If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check out all posts in this series.
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This month’s stumper
A 19-year-old woman comes to the clinic because of abdominal pain and nausea. Her last menstrual period began seven days ago. She admits to having unprotected sexual intercourse. Her temperature is 38.6 °C (101.5 °F). Physical examination shows lower abdominal tenderness. Pelvic examination shows a mucopurulent discharge, adnexal tenderness, and tenderness with cervical motion. A pregnancy test is negative and leukocyte count is 14,000 cells/mm3.
Which of the following is most likely a complication of this disorder?
B. Cervical carcinoma.
E. Pseudomyxoma peritonei.
The correct answer is D.
Kaplan Medical explains why
This patient has pelvic inflammatory disease (PID), which can involve the uterus, oviducts, ovaries and neighboring pelvic organs.
PID is classically caused by ascending infection with sexually transmitted agents such as Neisseria gonorrhoeae or Chlamydia trachomatis.
Symptoms include a mucopurulent cervicitis (often producing a vaginal discharge), abdominal pain, or abnormal vaginal bleeding. Fever, an elevated white count, and an elevated erythrocyte sedimentation rate may also be seen.