USMLE Step 2 CK Pre-eclampsia Practice Questions
Preeclampsia is a multisystem disorder of pregnancy characterized by new-onset hypertension and proteinuria or end-organ dysfunction after 20 weeks of gestation. It is a leading cause of maternal and perinatal morbidity and mortality, requiring careful monitoring and timely management.
A 28-year-old primigravid woman at 34 weeks' gestation presents to the emergency department with a 2-day history of headache, visual disturbances, and epigastric pain. Her blood pressure is 165/105 mm Hg. Physical examination reveals 2+ pitting edema in her lower extremities and hyperreflexia. Laboratory results show a platelet count of 95,000/mm³, AST 105 U/L, and ALT 98 U/L. Urinalysis demonstrates 3+ protein. Fetal heart rate monitoring shows a reassuring Category I tracing. Which of the following is the most appropriate next step in management?
A 30-year-old woman, gravida 3, para 2, at 30 weeks' gestation is diagnosed with preeclampsia without severe features. Her blood pressure has been consistently 145/95 mm Hg, and she has 1+ proteinuria. She denies headaches, visual changes, or epigastric pain. Fetal ultrasound shows appropriate growth. Which of the following is the most appropriate management plan for this patient?
A 24-year-old woman at 38 weeks' gestation presents with a blood pressure of 150/98 mm Hg and 2+ proteinuria. She has no other symptoms. Her previous prenatal visits were unremarkable. Laboratory tests are within normal limits. Which of the following is the most appropriate next step in management?
A 32-year-old woman, gravida 1, para 0, at 36 weeks' gestation presents with sudden onset of severe headache, blurred vision, and right upper quadrant pain. Her blood pressure is 170/110 mm Hg. Physical examination reveals clonus and brisk deep tendon reflexes. Laboratory results show hemoglobin 9.5 g/dL, platelet count 70,000/mm³, AST 250 U/L, and ALT 220 U/L. Urinalysis shows 4+ protein. Which of the following is the most likely diagnosis?
A 26-year-old woman at 28 weeks' gestation with a history of chronic hypertension is admitted for worsening blood pressure readings, now consistently above 160/100 mm Hg, despite being on two antihypertensive medications. She also has new-onset 3+ proteinuria. Her baseline blood pressure before pregnancy was 130/80 mm Hg, and she had no proteinuria. Which of the following is the most appropriate diagnosis for this patient?
Pre-eclampsia — frequently asked
What is the key distinction between gestational hypertension and preeclampsia for USMLE Step 2 CK?
The key distinction is the presence of proteinuria or signs of end-organ damage in preeclampsia. Gestational hypertension involves new-onset hypertension after 20 weeks without proteinuria or severe features, whereas preeclampsia includes these additional findings.
What are the 'severe features' of preeclampsia that USMLE questions often test?
Severe features include severe hypertension (systolic >=160 or diastolic >=110), thrombocytopenia (<100,000), impaired liver function (elevated transaminases), renal insufficiency (creatinine >1.1 or doubling), pulmonary edema, new-onset cerebral or visual disturbances. Recognize these as triggers for more aggressive management.
When is magnesium sulfate indicated in preeclampsia, and what is its primary role?
Magnesium sulfate is indicated for preeclampsia with severe features, and for eclampsia (seizures). Its primary role is seizure prophylaxis, not blood pressure control. It is also used for fetal neuroprotection in preterm deliveries before 32 weeks.
What is the definitive treatment for preeclampsia?
The definitive treatment for preeclampsia is delivery of the fetus and placenta. Management decisions often revolve around the timing of delivery, balancing maternal and fetal health.
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