A 37-Year-Old Woman, Gravida 1 Para 0, at 25 Weeks

question 304

Multiple Choice

A 37-year-old woman, gravida 1 para 0, at 25 weeks gestation is evaluated in the antepartum unit due to increasing chest pain.  The patient describes a sharp, substernal chest pain that is worse with inspiration and radiates to the right upper quadrant.  She has no fever, cough, or rashes.  The patient has had no vaginal bleeding or leakage of fluid.  She has a twin pregnancy and was admitted for inpatient monitoring for preterm labor 6 days ago.  The patient has reduced her activity level because walking increases the contractions, and she has been receiving heparin for venous thromboembolism prophylaxis.  Her pregnancy has been otherwise uncomplicated.  Temperature is 37.2 C (99 F) , blood pressure is 130/86 mm Hg, pulse is 116/min, and respirations are 24/min.  Heart rates for both fetuses are 155/min.  Lung auscultation shows decreased breath sounds over the right lung base.  The uterus is nontender.  The lower extremities have bilateral 1+ pitting edema to the knees.  Laboratory evaluation is as follows: Which of the following is the most likely diagnosis in this patient?

• A)Acute fatty liver of pregnancy
• B)HELLP syndrome
• C)Heparin-induced thrombocytopenia
• D)Preeclampsia with severe features
• E)Thrombotic thrombocytopenia purpura

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Definitions:

Well Defined

Clearly explained or identified with precise boundaries or criteria.

Classes

Categories or groups of objects or individuals sharing common attributes, qualities, or characteristics.

Distribution

In syllogistic logic, the term refers to the way in which a term in a categorical proposition is applied to all members of the category it denotes.

Serious Injuries

Injuries that are severe and potentially life-threatening, often requiring immediate medical attention.