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NBME p2ck_form7 Answers

step2ck_form7/Block 3/Question#38 (3.2 difficulty score)
A 72-year-old woman comes to the physician ...
Exploratory laparotomy🔍

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submitted by seagull(1432),

I literally stared at the word "cul-de-sac" for like 30 seconds and thought to myself - WTF is that? Then promptly missed the question.

P.S. it's the pouch of Douglas (rectouterine pouch).

submitted by step_prep5(25),
  • Older woman with history of breast cancer found to have increasing abdominal girth, ascites and a fixed non-tender adnexal mass most concerning for ovarian cancer
  • Key idea: Advanced ovarian cancer often spreads to the abdominal cavity, so exploratory laparotomy with cancer resection and inspection is needed for surgical staging
  • Key idea: Image-guided biopsy is contraindicated, as it can predispose to abdominal cavity seeding
  • Key idea: Ascites in a postmenopausal woman is always pathologic and is the origin of the typical symptoms of early satiety, weight gain, etc. seen in advanced ovarian cancer

submitted by nc1992(26),

Unless there is a contraindication because of the ascites, it would be an exploratory laparoscopy not a laparotomy. I took flak on GYN-Onc for saying the wrong one