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NBME 24 Answers

nbme24/Block 3/Question#47 (24.0 difficulty score)
A 22-year-old woman comes to the physician ...
Intrauterine deviceπŸ”

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submitted by m-ice(340),
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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? :/ +3  
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, +  
covid  IUDs are definitely not contraindicated in nulliparous women. +5  

submitted by centeno(2),

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.

submitted by initforthememes(0),

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.