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Atopic dermatitis — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareAtopic dermatitisUSMLE Step 3

A 32-year-old at 35 weeks gestation has severe headache, visual scotomata, BP 172/114 mmHg and 3+ proteinuria. While IV antihypertensive treatment is being given, she develops a generalized tonic-clonic seizure. What is the next immediate medication?

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Correct answer: A — Give IV magnesium sulfate and continue maternal stabilization

The best answer is “Give IV magnesium sulfate and continue maternal stabilization”. A generalized seizure with severe hypertension and proteinuria is eclampsia; IV magnesium sulfate is the first-line anticonvulsant while airway, blood pressure, and delivery planning are managed. Diazepam or phenytoin are not preferred routine therapy. Furosemide does not terminate eclamptic seizures, and delivery follows stabilization rather than preceding seizure control.

Reference: ACOG, Gestational Hypertension and Preeclampsia: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/06/gestational-hypertension-and-preeclampsia