A 39-year-old G1P0 at 39 weeks gestational age is sent to labor and delivery from her obstetrician’s office because of a blood pressure reading of 150/100 obtained during a routine OB visit. Her baseline blood pressures during the pregnancy were 100–120/60-70. On arrival to labor and delivery, the patient denies any headache, visual changes, nausea, vomiting, or abdominal pain. The heart rate strip is reactive and the tocodynamometer indicates irregular uterine contractions. The patient’s cervix is 3 cm dilated. Her repeat BP is 160/90. Hematocrit is 34.0, platelets are 160,000, SGOT is 22, SGPT is 15, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?
b. Chronic hypertension
c. Chronic hypertension with superimposed preeclampsia
e. Pregnancy-induced hypertension (gestational hypertension)
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is e; Pregnancy-induced hypertension (gestational hypertension).
Hypertension in pregnancy is defined as blood pressure of 140/90 mmHg or greater on at least two separate occasions that are 6 h or more apart. The presence of edema is no longer used as a diagnostic criteria because it is so prevalent in normal pregnant women. A rise in systolic blood pressure of 30 mmHg and a rise in diastolic blood pressure of 15 mmHg is no longer used, because women meeting this criteria are not likely to suffer adverse pregnancy outcomes if their absolute blood pressure is below 140/90 mmHg. In gestational hypertension, maternal blood pressure reaches 140/90 or greater for the first time during pregnancy, and proteinuria is not present. In preeclampsia, blood pressure increases to 140/90 after 20 weeks gestation and proteinuria is present (300 mg in 24 h or 1+ protein or greater on dipstick). Eclampsia is present when women with preeclampsia develop seizures. Chronic hypertension exists when a woman has a blood pressure of 140/90 or greater prior to the pregnancy or before 20 weeks gestation. A woman with hypertension who develops preeclampsia is described as having chronic hypertension with superimposed preeclampsia.