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Intrahepatic cholestasis of pregnancy — USMLE Step 2 CK MCQ

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EasyObstetrics & GynecologyIntrahepatic cholestasis of pregnancyUSMLE Step 2 CK

A 32-year-old African American woman comes to the emergency department because of pelvic symptoms or pregnancy-related concerns. History and focused examination are notable for third-trimester pruritus of palms and soles with elevated bile acids. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Obstetric evaluation shows fetal status, urine protein testing, and complete blood count findings relevant to the presentation. Which of the following is the most likely cause of this patient's condition?

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Correct answer: E — The pathophysiologic process suggested by the clinical findings

The vignette describes Intrahepatic cholestasis of pregnancy, supported by third-trimester pruritus of palms and soles with elevated bile acids. The pathophysiologic process suggested by the clinical findings is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: SMFM Consult Series on Intrahepatic Cholestasis of Pregnancy