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Retired NBME 15 Answers

nbme15/Block 1/Question#13 (reveal difficulty score)
A 24-year-old woman is admitted to the ...
Ectopic pregnancy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by justoil(0)
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In ectopic pregnancies, hCG is elevated from baseline, but less than in normal pregnancy and much less than hydatidiform mole.

This stem only says that hCG is elevated from baseline, so it could be ectopic, normal pregnancy or hydatidiform mole.

From those 3 options, it's not normal pregnancy bc of low hCG & presentation, and it's not hydatidiform mole because of low hCG, the presentation & the gross pathology (hydatidiform mole wouldn't have something that looks that much like a fetus). So it's most likely an ectopic pregnancy.

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hiroshimi  How do you know that the "increased hCG" is actually lower than what you expect, since the stem did not say anything else??? I was between ectopic pregnancy and hydatidiform mold since the partial mole can have partial fetus as well. But I guess it's just partial, not the full fetus like we see in the picture. Also, hydatidiform associate with irregular bleeding and/or hyperemesis than acute pain. +2
trazobone  Also to add to the partial vs ectopic, the presence of leukocytosis fits better with ectopic since sheโ€™s in pain which means the fallopian tube ruptured and now you need immune system to go work. But FA mentions nothing about leukocytosis associated with ectopic pregnancy so I am conjecturing. +2



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