Hypertensive disorders: pathogenesis: 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: pathogenesis

Sample item

Which angiogenic imbalance is found in the maternal circulation in pre-eclampsia?

AHigh soluble fms-like tyrosine kinase-1 with low placental growth factorBLow soluble fms-like tyrosine kinase-1 with low placental growth factorCHigh VEGF with high placental growth factorDLow soluble fms-like tyrosine kinase-1 with high placental growth factor

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

The answer and the reasoning

A. High soluble fms-like tyrosine kinase-1 with low placental growth factor

The ischaemic placenta releases excess sFlt-1, which binds and lowers free VEGF and PlGF, causing endothelial dysfunction. A high sFlt-1 to PlGF ratio supports the diagnosis and predicts adverse outcome. The opposite pattern is not seen.

Option by option

A. High soluble fms-like tyrosine kinase-1 with low placental growth factor (correct)
Correct. Excess sFlt-1 mops up PlGF and VEGF.
B. Low soluble fms-like tyrosine kinase-1 with low placental growth factor
sFlt-1 is raised, not low, in pre-eclampsia.
C. High VEGF with high placental growth factor
Free VEGF falls rather than rises because sFlt-1 binds it.
D. Low soluble fms-like tyrosine kinase-1 with high placental growth factor
This pattern is the reverse of the disease.

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 A, High soluble fms-like tyrosine kinase-1 with low placental growth factor. The ischaemic placenta releases excess sFlt-1, which binds and lowers free VEGF and PlGF, causing endothelial dysfunction.

Why is "Low soluble fms-like tyrosine kinase-1 with low placental growth fact…" not the answer?

sFlt-1 is raised, not low, in pre-eclampsia.

Why is "High VEGF with high placental growth factor" not the answer?

Free VEGF falls rather than rises because sFlt-1 binds it.

Why is "Low soluble fms-like tyrosine kinase-1 with high placental growth fac…" not the answer?

This pattern is the reverse of the disease.

What concept does this question test?

It tests Hypertensive disorders: pathogenesis in OBG. A high sFlt-1 to PlGF ratio supports the diagnosis and predicts adverse outcome. The opposite pattern is not seen.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: pathogenesis?

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.