NBME Step 2 CK Form 7 Exploratory laparotomy (NBME Answers)

Retired NBME Answer Explanations

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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 3/Question#38 (reveal difficulty score)
A 72-year-old woman comes to the physician ...
Exploratory laparotomy 🔍 / 📺 / 🌳 / 📖
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submitted by ∗step_prep5(246)

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Older woman with history of breast cancer found to have increasing abdominal girth, ascites and a fixed non-tender adnexal mass most concerning for ovarian cancer
Key idea: Advanced ovarian cancer often spreads to the abdominal cavity, so exploratory laparotomy with cancer resection and inspection is needed for surgical staging
Key idea: Image-guided biopsy is contraindicated, as it can predispose to abdominal cavity seeding
Key idea: Ascites in a postmenopausal woman is always pathologic and is the origin of the typical symptoms of early satiety, weight gain, etc. seen in advanced ovarian cancer

https://step-prep.org/tutoring/

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submitted by ∗seagull(1933)

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I literally stared at the word "cul-de-sac" for like 30 seconds and thought to myself - WTF is that? Then promptly missed the question.

P.S. it's the pouch of Douglas (rectouterine pouch).

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jlbae I lived on a cul-de-sac as a kid, so basically I grew up in a rectouterine pouch. F. +4

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submitted by ∗charcot_bouchard(574)

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Ascites & adnexal mass >> Follow adnexal mass workup Even if you follow ascites protocol - ans is diagnostic paracentesis, not therapeutic.

So here you do USG + CA 125 There can be 4 combination -

High Risk USG + Elevated CA125. Worst scene >>Imaging with CT/MRI Exploratory LAP

High Risk USG + Normal CA125. intermediate scene. Also do same as prev. We trust USG more.

Low Risk USG + Elevated CA125. Intermediate scene. But here do only imaging. CA 125 is less trustable.

Low Risk USG feature + Normal CA 125. Best scene. U do further imaging and CA 125 serially to monitor.

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azibird Agree with this workup. But since US and CA-125 aren't offered, how is ex-lap the most appropriate next step? Seems incredibly wrong to do surgery without the ultrasound, wouldn't the surgeon slap you? I thought you would need something diagnostic so chose paracentesis. Perhaps it should be called diagnostic instead of therapeutic but isn't that still better than rushing into the OR? +1

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submitted by ∗nc1992(25)

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Unless there is a contraindication because of the ascites, it would be an exploratory laparoscopy not a laparotomy. I took flak on GYN-Onc for saying the wrong one

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submitted by ∗niboonsh(409)

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so you just open a b__ up without any other workup whatsoever? stupid question

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ak8 watch your mouth! i see why nbme is testing harder on ETHICS now +1

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