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Old 01-08-2013
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ObGyn 18th week of gestation proteinuria

A 17-year-old African American patient, gravida I, para 0, in her 18th week of gestation, visits her obstetrics and gynecology (OB-GYN) clinic with complaints of headache, blurry vision, and abdominal pain. Her symptoms began 2 days ago. She has no other complaints, has always been healthy, takes no medications, and does not smoke or drink. Previous prenatal checkups have been entirely normal. On physical exam, vital signs are temperature: 37.3°C (99.2°F), blood pressure (BP): 170/95, heart rate (HR): 80 beats/min, and respiratory rate (RR): 14 breaths/min. Neuro exam is nonfocal; funduscopic exam reveals no retinopathy. Neck is supple without masses or bruits. Chest and cardiac exam are normal. Abdomen is soft with mild diffuse right upper quadrant tenderness. Pelvic exam is normal. There is generalized edema and 3+ deep tendon reflexes (DTRs) throughout. The patient is admitted to the hospital for observation, and appropriate screening labs are drawn. A clean catch urine sample shows 2+ proteinuria by dipstick. Six hours later the patient is resting comfortably in bed with a BP of 165/95. A second urine sample again shows 2+ proteinuria. What laboratory finding when compared against predicted values most closely correlates with this patient's acute metabolic disorder?

A. Decreased blood glucose
B. Decreased serum uric acid levels
C. Increased platelet count
D. Increased prothrombin time
E. Increased serum beta–human chorionic gonadotropin (HCG) levels
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Old 01-08-2013
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Originally Posted by Novobiocin View Post
A 17-year-old African American patient, gravida I, para 0, in her 18th week of gestation, visits her obstetrics and gynecology (OB-GYN) clinic with complaints of headache, blurry vision, and abdominal pain. Her symptoms began 2 days ago. She has no other complaints, has always been healthy, takes no medications, and does not smoke or drink. Previous prenatal checkups have been entirely normal. On physical exam, vital signs are temperature: 37.3°C (99.2°F), blood pressure (BP): 170/95, heart rate (HR): 80 beats/min, and respiratory rate (RR): 14 breaths/min. Neuro exam is nonfocal; funduscopic exam reveals no retinopathy. Neck is supple without masses or bruits. Chest and cardiac exam are normal. Abdomen is soft with mild diffuse right upper quadrant tenderness. Pelvic exam is normal. There is generalized edema and 3+ deep tendon reflexes (DTRs) throughout. The patient is admitted to the hospital for observation, and appropriate screening labs are drawn. A clean catch urine sample shows 2+ proteinuria by dipstick. Six hours later the patient is resting comfortably in bed with a BP of 165/95. A second urine sample again shows 2+ proteinuria. What laboratory finding when compared against predicted values most closely correlates with this patient's acute metabolic disorder?

A. Decreased blood glucose
B. Decreased serum uric acid levels
C. Increased platelet count
D. Increased prothrombin time
E. Increased serum beta–human chorionic gonadotropin (HCG) levels

D increased prothrombin time--------> HELLP syndrome.
elevated liver enzymes, liver damage, causing increased prothrombin time.
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Originally Posted by slamdunk View Post
D increased prothrombin time--------> HELLP syndrome.
elevated liver enzymes, liver damage, causing increased prothrombin time.
But isn't HELLP syndrome more of a platelet problem than a clotting factor problem ?
Moreover, this patient is in her second trimester while HELLP syndrome is more likely to present in third trimester.
Also, you need evidence of hemolysis and presence of thrombocytopenia to diagnose HELLP syndrome.
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E. Increased beta hcg.
The somewhat early presentation of preecplamsia is kinda making me lean towards a multiple pregnancy or molar pregnancy.

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Old 01-08-2013
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agree with smanthrav........probably a Molar pregnancy
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