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HELLP Syndrome — MRCP Part 1 MCQ

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HardObstetrics & GynaecologyHELLP SyndromeMRCP Part 1UKMLAPARAMRCEM SBA

A 30-year-old primigravida at 32 weeks gestation presents with severe right upper quadrant pain, nausea, and headache. Her blood pressure is 165/110 mmHg. Urinalysis shows 3+ proteinuria. Blood tests reveal: Hb 105 g/L, Platelets 85 x10^9/L, ALT 250 IU/L, AST 300 IU/L. What is the most likely diagnosis?

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Correct answer: B — HELLP syndrome complicating severe pre-eclampsia

This clinical picture strongly suggests HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), a severe variant of pre-eclampsia. Key features present are hypertension, proteinuria, evidence of haemolysis (potentially low Hb, though not definitively shown here), elevated liver enzymes (ALT, AST), and low platelets. Acute fatty liver of pregnancy presents similarly but often with more profound liver dysfunction and hypoglycemia. ICP causes pruritus and raised bile acids. Cholecystitis would typically have localised RUQ tenderness +/- fever. Pyelonephritis presents with fever, flank pain and urinary symptoms.

Reference: NICE NG133 hypertension in pregnancy: https://www.nice.org.uk/guidance/ng133/chapter/Recommendations GMC PA registration assessment content map: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/pa-and-aa-prequalification-education-framework/pa-registration-assessment-content-map