A third-trimester patient with blurred vision, vomiting, edema, and severe hypertension is most likely to have which condition?

• A. Pulmonary embolism
• B. Preeclampsia
• C. Right-sided heart failure
• D. Liver disease

Answer: (B)

The scenario tests recognizing preeclampsia with severe features in a late-pregnancy patient. After 20 weeks, new or worsening hypertension with signs of end-organ involvement points to preeclampsia, and when symptoms are severe—such as visual disturbances and persistent vomiting—the condition is considered to have severe features. Visions changes come from retinal arteriolar vasospasm and the nervous system being affected by the pregnancy-related vascular dysfunction. The combination of high blood pressure, neurologic/visual symptoms, and GI symptoms like vomiting reflects widespread endothelial dysfunction and vasospasm that can affect multiple organs.

This pattern is not typically explained by pulmonary embolism, right-sided heart failure, or liver disease in this context. Those conditions can cause edema or other symptoms, but they do not consistently present with new-onset severe hypertension accompanied by neuro-visual symptoms in the third trimester. The emphasis here is that the late-pregnancy hypertension with vision changes signals preeclampsia, and it carries risk for progression to more serious states, requiring urgent obstetric evaluation and secure transport to a hospital.