NBME form1, q2

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NBME form1, q2

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Perhaps
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08/14/06 - 01:24 PM

2 A 28-year-old nulligravid woman comes for a routine health maintenance examination. She has had progressively severe dysmenorrhea over the past 6 months adequately controlled by nonsteroidal anti-inflammatory agents. Pelvic examination shows a normal vagina and cervix. The uterus is retroverted and fixed, and there is nodularity of the cul-de-sac. A 6-cm left adnexal mass is palpated. Transvaginal ultrasonography shows a 7-cm septated adnexal mass. Four weeks later, there is no change in the size of the adnexal mass. Which of the following is the most appropriate diagnostic test?

A) Measurement of serum CA 125 level
B) Barium enema
C) CT scan of the pelvis
D) MRI of the pelvis
E) Laparoscopy

shumaila
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08/14/06 - 02:25 PM

Perhaps
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08/15/06 - 09:19 AM

not sure. picked E also

achilles
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08/15/06 - 09:45 AM

not sure myself ! i'd pick e too.

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djacosta
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08/16/06 - 04:58 AM

lap

frank100
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08/16/06 - 05:20 PM

e, then traNS-op biopsy and there desde what to do

study_ing
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08/16/06 - 05:28 PM

e. the patent needs a biopsy for sure.

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ram3
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06/18/07 - 01:21 PM

Guys you are wrong again according to first aid you measure the tumor marker

in suspecting an ovarian tumor a size of more than eight centimeters is mos likely malignant

this tumor marker is positive in ninety percent of ovarian tumors the answer is choice a big time

Justice
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06/19/07 - 12:09 AM

ram3 wrote:
Guys you are wrong again according to first aid you measure the tumor marker

in suspecting an ovarian tumor a size of more than eight centimeters is mos likely malignant

this tumor marker is positive in ninety percent of ovarian tumors the answer is choice a big time

To me it sounds like entometriosis...
(E)

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DeltaF508
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06/21/07 - 09:04 AM

#10

It is a septated mass; doesn't that usually mean something malignant? I would check Ca-125 levels, and then do a lap. I don't think it's endometriosis because that's more cystic in nature, and no septa.

fnx
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11/08/07 - 09:23 AM

#11

The most common cause for Complex Adnexal Mass in reproductive age is Dermoid Cyst (Benign Cystic Teratoma) followed by ENDOMETRIOMA, Tuboovarian Abscess and Cancer. This patients probably has endometrioma considering the history of dysmenorrhea. Either way the management of complex mass is surgery for biopsy, and the tumor markers are used for followup if there is cancer. I chose Laparoscopy

MAGY17
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11/08/07 - 01:03 PM

#12

laparoscopy, for me is endometriosis

darkhorse
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11/08/07 - 01:15 PM

#13

EEE

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Ivonne
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01/18/08 - 07:01 PM

#14

Yup picked E too

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drshvetasm
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01/26/08 - 11:03 AM

#15

E

Although when such questions come ppl r generally confused coz they think....oh this is soooo clearly endometriosis...they have fed me this diagnosis...so now do they want me to confirm this by laproscopy or do they want me to think beyond it into ruling out cancer...! nbme is mean wink

Al Durra
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02/28/08 - 06:30 AM

#16

Dear ram 3 , u should read the Q carefully before deciding who is righr and who is wrong . OK
the Q asks about the most appropriate diagnostic test not the initial test so striaght forward its E , besides the classical describtion of the case .

inkspot
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04/09/08 - 04:01 AM

#17

E, but i have few questions,

the mass does not regress in 4 weeks and the mass is " septated "

does it make it any thing like a neoplasm? i think endometeriosis changes in size with every cycle just like how normal uterus would behave. and also its not a cystic mass. it would be solid ( not septated)

even if we presume it to be neoplasm: the test of choice should be lap, to obtain a biopsy. if it was endometeriosis then ablation.

more discussion please

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ricardoricardo
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04/18/08 - 01:53 AM

#18

Markus2009
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04/18/08 - 07:19 AM

#19

EEEEEEEEEEEEEEEEEEEEEEE

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