Hypertensive disorders: phaeochromocytoma in pregnancy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Hypertensive disorders: phaeochromocytoma in pregnancy

Sample item

A woman at 22 weeks has paroxysmal headache, sweating and palpitations with blood pressure 190/110 mmHg. Urine metanephrines are raised and imaging shows an adrenal mass. What is the correct order of antihypertensive therapy?

AAn ACE inhibitor aloneBA thiazide diuretic aloneCAlpha-blockade first, then a beta-blocker if neededDBeta-blocker first, then an alpha-blocker

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Alpha-blockade first, then a beta-blocker if needed

Alpha-blockade, usually with phenoxybenzamine, is started first. A beta-blocker given first leaves alpha-mediated vasoconstriction unopposed and can provoke a hypertensive crisis. Surgery is timed according to gestation, with excision in the second trimester or after delivery.

Option by option

A. An ACE inhibitor alone
ACE inhibitors are contraindicated in pregnancy and do not control catecholamine excess.
B. A thiazide diuretic alone
A thiazide would not control catecholamine-driven hypertension and worsens volume depletion.
C. Alpha-blockade first, then a beta-blocker if needed (correct)
Correct. Alpha-blockade must precede beta-blockade.
D. Beta-blocker first, then an alpha-blocker
A beta-blocker first leaves alpha stimulation unopposed and may cause a crisis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Alpha-blockade first, then a beta-blocker if needed. Alpha-blockade, usually with phenoxybenzamine, is started first.

Why is "An ACE inhibitor alone" not the answer?

ACE inhibitors are contraindicated in pregnancy and do not control catecholamine excess.

Why is "A thiazide diuretic alone" not the answer?

A thiazide would not control catecholamine-driven hypertension and worsens volume depletion.

Why is "Beta-blocker first, then an alpha-blocker" not the answer?

A beta-blocker first leaves alpha stimulation unopposed and may cause a crisis.

What concept does this question test?

It tests Hypertensive disorders: phaeochromocytoma in pregnancy in OBG. A beta-blocker given first leaves alpha-mediated vasoconstriction unopposed and can provoke a hypertensive crisis. Surgery is timed according to gestation, with excision in the second trimester or after delivery.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hypertensive disorders: phaeochromocytoma in pregnancy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.