Viva 4

HELLP syndrome

A 36 year old Gravida 2 Para 0 nurse presents at 29 weeks gestation with headaches and nausea.

She has had difficulty conceiving in the past and apart from mild asthma suffers from no other illnesses. The present pregnancy was unremarkable. Examination reveals an anxious lady with a blood pressure of 170/120. She has generalised tissue oedema. She also has mild right upper quadrant tenderness.Apart from this her examination is unremarkable.

Investigations done on the day of presentation reveal

a) 3+ proteinuria,

b) abnormal liver function tests with a bilirubin 30μmo/L

c) AST 300 IU/L (N<30)

d) Hb 78 g/L (130 -150)

e) platelet count 75 x 10 /L (150 -300)

The blood film shows fragmented red cells.

What do you think this patient is suffering from?

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.