Hyperemesis gravidarum
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Hyperemesis gravidarum
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USMLE® Step 1 style questions USMLE
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A 36-year-old primigravid woman comes to the office at 15 weeks gestation due to vaginal bleeding. This morning, she woke up and noticed blood in her underwear. She has also had severe morning nausea that has been worsening, resulting in multiple episodes of vomiting throughout the day for the past week. She states it has been difficult to keep down anything she eats or drinks. She denies shortness of breath, changes in vision, or chest pain. She does not use tobacco, alcohol or illicit drugs. Current temperature is 37.0°C (98.6°F), pulse is 100/min, and blood pressure is 145/85 mmHg. On physical examination, a 19-week-size uterus and bilateral adnexal masses are palpated on bimanual examination. Laboratory tests show hCG concentrations of 110,000 mIU/mL. TSH is 0.1 μU/mL. Which of the following is the most likely diagnosis?
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Hyperemesis gravidarum p. 656
Summary
Hyperemesis gravidarum is a complication of pregnancy, in which there is persistent severe nausea and vomiting that can lead to dehydration and weight loss. People with Hyperemesis gravidarum experience vomiting several times a day, usually before the 20th week of pregnancy. This condition is often seen in primigravid young women and those with twin gestation or molar pregnancy.