magnesium sulfate is maintained at 2 g/hour via IV infusion to ensure therapeutic levels and prevent recurrent seizures.

Answer 62

B. Stop the infusion and provide supportive care Rationale: Hypotension and respiratory depression are potential side effects of phenytoin infusion. The infusion should be stopped, and supportive measures such as oxygen therapy should be initiated.

Answer 63

B. Administer diazepam 10 mg IV over 2 minutes Rationale: During an active seizure, diazepam is the drug of choice for rapid seizure control. Magnesium sulfate acts peripherally and is not effective for managing acute seizures.

Answer 64

C. Delivery at or beyond 37 weeks gestation Rationale: For stable preeclampsia without severe features, delivery is recommended at or beyond 37 weeks gestation to minimize maternal and fetal risks. B. Induction of labor with prostaglandins and/or oxytocin Rationale: Vaginal delivery is often attempted unless contraindicated. Induction of labor is preferred unless there are obstetric complications requiring cesarean delivery.

Answer 65

B. Perform immediate delivery after maternal stabilization Rationale: HELLP syndrome is an indication for immediate delivery at any gestational age once maternal stabilization is achieved, as delaying delivery increases the risk of severe maternal complications. A. Administer antihypertensives and magnesium sulfate Rationale: Stabilization with antihypertensives and magnesium sulfate is critical to prevent complications such as stroke or eclampsia before delivery.

Answer 66

A. Immediate delivery regardless of maternal or fetal status Rationale: In preeclampsia with severe features at ≥34 weeks, delivery is expedited to prevent worsening maternal and fetal complications, regardless of maternal or fetal stability. B. Immediate cesarean section Rationale: Non-reassuring fetal heart rate tracings indicate fetal compromise, requiring immediate delivery via cesarean section if vaginal delivery poses additional risks.

Answer 67

B. Expectant management with close monitoring Rationale: In preeclampsia with severe features at <34 weeks, expectant management can be considered if maternal and fetal conditions are stable, along with close monitoring and corticosteroid administration.

Answer 68

C. Induction of labor after corticosteroid administration Rationale: PROM at 33 weeks in preeclampsia requires induction of labor after corticosteroid administration to reduce neonatal complications while minimizing infection risk.

Answer 69

C. Immediate delivery Rationale: Uncontrolled severe hypertension and persistent neurological symptoms (e.g., headache, visual changes) are maternal indications for immediate delivery to prevent further complications such as stroke or eclampsia. B. Epigastric pain with AST >2x normal Rationale: Epigastric pain with elevated liver enzymes is indicative of hepatic dysfunction or impending HELLP syndrome, necessitating immediate delivery.

Answer 70

C. Immediate delivery due to fetal indications Rationale: Absent end-diastolic flow (AEDF) and a persistent BPP <4 are strong fetal indications for immediate delivery to prevent worsening hypoxia and fetal death. A. Persistent severe oligohydramnios Rationale: Severe oligohydramnios and abnormal Doppler findings indicate placental insufficiency and fetal distress, necessitating immediate delivery.

Answer 71

B. Administer magnesium sulfate and plan delivery within 24 hours Rationale: Thrombocytopenia (<100,000/mm³), elevated liver enzymes, and renal impairment are maternal indications for expedited delivery in preeclampsia with severe features. A. Estimated fetal weight <5th percentile Rationale: Severe fetal growth restriction (<5th percentile) is indicative of placental insufficiency, warranting immediate delivery.

Answer 72

B. Emergency cesarean delivery Rationale: Reversed end-diastolic flow (RED) and non-reassuring fetal heart tracing in the presence of maternal hepatic dysfunction are strong indications for emergency cesarean delivery to prevent maternal and fetal morbidity. B. Severe oligohydramnios with amniotic fluid index <2 cm Rationale: Severe oligohydramnios is a sign of placental insufficiency, and when combined with reversed end-diastolic flow or non-reassuring fetal status, it warrants immediate delivery.

Answer 73

B. Vaginal delivery with induction of labor Rationale: Vaginal delivery is the preferred mode of delivery in stable preeclamptic patients, especially when the fetus is in cephalic presentation and maternal and fetal conditions are stable. Induction of labor with prostaglandins and/or oxytocin can be used to facilitate vaginal delivery. A. Dinoprostone for cervical ripening Rationale: Dinoprostone is a prostaglandin used to ripen the cervix and promote labor in preeclamptic women. Oxytocin can be added after cervical ripening to strengthen contractions.

Answer 74

B. Perform an emergency cesarean section Rationale: Failed induction combined with non-reassuring fetal heart rate patterns (late decelerations) is an indication for cesarean delivery to ensure maternal and fetal safety.

Answer 75

B. Cesarean section due to breech presentation Rationale: Non-cephalic presentations, such as breech, are indications for cesarean section to reduce maternal and fetal risks. Vaginal delivery is not recommended in this case. B. Administer magnesium sulfate for seizure prophylaxis Rationale: Magnesium sulfate is indicated for seizure prophylaxis in preeclampsia with severe features, particularly before cesarean delivery.

Answer 76

B. Cesarean section due to abnormal Doppler findings Rationale: Absent end-diastolic flow (AEDF) in fetal Doppler studies indicates significant placental insufficiency, necessitating cesarean delivery to reduce the risk of fetal hypoxia.

Answer 77

C. Cesarean section due to fetal distress Rationale: Persistent late decelerations suggest fetal distress, making cesarean section the safest option to prevent further fetal compromise.

Answer 78

C. To minimize postpartum hemorrhage (PPH) due to reduced tolerance for blood loss Rationale: Preeclamptic women have reduced tolerance for blood loss due to hemoconcentration and lack of normal pregnancy-induced hypervolemia. Active management of the third stage of labor, including oxytocin administration, is critical to prevent postpartum hemorrhage. C. Oxytocin (e.g., Duratocin) Rationale: Oxytocin is the first-line agent for stimulating uterine contraction and minimizing postpartum hemorrhage in preeclamptic patients.

Answer 79

B. Perform an emergency cesarean section Rationale: Failed induction combined with non-reassuring fetal heart rate patterns (late decelerations) is an indication for cesarean delivery to ensure maternal and fetal safety.

Answer 80

B. Cesarean section due to breech presentation Rationale: Non-cephalic presentations, such as breech, are indications for cesarean section to reduce maternal and fetal risks. Vaginal delivery is not recommended in this case. B. Administer magnesium sulfate for seizure prophylaxis Rationale: Magnesium sulfate is indicated for seizure prophylaxis in preeclampsia with severe features, particularly before cesarean delivery.

Answer 81

B. Cesarean section due to abnormal Doppler findings Rationale: Absent end-diastolic flow (AEDF) in fetal Doppler studies indicates significant placental insufficiency, necessitating cesarean delivery to reduce the risk of fetal hypoxia.

Answer 82

C. Cesarean section due to fetal distress Rationale: Persistent late decelerations suggest fetal distress, making cesarean section the safest option to prevent further fetal compromise.

Answer 83

A. Continue magnesium sulfate for 24 hours Rationale: Magnesium sulfate should be continued for 24 hours postpartum to prevent eclampsia, as the postpartum period is the maximum risk period for convulsions in preeclamptic women. B. ≥150/100 mmHg Rationale: Antihypertensive therapy is indicated when BP exceeds 150/100 mmHg in the postpartum period to reduce the risk of complications such as stroke.

Answer 84

B. Nifedipine Rationale: Nifedipine is the most commonly used antihypertensive in the postpartum period for BP control. Methyldopa is avoided postpartum due to its side effect of depression, which can exacerbate postpartum mood changes. C. It has a side effect of depression, which can worsen postpartum mood changes Rationale: Methyldopa is avoided postpartum due to its association with depression, which can exacerbate postpartum mood disorders.

Answer 85

B. Epidural anesthesia Rationale: Epidural anesthesia is the preferred method for pain relief in laboring preeclamptic women, as it reduces pain and stress, thereby controlling maternal hypertension and preventing complications. C. It increases the risk of hypertensive crises during intubation Rationale: General anesthesia is associated with a higher risk of hypertensive crises during intubation due to stress-induced catecholamine release, increasing the risk of intracranial hemorrhage and other complications.

Answer 86

C. Opioids Rationale: Opioids are preferred for postpartum pain relief in preeclamptic patients to avoid potential complications from NSAIDs, such as impaired renal function or increased BP. B. They impair renal function and may exacerbate hypertension Rationale: NSAIDs are avoided in postpartum preeclamptic patients due to their potential to impair renal function and exacerbate hypertension, which are already concerns in this population.

LE4 - HTN Flashcards

(110 cards)