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NBME 24 Answers

nbme24/Block 2/Question#13 (reveal difficulty score)
An 80-year-old woman, gravida 4, para 4, ...
Damage to the rectovaginal septum ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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 +56  upvote downvote
submitted by โˆ—drachenx(72)
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These kinds of questions are really hard because I've never seen female reproductive structures irl. :c

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nbmehelp  Lmao +3
regularstudent  Lmao +1
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rockodude  lmao +
abkapoor  Lmao +
dang90  LMao +
noopnoop  Lmfao +
stunna216  LMAO +
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peteralamir  Lmaoo +
empem28  lmao +

 +3  upvote downvote
submitted by โˆ—beeip(141)
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You can see the aforementioned structure in this diagram.

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lsmarshall  Rectal prolapse through posterior vagina ("rectocele"). +8
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 (โ€œsplintingโ€). Rectoceles are more common in women who have delivered children vaginally." +19
usmleuser007  really like the pubic hair.... +5
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
ajss  I did the same, put sphincter spasm because I thought a rectocele would be found on a physical exam. +
thisshouldbefree  this is the map ive been looking for +1
mnunez187  I didn't choose spasm because the stem says there the rectal tone is normal +1

 +2  upvote downvote
submitted by โˆ—yex(128)
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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.

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 +0  upvote downvote
submitted by โˆ—an1(114)
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"splinting" (pushing the vaginal canal with fingers to defecate) is commonly seen with a rectocele.

+Pelvic organ prolapse includes pelvic pressure ("feeling a bulge or that something is falling out of the vagina")

+Posterior vaginal wall prolapse (rectocele) can cause constipation

+splinting is common but not uterine enlargement

+Premenopausal, nonobese nulliparous women are at lowest risk for pelvic organ prolapse.

Stool seems to go towards the vaginal wall, but doesn't come out. pushing the POSTERIOR vaginal wall towards the bum will help with defecation

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drdoom  quick tip! if you want to make a bulleted list, put a space after the โ€™+โ€™ sign ๐Ÿ‘ +1
an1  I tried haha, this is what came out lol +
drdoom  there is no space after your plus sign above; if you put a space after, it will work! (``+ Pelvic`` instead of ``+Pelvic``) hope that makes sense! +1

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