need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)
NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 2/Question#7 (reveal difficulty score)
A 36-year-old woman, gravida 1, para 1, has ...
Uterine atony ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: repro inc

 Login (or register) to see more

 +11  upvote downvote
submitted by โˆ—athleticmedic(18)

"Placenta appears complete but torn" - if it's torn and only appears complete, rather than being confirmed as complete, how can you rule out retained placental tissue? You wouldn't just assume it was complete at a complex delivery, it would require confirmation.

 Login (or register) to see more
drmohandes  I feel you man, was guessing between the two answers as well. I think torn but complete means the whole placenta is there, but in pieces? Anyway classic scumbag NBME question writing. +4
sahusema  For NBME questions, I've found that whatever is told in the findings section of a stem should be taken as 100% true even if it's an incomplete description, super confusing, or misleading. So placenta complete? โ†’ uterine atony +2

 +8  upvote downvote
submitted by โˆ—yotsubato(1208)

You know they could throw us a bone or something... Tell us the uterus is boggy at least, or hard, or ANYTHING AT ALL REALLY....

 Login (or register) to see more
saffronshawty  They mentioned that the uterus is 3 cm above the umbilicus which is an indication that it's enlarged and hasn't returned to the normal post-partum size it should be, which is at the level of the umbilicus +/- 2 cm. +4
derpymd  So that +1cm is the distinction here? They misdirect to suggest there may be retained placental tissue, but tell us nothing truly valuable about the state of the uterus. I think this is a poor question. +1
cinnapie  @derpymd i get what you are saying but they said that the placenta is torn but complete. I guess we need to take their word for it if they say the placenta is complete and there is absolutely NOTHING left behind to cause the symptoms +1
machetebetty  Also, big baby -> floppy uterus . +1

 +2  upvote downvote
submitted by โˆ—osler_weber_rendu(160)

Placenta appears "complete but torn???" Classic NBME shithousery!

 Login (or register) to see more

 +1  upvote downvote
submitted by โˆ—step_prep5(246)
  • Woman with complicated/prolonged delivery with excessive postpartum bleeding who does not have retained placenta, genital tract trauma or history of coagulopathy, and therefore most likely has uterine atony (most common cause of postpartum bleeding and commonly seen after prolonged/difficult delivery)
  • Causes of post-delivery bleeding is 4 Tโ€™s: (1)ย aTony (most common)ย (2) Traumaย (3) Thrombin (coagulopathy)ย (4) Tissue (retained placenta, etc.)

 Login (or register) to see more
krewfoo99  Yes but how do you know that the placenta is not retained? +

 +0  upvote downvote
submitted by โˆ—usmile1(154)

This presentation really could be either retained placental tissue or uterine atony. i think the key with these nbme questions is to go with the most likely diagnosis, and the most common cause of post partum hemorrhage is uterine atony

"At times the bulk of the placenta will deliver spontaneously or manually, but small portions or an accessory lobe may be retained. This may be suspected when the placenta appears fragmented after delivery or when there is ongoing heavy uterine bleeding. In this situation, the uterine cavity may be evaluated with manual exploration or with ultrasound. The utility of ultrasound in this situation has yet to be established, with a focal endometrial mass, particularly with Doppler flow, being the findings of interest. In one study of routine ultrasound immediately after vaginal delivery, the sensitivity for diagnosing retained placental fragments was only 44% with a positive predictive value (PPV) of 58%"

 Login (or register) to see more

Must-See Comments from step2ck_form7

seagull on Analgesic therapy
athleticmedic on Uterine atony
seagull on Haemophilus influenzae
jlbae on Lorazepam therapy
seagull on Spondylolisthesis
carolebaskin on B lymphocyte
yotsubato on Indomethacin
yotsubato on Uterine atony
study_dude_guy on Bone marrow aspiration
chris07 on Heat stroke
osler_weber_rendu on Compression fracture
buttercup on Repeat blood pressure measurement in 4 weeks
step_prep5 on CT scan of the head
thajoker on Brisk rotatory nystagmus on left lateral gaze

search for anything NEW!