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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}} {{AJL}} {{Alison}}
|QuestionAuthor={{Rim}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
Line 20: Line 20:
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Reproductive
|SubCategory=Reproductive
|Prompt=At 34 weeks of gestation, a 38-year-old female, G3P2A0, presents to the ER with complaints of severe nausea and a dull pain in her right upper abdomen. Her medical history is significant for preeclampsia. Upon appropriate work-up you observe elevated ALT, AST, and LDH levels, thrombocytopenia, and low haptoglobin levels. You inform the patient that immediate delivery is recommended. Given this patient's condition, which of the following is the most likely cause of mortality?
|Prompt=A 38 year old woman G3P2A0 at 34 weeks of gestation presents to the emergency department complaining of severe nausea and dull right upper abdominal pain. Her past medical history is significant for preeclampsia. Appropriate work-up shows elevated ALT and AST, thrombocytopenia, and elevated LDH and low haptoglobin. The physician informs the patient that immediate delivery of the patient is recommended. What is the most likely cause of mortality in this patient's condition?
|Explanation= The patient in this condition is most likely presenting with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. [[HELLP syndrome]], considered a life-threatening form of [[preeclampsia]], is associated with [[preeclampsia]] and typically manifests in pregnant women between 32-34 weeks of gestation. Patients with [[HELLP syndrome]] typically present with right upper abdominal pain and with non-specific symptoms, such as fatigue and nausea. A serum haptoglobin test is crucial for the detection of early hemolysis. Usually, an elevation of the liver enzymes precedes the decrease in platelets. Patients are usually recommended to deliver promptly, when diagnosed at 32-34 weeks. The most common causes of mortality in patients with [[HELLP syndrome]] are [[intracranial hemorrhage]] and [[ARDS]].
|Explanation=The patient is most likely presenting with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. The disease is associated with preeclampsia and typically manifests in pregnant women between 32-34 weeks of gestation. It is considered a life-threatening form of preeclampsia. Similar to the patient's presentation, patients with HELLP syndrome typically present with right upper abdominal pain with non-specific symptoms, such as fatigue and nausea. Serum haptoglobin is important for the detection of early hemolysis. Usually an elevation in liver enzymes precedes the decrease in platelets. Patients are usually recommended to deliver as soon as the diagnosis is made when diagnosed at 32-34 weeks. The most common causes of mortality in patients with HELLP syndrome are intracranial hemorrhage and ARDS.


|EducationalObjectives= Intracranial hemorrhage and ARDS are the most common causes of mortality in patients with HELLP syndrome.
Educational Objective:
Intracranial hemorrhage and ARDS are the most common causes of mortality in patients with HELLP syndrome.


|References= Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. J Perinat Med. 2000;28(4):249-60.
Reference:
Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. J Perinat Med. 2000;28(4):249-60.


|AnswerA=GI bleeding
|AnswerA=GI bleeding
|AnswerAExp=GI bleeding is not a common cause of mortality in patients with [[HELLP syndrome]].
|AnswerAExp=GI bleeding is not a very common cause of mortality in patients with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.
|AnswerB=Myocardial infarction
|AnswerB=Myocardial infarction
|AnswerBExp=Myocardial infarction is not a very common cause of mortality in patients with [[HELLP syndrome]].
|AnswerBExp=Myocardial infarction is not a very common cause of mortality in patients with HELLP syndrome.
|AnswerC=Uterine bleeding
|AnswerC=Uterine bleeding
|AnswerCExp=Uterine bleeding is not a common cause of mortality in patients with [[HELLP syndrome]]. [[Uterine atony]] is a common cause of uterine bleeding, post-delivery, that may be fatal.
|AnswerCExp=Uterine bleeding is not a very common cause of mortality in patients with HELLP syndrome. Uterine atony is a common cause of uterine bleeding post-delivery that may be associated with mortality.
|AnswerD=Hematologic malignancy
|AnswerD=Hematologic malignancy
|AnswerDExp=[[Hematologic malignancies]], such as lymphomas and leukemias, are not a common cause of mortality in patients with [[HELLP syndrome]].
|AnswerDExp=Hematologic malignancies, such as lymphomas and leukemias, are not a very common cause of mortality in patients with HELLP syndrome.
|AnswerE=Intracranial hemorrhage
|AnswerE=Intracranial hemorrhage
|AnswerEExp=An [[intracranial hemorrhage]] is a common cause of death in patients with HELLP syndrome.
|AnswerEExp=Intracranial hemorrhage is a common cause of death in patients with HELLP syndrome.
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=intracranial, cerebral, hemorrhage, stroke, cause, of, mortality, death, pregnancy, pregnant, HELLP, syndrome, preeclampsia, pre-eclampsia, eclampsia, hypertension, high, blood, pressure, fatigue, nausea, right, abdominal, pain, upper, hemolysis, haptoglobin, LDH, low, platelet, platelets, thrombocytopenia, elevated, high, increase, increased, liver, enzyme, enzymes, AST, ALT, SGOT, SGPT
|WBRKeyword=intracranial, cerebral, hemorrhage, stroke, cause, of, mortality, death, pregnancy, pregnant, HELLP, syndrome, preeclampsia, pre-eclampsia, eclampsia, hypertension, high, blood, pressure, fatigue, nausea, right, abdominal, pain, upper, hemolysis, haptoglobin, LDH, low, platelet, platelets, thrombocytopenia, elevated, high, increase, increased, liver, enzyme, enzymes, AST, ALT, SGOT, SGPT
|Approved=Yes
|Approved=No
}}
}}

Revision as of 21:58, 30 August 2014
Author [[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Reproductive
Prompt [[Prompt::A 38 year old woman G3P2A0 at 34 weeks of gestation presents to the emergency department complaining of severe nausea and dull right upper abdominal pain. Her past medical history is significant for preeclampsia. Appropriate work-up shows elevated ALT and AST, thrombocytopenia, and elevated LDH and low haptoglobin. The physician informs the patient that immediate delivery of the patient is recommended. What is the most likely cause of mortality in this patient's condition?]]
Answer A AnswerA::GI bleeding
Answer A Explanation AnswerAExp::GI bleeding is not a very common cause of mortality in patients with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.
Answer B AnswerB::Myocardial infarction
Answer B Explanation AnswerBExp::Myocardial infarction is not a very common cause of mortality in patients with HELLP syndrome.
Answer C AnswerC::Uterine bleeding
Answer C Explanation AnswerCExp::Uterine bleeding is not a very common cause of mortality in patients with HELLP syndrome. Uterine atony is a common cause of uterine bleeding post-delivery that may be associated with mortality.
Answer D AnswerD::Hematologic malignancy
Answer D Explanation AnswerDExp::Hematologic malignancies, such as lymphomas and leukemias, are not a very common cause of mortality in patients with HELLP syndrome.
Answer E AnswerE::Intracranial hemorrhage
Answer E Explanation AnswerEExp::Intracranial hemorrhage is a common cause of death in patients with HELLP syndrome.
Right Answer RightAnswer::E
Explanation [[Explanation::The patient is most likely presenting with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. The disease is associated with preeclampsia and typically manifests in pregnant women between 32-34 weeks of gestation. It is considered a life-threatening form of preeclampsia. Similar to the patient's presentation, patients with HELLP syndrome typically present with right upper abdominal pain with non-specific symptoms, such as fatigue and nausea. Serum haptoglobin is important for the detection of early hemolysis. Usually an elevation in liver enzymes precedes the decrease in platelets. Patients are usually recommended to deliver as soon as the diagnosis is made when diagnosed at 32-34 weeks. The most common causes of mortality in patients with HELLP syndrome are intracranial hemorrhage and ARDS.

Educational Objective: Intracranial hemorrhage and ARDS are the most common causes of mortality in patients with HELLP syndrome.

Reference: Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. J Perinat Med. 2000;28(4):249-60.
Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::intracranial, WBRKeyword::cerebral, WBRKeyword::hemorrhage, WBRKeyword::stroke, WBRKeyword::cause, WBRKeyword::of, WBRKeyword::mortality, WBRKeyword::death, WBRKeyword::pregnancy, WBRKeyword::pregnant, WBRKeyword::HELLP, WBRKeyword::syndrome, WBRKeyword::preeclampsia, WBRKeyword::pre-eclampsia, WBRKeyword::eclampsia, WBRKeyword::hypertension, WBRKeyword::high, WBRKeyword::blood, WBRKeyword::pressure, WBRKeyword::fatigue, WBRKeyword::nausea, WBRKeyword::right, WBRKeyword::abdominal, WBRKeyword::pain, WBRKeyword::upper, WBRKeyword::hemolysis, WBRKeyword::haptoglobin, WBRKeyword::LDH, WBRKeyword::low, WBRKeyword::platelet, WBRKeyword::platelets, WBRKeyword::thrombocytopenia, WBRKeyword::elevated, WBRKeyword::high, WBRKeyword::increase, WBRKeyword::increased, WBRKeyword::liver, WBRKeyword::enzyme, WBRKeyword::enzymes, WBRKeyword::AST, WBRKeyword::ALT, WBRKeyword::SGOT, WBRKeyword::SGPT
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