OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is HELLP syndrome (a complication of preeclampsia). While this may seem a odd practice, it is useful to see multiple examples of how HELLP syndrome 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 35 year old obese woman, G2P1, comes to the clinic at 31 weeks gestation. She complains that she has been having severe heartburn and right upper quadrant abdominal pain. She also admits to experiencing a few episodes of nausea and vomiting in the morning before she came to the office. The patient has been diagnosed with GERD during the course of her pregnancy, and her symptoms seem to have rapidly worsened. During her visit last week she was fatigued and her blood pressure was 135/85 mm Hg. Currently her blood pressure is 165/95 mm Hg and her pulse is 87/min. Her physical exam shows that there is extreme tenders to palpation in the right upper quadrant, but there is no rebound tenderness. Using Doppler ultrasound, fetal heart tones are audible. Laboratory results are listed below:
Complete blood count:
- Hemoglobin: 9.0 g/dL
- Platelets: 75,000/µL
Liver function studies:
- Total protein: 6.2 g/dL
- Albumin: 2.5 g/dL
- Total bilirubin: 2.5 mg/dL
- Direct bilirubin: 0.6 mg/dL
- Alkaline phosphatase: 170 U/L
- Aspartate aminotransferase: 113 U/L
- Alanine aminotransferase: 125 U/L
- Lipase: 75 U/L
Urine dipstick shows 2+ protein. What is the diagnosis in this patient given her presentation and lab results?
Explanation:
- Preeclampsia: hypertension + right upper abdominal pain + protein in urine
- HELLP syndrome: hemolysis (anemia + increased bilirubin)+ elevated liver enzymes + low platelets
Question # 2
A 30 year old woman, G1P0, is at 36 weeks gestation when she comes to the emergency department. She complains of nausea, vomiting, and right upper quadrant pain that has not improved after taking ibuprofen. Her pregnancy course has been complicated by gestational hypertension since 35 weeks gestation. Her temperature is 99.0°F, blood pressure is 160/100 mm Hg, and her pulse is 80/min. Physical examination reveals right upper quadrant tenderness, and her bowel sounds are noted to be diminished. A fetal heart tracing shows a baseline of 140 with moderate variability, no decelerations, and no accelerations. The patient has 2+ pitting edema up to the mid calves. A urine dipstick shows 2+ protein. The patients laboratory results are listed below.
Complete blood count:
- Hemoglobin: 7.8 g/dL
- Platelets: 85,000/µL
Liver function studies:
- Total bilirubin: 2.7 mg/dL
- Direct bilirubin: 0.9 mg/dL
- Alkaline phosphatase: 150 U/L
- Aspartate aminotransferase: 313 U/L
- Alanine aminotransferase: 225 U/L
- Lipase: 75 U/L
What is this patient’s likely diagnosis?
Explanation:
- Preeclampsia: hypertension + right upper abdominal pain + protein in urine
- HELLP syndrome: hemolysis (anemia + increased bilirubin)+ elevated liver enzymes + low platelets
Question # 2
A 25 year old primigravida woman is at 31 weeks gestation when she comes to the emergency department. She complain of a headache, blurred vision, and constant right upper quadrant pain for the past 10 hours. Her pulse is 90/min, respirations are 15/min, and blood pressure is 139/100 mm Hg. Examination shows moderate edema on the face and fingers. Her deep tendon reflexes are 3+. Laboratory studies are as follows:
- Platelet count: 42,000/mm³*
- AST: 1300 U/L*
- ALT: 370 U/L*
- Lactate dehydrogenase: 2000 U/L*
Explanation:
- Preeclampsia: hypertension + right upper abdominal pain + headache/vision changes
- HELLP syndrome: hemolysis (anemia + increased bilirubin) + elevated liver enzymes + low platelets
Page Updated: 10.02.2016