OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is intrahepatic cholestasis of pregnancy. While this may seem a odd practice, it is useful to see multiple examples of how intrahepatic cholestasis of pregnancy will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 30 year old primigravida woman comes to her doctor at 30 weeks gestation because she has been experiencing decreased appetite, nausea, and generalized itching for the past 9 days. She has no remarkable past medical history, and her pregnancy has been uncomplicated. Her pulse is 95/min and regular, blood pressure is 100/60 mm Hg. Physical exam shows skin excoriations on the right shoulder. Her lung fields are clear bilaterally. A grade 2/6 systemic murmur is heard, and is loudest at the left sternal border. The patient’s uterus size is consistent with 30 weeks gestation. The patients lab studies are listed below:
- Hemoglobin: 11.2 g/dL
- MCV: 85 µm³
- Leukocyte count: 10,500/mm³
- Platelet count: 115,000/mm³
- Total bilirubin: 2.2 mg/dL
- Alkaline phosphatase: 220 U/L
- AST: 31 U/L
- ALT: 27 U/L
Abodminla ultrasound shows no remarkable findings. What is the most likely explanation for this patient’s symptoms?
Question # 2
A 30 year old, G2P1 woman is at 35 weeks gestation. She comes to the clinic with complaints of intense itching, that she has especially noticed on the palms of her hands. Her previous pregnancy was eventful, and ended in a term spontaneous vaginal delivery. She immigrated to the US ~12 years ago, and now works as a secretary. She takes her prenatal vitamin, but does not use alcohol, tobacco products, or any other types of drugs. All of her immunizations are up to day. Her temperature is 98.4°F, blood pressure is 120/70 mm/Hg, her pulse is 75/min and respiration’s are 14/min. On physical examination she is not in any visible acute distress. Her lungs are clear to auscultation, and her heart sounds are unremarkable. There is no hepatosplenomegaly, or abodminla tenderness with palpation of the abdomen. Her fundal height is consistent with her gestational age. There is 1+ edema on the lower extremities. There is no jaundice present. Below are some lab values collected on the patient:
Liver studies:
- Total bilirubin: 2.4 mg/dL
- Direct bilirubin: 1.1 mg/dL
- Total bile acids: 30 µmol/L (ref range: 4-16 µmol/L) *
- ALP: 210 U/L
Hepatitis panel:
- HBsAg: Negative
- Anti-HBsAb: Positive
- Anti-HbcAb: Negative
- Anti-HAV IgM: Negative
- Anti-HAV IgG: Positive
- Anti-HCV: Negative
Complete blood count:
- Hemoglobin: 12.6 g/L
- Mean corpuscular volume: 93 fL
- Platelets: 145,000/µL
- Leukocytes: 8,000/µL
What is the most likely diagnosis in this patient?
Explanation: intense itching on palms + elevated total bile acids = intrahepatic cholestasis of pregnancy
Page Updated: 09.29.2016