Hypertensive disorders: TTP versus HELLP: 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: TTP versus HELLP

Sample item

A woman at 24 weeks has fever, confusion, severe thrombocytopenia, haemolysis with schistocytes and rising creatinine. BP is normal, the coagulation screen is normal and transaminases are near normal. Which test best confirms the diagnosis?

APlasma fibrinogen and ammoniaBADAMTS13 activityCDirect Coombs testDSerum sFlt-1 to PlGF ratio

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

The answer and the reasoning

B. ADAMTS13 activity

Thrombotic thrombocytopenic purpura presents with the pentad of fever, neurological signs, renal involvement, haemolysis and thrombocytopenia, often with a normal blood pressure and coagulation. Severely reduced ADAMTS13 activity confirms it. Plasma exchange is the treatment, and delivery does not cure it.

Option by option

A. Plasma fibrinogen and ammonia
Low fibrinogen and raised ammonia suggest acute fatty liver of pregnancy.
B. ADAMTS13 activity (correct)
Correct. Severely reduced ADAMTS13 activity confirms TTP.
C. Direct Coombs test
A direct Coombs test would be positive in immune haemolysis and negative here.
D. Serum sFlt-1 to PlGF ratio
The sFlt-1 to PlGF ratio supports pre-eclampsia, which does not fit a normotensive woman at 24 weeks.

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 B, ADAMTS13 activity. Thrombotic thrombocytopenic purpura presents with the pentad of fever, neurological signs, renal involvement, haemolysis and thrombocytopenia, often with a normal blood pressure and coagulation.

Why is "Plasma fibrinogen and ammonia" not the answer?

Low fibrinogen and raised ammonia suggest acute fatty liver of pregnancy.

Why is "Direct Coombs test" not the answer?

A direct Coombs test would be positive in immune haemolysis and negative here.

Why is "Serum sFlt-1 to PlGF ratio" not the answer?

The sFlt-1 to PlGF ratio supports pre-eclampsia, which does not fit a normotensive woman at 24 weeks.

What concept does this question test?

It tests Hypertensive disorders: TTP versus HELLP in OBG. Severely reduced ADAMTS13 activity confirms it. Plasma exchange is the treatment, and delivery does not cure it.

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: TTP versus HELLP?

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.