WBR0171
| 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. |
| 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 |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |