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NBME 24 Answers

nbme24/Block 2/Question#13

An 80-year-old woman, gravida 4, para 4, comes to ...

Damage to the rectovaginal septum

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submitted by drachenx(20),

These kinds of questions are really hard because I've never seen female reproductive structures irl. :c

nbmehelp  Lmao +1  

lsmarshall  Rectal prolapse through posterior vagina ("rectocele"). https://www.drugs.com/cg/images/en2362586.jpg +5  
famylife  "When a rectocele becomes large, stool can become trapped within it, making it difficult to have a bowel movement or creating a sensation of incomplete evacuation. Symptoms are usually due to stool trapping, difficulty passing stool, and protrusion of the back of the vagina through the vaginal opening. During bowel movements, women with large, symptomatic rectoceles may describe the need to put their fingers into their vagina and push back toward the rectum to allow the stool to pass (“splinting”). Rectoceles are more common in women who have delivered children vaginally." https://www.fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version +7  
usmleuser007  really like the pubic hair.... +  
nnp  why not spasm of external anal sphincter? +  
vulcania  After looking it up I think that external anal sphincter spasm would be more associated with rectal pain and maybe fecal incontinence. I chose the same answer because I figured if there was a problem with the rectovaginal septum it would have been noted on physical exam... +1  

 +1  upvote downvote
submitted by yex(38),

There are questions about splinting on Pastest and UW. UW q id 11885 shows another scenario. Good images on the explanation though. Nulliparous, nonobese 39 y/o pelvic pressure & constipation and does splinting to defecate, bla bla bla. Exam: irregularly enlarged uterus. Dx was posterior subserosal uterine leiomyoma and rectocele was on the options... Splinting is NOT just for rectocele.