NBME 24 Intrauterine device (NBME Answers)

Retired NBME 24 Answers

nbme24/Block 3/Question#47 (reveal difficulty score)
A 22-year-old woman comes to the physician ...
Intrauterine device 🔍 / 📺 / 🌳 / 📖
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+16 upvote downvote
submitted by ∗m-ice(370)

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The patient states that she does not want a hormonal form of birth control. So, the question is really asking which of the non-hormonal options is most effective. The tricky part here, I think, is that the question makes you want to not pick IUD, because many IUDs are hormonally based. However, a non-hormonal IUD, like a copper IUD, is still more effective than the other options listed.

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bullshitusmle copper intrauterine devices are hormon free FA2017 page 622 +2

medguru2295 they needed to specifiy. I eliminated IUD bc patient states no hormones. +1

abhishek021196 The question doesnt make sense. IUDs are typically contraindicated in nullipara because of increased risk of expulsion and intractable abdominal pain, among other things such as perforation. The pt is 22, likely to be a nullipara. Why cant we prescribe a diaphragm instead which is a non hormonal method too, and remove the vaguity of hormonal vs non hormonal IUD? :/ +4

123ojm in practice many nullparious women have IUDs. I think this question was seeing whether you knew that some forms of IUDs are non-hormonal and that the other methods are far less effective, +1

covid IUDs are definitely not contraindicated in nulliparous women. +5

neurotic999 Although all the above comments are valid, I think the point to be focused on was the patient asking for the 'most effective' alternative. Even I was leaning toward diaphragm considering she's a young patient, but I didn't feel like it fit the description of being most effective. Guess it's one of those questions where nbme expects you to pick up on subtle hints/read their minds and forego practicality altogether. +1

+2 upvote downvote
submitted by centeno(3)

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The patient asks about the most effective treatment. FA 2019 page 642: Copper IUD = long-acting reversible contraception, most effective emergency contraception. Although FA refers to emergency situations, maybe the word most effective is the clue.

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+0 upvote downvote
submitted by initforthememes(0)

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Sorry for making things more complicated but it is important to point out there are varying strengths of hormonal IUDs. Weaker progestins (ex. levonorgesterel) will allow for ovulation as they only act on surrounding tissue (uterus). It is not until you prescribe stronger progestins do you see systemic effects. Thus in real world, this could be an option. Not sure if this is what they were going after, Copper may be the more obvious answer here.

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