Preeclampsia Practice Questions with complete Solutions Graded A+

Preeclampsia Practice Questions with complete Solutions Graded A+ Factors implicated in the etiology of preeclampsia - Answers 1) Immunologic i.e. "it's dad's fault" 2) Spiral Artery Problem 3) Endothelial activation and inflammation 4) Genetic-conflict hypothesis and genetic imprinting Summarize changes from preeclampsia in the kidneys - Answers Swelling of glomerular endothelial cells leads to -Proteinuria -Decreased renal blood flow and glomerular filtration rate -Decreased clearance of uric acid and renal calcium (blood levels of both may rise) Summarize changes from preeclampsia in the liver - Answers Increase in microvascular fat desposition leads to -Increased plasma uric acid -Decreased platelet count -Elevated serum enzymes (ALT AST) -HELLP -Coagulability increases- can lead to DIC Summarize changes from preeclampsia in the CNS - Answers Microvascular changes and ischemia lead to vasoconstriction -Seizures - NOT directly related to the severity of BP elevation -Cortical blindness, seeing spots/scotomata List the demographic and risk factors associated with an increased risk for preeeclampsia. - Answers -Teens:immunologic -Primiparous women -Age 40 -AA ethnicitiy -Mutifetal pregnancy -Family history or personal history: past pregnancy -Obese women -RA, Chronic HTN, Renal disease, DM, -Infections (UTI, periodontal disease, chlamydia, CMV) -***SMOKERS*** Define and differentiate Chronic Hypertension - Answers -Diagnosed prior to 20 weeks EGA, -Does not resolve in 12 weeks postpartum -SBP 140 and DBP 90 Define and differentiate Gestational Hypertension - Answers -HTN w/o proteinuria after 20 weeks EGA (diagnose post partum) Define and differentiate Severe gestational Hypertension - Answers -HTN 160/110....but nothing else Define and differentiate Preeclampsia w/o severe features - Answers -Diagnosed after 20 weeks EGA -HTN between 140/90 - 160/110 -Proteinuria 0.3g/24 hours Define and differentiate Severe preeclampsia - Answers -HTN 160/110 and above -Persistent Sx (dont respond to usual Tx) and/or -other abnormal labs (w/ or without proteinuria) Define and differentiate Eclampsia - Answers Preeclampsia progresses to eeclampsia --- Seizures Define and differentiate Preeclampsia superimposed on chronic hypertension - Answers -Hypertensive women who develop new onset proteinuria -HTN + Proteinuria even if prior to 20 weeks -Sudden uncontrolled hypertension Most common subjective symptoms of preeclampsia - Answers -Headache (worse than usual) -Visual changes (may be from cerebral edema) -Epigastric Pain -RUQ pain (front or back) -Indigestion (worse than usual) or nausea -Edema is not predictive Routine labs to evaluate for preeclamspia - Answers -CBC (H&H) -Liver enzymes (AST, ALT) -LDH -Serum uric acid -Urine protein -Serum Creatinine -Clotting Studies -24 hour urine -Urine dipstick Concerning trends for routine labs - Answers -hematocrit and hemoglobin -increased from hemoconcentration (from 3rd spacing) -Platelet count- (Significantly decreasing, or 100,000/mm3) -Liver enzymes- rising levels may indicate hepatic involvement from severe preeclampsia -especially if doubled. -LDH - (increasing - indicates hemolysis) -Serum uric acid (early predictor- coincides w/ increasing BP and precedes protein uria) -Urine protein/ Creatinine ratio 0.3 Serum creatinine (rising levels or level ?1.2 mg/dL, especially if occurs with oliguria) Factors to consider when evaluating a patient with the diagnosis of preecampsia - Answers -Gestational Age -Severity of Disease