Next time your attending asks you your top differential for a 2nd trimester pregnant female coming in with severe acute bleeding, say "cervical cancer" and when they question you, flash this question at them as the source. Ah, NBME really prepares us for the real world.
Pregnant woman with no prenatal care presents with painless vaginal bleeding and a friable ulcer on the cervix, concerning for cervical cancer
Key idea: For the NBME exam, if a patient has no prenatal care, then they want you to assume that the patient does not consistently engage in care and likely does not get regular pap smears
Note: Fundal placenta excludes placenta previa as a cause (important cause to consider in setting of painless 3rd trimester vaginal bleeding)
seagullWhen I hear ulcer on the cervix while pregnant. I dont go jumping and claiming cancer. I think more was needed to clarify this question (as I say about all questions I miss - fml). Maybe a hx of abnormal pap smear or non hpv vaccine hx, something else.+5
stinkysulfaeggsI also found it interesting how much she was bleeding. People go with cervical cancer undetected all the time, right? Why did this particular ulcer bleed through a pad every 2 hours all of a sudden? +2
lindasmith462especially because she just had an ultrasound (despite no prenatal but w/e) ~ 2 months ago. like at some point shes had a gynecologic exam how did a cervical cancer so bad that she has that much bleeding develop in 2 months. does she have secret HIV? is she henrietta lacks?+2
adongReally poorly written question but if you do elimination: not a polyp or acuminata base on the exam, not previa because of the ultrasound. The only thing left that ulcerates on the cervix is cervical cancer+1
"She has had no prenatal care."
"Ultrasonography at 16 weeks gestation..."
Anybody else find that interesting?
submitted by โkstudy(9)
Next time your attending asks you your top differential for a 2nd trimester pregnant female coming in with severe acute bleeding, say "cervical cancer" and when they question you, flash this question at them as the source. Ah, NBME really prepares us for the real world.