Hypertensive disorders of pregnancy

41 NEET-PG practice questions on Hypertensive disorders of pregnancy, part of Obstetrics & Gynaecology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   In the labour room of a district hospital, a 23-year-old primigravida at 36 weeks who had an eclamptic fit is receiving the Pritchard regimen of magnesium sulphate. Before the next 5 g intramuscular dose, the duty doctor considers four checks: 1. Blood pressure has come down below 140/90 mm Hg. 2. Patellar reflexes are present. 3. Respiratory rate is not depressed. 4. Urine output over the last 4 hours is adequate. Which checks must be satisfied before the dose is given?

   1. A1, 2, 3 and 4
   2. B2, 3 and 4 only
   3. C2 and 3 only
   4. D1, 2 and 3 only

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   Answer: B · 2, 3 and 4 only

   Checks 2, 3 and 4 are the bedside conditions for every maintenance dose: knee jerks present, respiratory rate at least 16/min in standard Indian teaching, and urine output at least 30 mL/hour (100 mL in 4 hours), because magnesium is cleared by the kidneys. Loss of the knee jerk is the earliest sign of toxicity and appears before respiratory depression; the antidote is 10 mL of 10% calcium gluconate given slowly IV. Check 1 is wrong: magnesium prevents seizures and is not an antihypertensive, so raised blood pressure is treated with labetalol or nifedipine while magnesium continues.

   • A: Includes a blood pressure target, which is not a condition for giving magnesium.
   • C: Omits urine output, which matters because magnesium is excreted by the kidneys.
   • D: Includes a blood pressure target and omits urine output.

2. Question 2 · Hard

   A teaching registrar shows students a list of findings in a 28-year-old at 31 weeks with BP 150/98 mm Hg, judged by the ACOG 2020 criteria: 1. Platelets 90,000/µL. 2. 24-hour urine protein 6 g. 3. Serum creatinine 1.4 mg/dL. 4. Estimated fetal weight below the 10th centile. Which of these are severe features of pre-eclampsia by those criteria?

   1. A1, 2 and 3 only
   2. B1, 2, 3 and 4
   3. C1 and 3 only
   4. D1, 3 and 4 only

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   Answer: C · 1 and 3 only

   By the ACOG criteria, severe features are BP of 160/110 mm Hg or more, platelets below 100,000/µL, transaminases twice normal or more, severe persistent right upper quadrant or epigastric pain, creatinine above 1.1 mg/dL or doubled, pulmonary oedema, and new headache or visual disturbances. Platelets of 90,000/µL and a creatinine of 1.4 mg/dL therefore qualify. Massive proteinuria (over 5 g) and fetal growth restriction were removed from the list because they do not predict maternal outcome well, though growth restriction still changes fetal monitoring and timing. Older Indian texts may still list heavy proteinuria, so the criteria in use must be stated.

   • A: Massive proteinuria is no longer a severe feature by ACOG.
   • B: Neither massive proteinuria nor FGR is a severe feature now.
   • D: Fetal growth restriction is not a severe feature by ACOG.

3. Question 3 · Easy

   A 33-year-old with chronic hypertension who takes enalapril 10 mg daily finds she is 7 weeks pregnant. Her BP is 136/86 mm Hg. What should be done about her antihypertensive?

   1. ASwitch enalapril to losartan
   2. BContinue enalapril to term
   3. CSwitch enalapril to furosemide
   4. DSwitch enalapril to labetalol

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   Answer: D · Switch enalapril to labetalol

   ACE inhibitors and angiotensin receptor blockers are contraindicated in pregnancy. In the second and third trimesters they impair the fetal renal angiotensin system, causing oligohydramnios, renal failure, limb contractures and poor skull ossification. She should be switched at once to a drug safe in pregnancy, such as labetalol, nifedipine or methyldopa. First-trimester exposure carries a smaller risk, so continuing the pregnancy with a detailed anomaly scan is reasonable.

   • A: ARBs carry the same fetal risks as ACE inhibitors.
   • B: ACE inhibitors cause fetal renal damage in later pregnancy.
   • C: Diuretics reduce plasma volume and are not first-line in pregnancy.

4. Question 4 · Medium

   A 24-year-old primigravida at 37 weeks has BP 144/92 mm Hg on repeated readings, no proteinuria, normal platelets, liver and kidney tests and no symptoms. The fetus is well grown with normal liquor, and the cervix is favourable (Bishop score 8). What is the best management?

   1. AStart labetalol and review in 2 weeks
   2. BContinue the pregnancy to 40 weeks
   3. CElective caesarean section now
   4. DInduce labour now

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   Answer: D · Induce labour now

   This is gestational hypertension without severe features. Delivery at 37 weeks is advised, because continuing the pregnancy adds the risk of progression to severe pre-eclampsia, abruption and eclampsia without benefit to a term fetus. With a favourable cervix, induction of labour is appropriate; caesarean section is kept for the usual obstetric indications. BP and symptoms are watched during labour and after delivery.

   • A: Treating the BP does not remove the reason to deliver at term.
   • B: Waiting beyond 37 weeks raises the risk of severe disease.
   • C: Hypertension alone is not an indication for caesarean.

5. Question 5 · Medium

   A 22-year-old who had an eclamptic fit at 36 weeks wakes up afterwards saying she cannot see, although her pupils react normally to light. BP is 170/110 mm Hg. MRI shows bilateral white matter oedema in the parieto-occipital regions. What is the most likely diagnosis?

   1. APituitary apoplexy
   2. BOccipital lobe haemorrhage
   3. CCerebral venous sinus thrombosis
   4. DPosterior reversible encephalopathy syndrome

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   Answer: D · Posterior reversible encephalopathy syndrome

   Cortical blindness with reacting pupils and vasogenic oedema of the posterior white matter is posterior reversible encephalopathy syndrome (PRES). In eclampsia, endothelial damage and loss of cerebral autoregulation at high BP let fluid leak into the brain, and the posterior circulation has less sympathetic protection. Vision usually returns within days once BP is controlled and magnesium is given. Retinal detachment is another cause of visual loss in pre-eclampsia, but it causes no MRI changes.

   • A: Pituitary apoplexy causes field defects and ophthalmoplegia.
   • B: Haemorrhage would show blood, not symmetrical oedema.
   • C: Venous thrombosis gives venous infarcts, not this pattern.

6. Question 6 · Medium

   A 23-year-old primigravida with early-onset pre-eclampsia at 29 weeks asks why it happened. Her serum is analysed in a research study. Which pattern of angiogenic factors would be expected?

   1. AHigh sFlt-1 and high PlGF
   2. BHigh sFlt-1 and low PlGF
   3. CLow sFlt-1 and low PlGF
   4. DLow sFlt-1 and high PlGF

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7. Question 7 · Medium

   At a booking visit in the ANC clinic, a doctor reviews the history of a 30-year-old for risk factors for pre-eclampsia. Four features are noted: 1. This is her first pregnancy. 2. She smokes cigarettes. 3. She is carrying twins. 4. She has antiphospholipid syndrome. Which of these increase her risk of pre-eclampsia?

   1. A1, 2 and 3 only
   2. B3 and 4 only
   3. C1, 2, 3 and 4
   4. D1, 3 and 4 only

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8. Question 8 · Easy

   A 30-year-old at 35 weeks with pre-eclampsia has BP 164/112 mm Hg, still 162/110 mm Hg when repeated 15 minutes later. Which drug is a first-line choice to lower it?

   1. AOral enalapril
   2. BIV labetalol
   3. CIV furosemide
   4. DIV sodium nitroprusside

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9. Question 9 · Easy

   A 28-year-old with pre-eclampsia has 3+ proteinuria and a creatinine of 1.3 mg/dL. Which renal lesion is characteristic of pre-eclampsia?

   1. ACrescentic glomerulonephritis
   2. BGlomerular endotheliosis
   3. CMembranous thickening
   4. DNodular glomerulosclerosis

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10. Question 10 · Medium

    A 28-year-old is brought to casualty on day 4 after a normal vaginal delivery with a severe headache and then a generalised fit. BP is 168/108 mm Hg and urine protein is 2+. Her antenatal BP had been normal. She has no fever or neck stiffness, and there are no focal neurological signs. What is the most likely diagnosis?

    1. ANew-onset epilepsy
    2. BBacterial meningitis
    3. CCerebral venous thrombosis
    4. DPostpartum eclampsia

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11. Question 11 · Medium

    A 27-year-old with eclampsia on magnesium sulphate needs an emergency caesarean section under general anaesthesia because of a failed spinal. The anaesthetist reduces the dose of rocuronium and monitors neuromuscular block closely. Why does magnesium increase sensitivity to rocuronium?

    1. AIt reduces acetylcholine release at the motor end plate
    2. BIt inhibits plasma cholinesterase activity
    3. CIt slows the hepatic clearance of rocuronium
    4. DIt increases the number of nicotinic receptors

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12. Question 12 · Medium

    A 35-year-old has had hypertension for 4 years and takes nifedipine; her urine protein was negative at 10 weeks. At 30 weeks her BP has risen to 150/100 mm Hg on the same dose, and the urine protein-creatinine ratio is 0.6 mg/mg. Platelets and liver tests are normal. What is the diagnosis?

    1. AGestational hypertension
    2. BChronic hypertension alone
    3. CPre-eclampsia without chronic hypertension
    4. DChronic hypertension with superimposed pre-eclampsia

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13. Question 13 · Medium

    A 29-year-old at 36 weeks with HELLP syndrome is to have an emergency caesarean under general anaesthesia. Her platelet count is 18,000/µL, with no active bleeding. What should be done before the incision?

    1. AGive fresh frozen plasma
    2. BTransfuse platelets
    3. CStart high-dose dexamethasone
    4. DGive IV tranexamic acid only

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14. Question 14 · Medium

    A district maternal health officer reviews measures for preventing pre-eclampsia among pregnant women in a population with low dietary calcium. Four measures are proposed: 1. Low-dose aspirin from 12 weeks for high-risk women. 2. Calcium supplementation for all pregnant women. 3. Dietary salt restriction for all. 4. Vitamin C and E supplements for all. Which measures are supported by evidence?

    1. A1 and 2 only
    2. B2 and 4 only
    3. C1, 2 and 3 only
    4. D1, 2, 3 and 4

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15. Question 15 · Medium

    A 34-year-old with chronic hypertension continued losartan throughout pregnancy because she missed her antenatal visits. A scan at 28 weeks shows severe oligohydramnios with normal fetal kidneys in shape and no rupture of membranes. What is the mechanism of the oligohydramnios?

    1. ALosartan causes placental vasoconstriction
    2. BLosartan causes renal agenesis in the embryo
    3. CBlocked fetal renin-angiotensin system cuts urine output
    4. DLosartan blocks fetal ADH and causes diuresis

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16. Question 16 · Medium

    A 20-year-old primigravida at 36 weeks with known pre-eclampsia suddenly has a generalised tonic-clonic fit in the ANC clinic waiting area. What is the first action of the attending doctor?

    1. AShift to theatre for caesarean
    2. BLeft lateral position and airway protection
    3. CIV labetalol to lower the BP
    4. DImmediate IV diazepam injection

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17. Question 17 · Easy

    A 24-year-old at 16 weeks has BP 160/104 mm Hg, 3+ proteinuria and vaginal spotting. Her uterus is the size of 22 weeks, no fetal heart is seen, and serum beta-hCG is very high. What is the most likely underlying condition?

    1. ATwin pregnancy
    2. BLupus nephritis
    3. CComplete hydatidiform mole
    4. DChronic hypertension

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18. Question 18 · Medium

    A medical officer prepares a teaching session on magnesium sulphate for labour room staff. Four statements are offered: 1. It acts partly as an NMDA receptor antagonist. 2. It is excreted almost entirely by the kidneys. 3. It is the first-line drug for lowering severe BP. 4. Given before 32 weeks, it reduces cerebral palsy in the newborn. Which statements are correct?

    1. A1, 2, 3 and 4
    2. B1, 2 and 3 only
    3. C1, 2 and 4 only
    4. D2 and 4 only

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19. Question 19 · Hard

    A 26-year-old primigravida at 30 weeks was admitted with BP 164/110 mm Hg and 3+ proteinuria. Over 48 hours, oral labetalol and nifedipine have kept her BP at 140-150/90-100 mm Hg. She has no headache, visual or epigastric symptoms; platelets 1.8 lakh/µL, AST 28 IU/L, creatinine 0.7 mg/dL. The fetus has an estimated weight on the 30th centile with normal umbilical artery Doppler. She received betamethasone on admission. What is the best plan?

    1. AInduce labour after a second steroid course
    2. BCaesarean section today
    3. CDischarge on oral labetalol
    4. DInpatient expectant care, aiming for 34 weeks

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20. Question 20 · Hard

    At a PHC with no infusion pump, a 23-year-old with severe pre-eclampsia must receive the 4 g IV loading dose of the Pritchard regimen as a 20% solution. Only 50% magnesium sulphate ampoules (2 mL = 1 g) and sterile water are available. How should the IV dose be prepared?

    1. A8 mL of 50% solution with 12 mL water
    2. B8 mL of 50% solution with 32 mL water
    3. C20 mL of 50% solution undiluted
    4. D4 mL of 50% solution with 16 mL water

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21. Question 21 · Medium

    A 30-year-old at 33 weeks with pre-eclampsia has these results reported on the same day. Four values are listed: 1. LDH 740 IU/L. 2. AST 160 IU/L. 3. Platelets 76,000/µL. 4. Blood glucose 48 mg/dL. Which of these values are part of the Tennessee criteria for HELLP syndrome?

    1. A1, 2 and 3 only
    2. B1, 3 and 4 only
    3. C1, 2, 3 and 4
    4. D2 and 3 only

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22. Question 22 · Easy

    A 21-year-old primigravida at 38 weeks is admitted in labour with BP 166/110 mm Hg, 3+ proteinuria and a severe frontal headache. She has had no fit. Which drug should be started to prevent eclampsia?

    1. AMagnesium sulphate
    2. BPhenytoin
    3. CDiazepam
    4. DLevetiracetam

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23. Question 23 · Medium

    A 30-year-old who was delivered for pre-eclampsia 3 days ago still has BP 152/100 mm Hg. She had postnatal depression after her first baby. Which antihypertensive is best avoided in her?

    1. ALabetalol
    2. BAmlodipine
    3. CMethyldopa
    4. DNifedipine

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24. Question 24 · Medium

    A 33-year-old was diagnosed with pre-eclampsia at 33 weeks and delivered at 34 weeks. At a follow-up visit 14 weeks after delivery her BP is still 150/96 mm Hg on two occasions, and her urine is free of protein. What is the diagnosis, and what counselling matters most?

    1. AWhite-coat hypertension; no follow-up
    2. BGestational hypertension; it will settle
    3. CPersisting pre-eclampsia; repeat proteinuria tests
    4. DChronic hypertension; lifelong cardiovascular risk

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25. Question 25 · Medium

    A 25-year-old with eclampsia at 34 weeks received the Pritchard loading dose an hour ago. She now has a second generalised fit lasting about a minute. Her airway is protected and she is in the left lateral position. What is the next step?

    1. AGive IV diazepam 10 mg
    2. BWait and start the IM maintenance
    3. CGive a phenytoin loading dose
    4. DGive another 2 g magnesium sulphate IV

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