{"id":9061,"date":"2026-01-28T00:02:04","date_gmt":"2026-01-28T08:02:04","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9061"},"modified":"2026-06-30T14:22:54","modified_gmt":"2026-06-30T22:22:54","slug":"usmle-step-2-ck-question-of-the-day-l-and-d-triage","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0L&#038;D triage"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>A 25-year-old woman at 30 weeks\u2019 gestation presents with uterine cramping and regular contractions with minimal cervical dilation. Which diagnostic finding best distinguishes preterm labor from threatened preterm labor?<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 25-year-old primigravid woman at&nbsp;30 weeks&nbsp;estimated gestational age (EGA) presents to Labor &amp; Delivery Triage with cramping and low back pain after a long walk on a scorching summer day. She has had no vaginal bleeding, loss of fluid, or decreased fetal movement. She has received regular prenatal care, and her pregnancy has been uncomplicated. Past medical history is notable for mild intermittent asthma, requiring her rescue inhaler about once per month. Temperature is 36.5\u00b0C (97.8\u00b0F), pulse is 88\/min, respirations are 18\/min, and blood pressure is 112\/76 mmHg. A sterile speculum exam (SSE) is performed, showing white-clear vaginal discharge without an odor; samples are collected. A sterile vaginal exam (SVE) shows the cervix is &lt;&nbsp;1 cm&nbsp;dilated and 30% effaced. Initial cardiotocographic monitoring shows a baseline fetal heart rate of 130, moderate variability, no decelerations, and contractions every 3 to 5 minutes. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following is the best next step in the evaluation?&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Abdominal ultrasound<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Send a fetal fibronectin (fFN) sample<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Wet mount of vaginal secretions<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Assess the cervical length<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Urinalysis<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Assess the cervical length<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Abdominal ultrasound<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The best next step is to sonographically measure the <strong>cervical length<\/strong>. However, this measurement should be obtained using an endovaginal, rather than abdominal, ultrasound.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Send a fetal fibronectin (fFN) sample<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The <strong>fFN <\/strong>should only be sent if the diagnosis of preterm labor is uncertain based on the <strong>SVE <\/strong>(cervix &lt; 3 cm dilated) and the cervical length (between 20 and 30 mm). Therefore, for this patient, a <strong>transvaginal ultrasound<\/strong> should first be performed to assess cervical length.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Wet mount of vaginal secretions<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Gardnerella_vaginalis_(Bacterial_vaginosis)\">Bacterial vaginosis (BV)<\/a><\/strong> has been associated with an increased risk of preterm birth in some studies. Testing for BV is indicated in the presence of <strong>abnormal discharge<\/strong>, which this patient lacks. Although screening for BV in patients with uterine irritability is reasonable, it is a lower priority than assessing the cervical length.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Urinalysis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Urinary tract infections<\/strong> are associated with <strong>preterm labor<\/strong>, and a <strong>urinalysis <\/strong>should be obtained in all patients undergoing a preterm labor evaluation. However, measuring the cervical length is a higher priority, as it is a key criterion used to diagnose preterm labor.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"921\" height=\"538\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/image-1.png\" alt=\"Table titled \u201cInterpreting Results in a Preterm Labor Evaluation.\u201d Columns include cervical dilation, cervical length, fetal fibronectin, and diagnosis with disposition. For patients with cervical dilation less than 3 cm: a cervical length greater than 30 mm indicates threatened preterm labor and discharge home; a length of 20\u201330 mm with negative fetal fibronectin also indicates threatened preterm labor and discharge; a length of 20\u201330 mm with positive fetal fibronectin indicates preterm labor and admission; and a cervical length less than 20 mm indicates preterm labor and admission. For patients with cervical dilation of 3 cm or greater, cervical length and fetal fibronectin testing are not indicated, and the diagnosis is preterm labor requiring admission. A note clarifies that PTL means preterm labor and D\/C means discharge.\" class=\"wp-image-9078\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/image-1.png 921w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/image-1.png?resize=300,175 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/image-1.png?resize=768,449 768w\" sizes=\"auto, (max-width: 921px) 100vw, 921px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient, who&nbsp;presents with&nbsp;<strong>cramping, low back pain, <\/strong>and <strong>contractions<\/strong> on&nbsp;<strong>tocographic&nbsp;monitoring<\/strong>, has symptoms suggestive of&nbsp;<strong>possible<\/strong>&nbsp;<strong>preterm labor.<\/strong>&nbsp;Preterm labor is defined as regular uterine contractions that cause cervical change between 20 and 36 6\/7&nbsp;weeks&nbsp;EGA. The two most important components of the evaluation are a&nbsp;<strong>sterile vaginal exam (SVE)<\/strong>&nbsp;to assess&nbsp;<strong>cervical dilation<\/strong>&nbsp;and effacement and, if dilation is &lt; 3 cm, an&nbsp;<strong>endovaginal&nbsp;sonographic measurement of the cervical length (CL)<\/strong>, which is the most appropriate next step in the vignette where the cervix is &lt; 1 cm dilated.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Preterm labor is&nbsp;<strong>diagnosed&nbsp;<\/strong>if the cervix is&nbsp;<strong>dilated to \u2265 3 cm and\/or the CL is &lt; 20 mm<\/strong>&nbsp;on&nbsp;endovaginal&nbsp;ultrasound. Conversely, preterm labor is&nbsp;<strong>ruled<\/strong>&nbsp;<strong>out&nbsp;<\/strong>if the cervix is dilated to &lt; 3 cm&nbsp;<strong>and<\/strong>&nbsp;the CL is &gt; 30 mm. If the cervix is &lt; 3 cm, but the CL is between 20 and 30 mm, this is an indeterminate result, and an&nbsp;fFN&nbsp;sample should be sent for evaluation.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Additionally, pelvic infections can lead to uterine irritability. Therefore, it is also prudent to obtain a urinalysis and culture in patients with risk factors for sexually transmitted infections, including chlamydia and gonorrhea. A rectovaginal swab should be obtained to screen for group B&nbsp;<em>Streptococcus<\/em>&nbsp;(GBS), the results of which will affect intrapartum management.&nbsp;&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The two most important components of a preterm labor evaluation include a sterile vaginal exam to assess cervical dilation and effacement; and, if cervical dilation is &lt;&nbsp;3 cm, an&nbsp;endovaginal&nbsp;sonographic measurement of the cervical length.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video: <a href=\"https:\/\/www.osmosis.org\/learn\/Preterm_labor:_Clinical_sciences\">Preterm labor: Clinical sciences<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>American College of Obstetricians and Gynecologists\u2019 Committee on Practice Bulletins\u2014Obstetrics (2016). Practice Bulletin No. 171: Management of Preterm Labor.&nbsp;<em>Obstetrics and Gynecology<\/em>,&nbsp;<em>128<\/em>(4), e155\u2013e164.&nbsp;<a href=\"https:\/\/doi.org\/10.1097\/AOG.0000000000001711\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1097\/AOG.0000000000001711<\/a><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"http:\/\/osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 2 CK practice questions<\/strong>? Try <strong>Osmosis from Elsevier<\/strong> today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>&nbsp;and discover why millions of current and future <strong>clinicians and caregivers<\/strong> love learning by Osmosis.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A pregnant patient with contractions and minimal cervical dilation requires careful evaluation. Measuring cervical length via endovaginal ultrasound is key to distinguishing preterm labor.<\/p>\n","protected":false},"author":204,"featured_media":9079,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1370,45],"tags":[2498,2495,2494,2496,1843,2499,270,2502,2501,2504,1633,2503,2500,2493,2497],"class_list":["post-9061","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-cervical-dilation","tag-cervical-length","tag-endovaginal-ultrasound","tag-fetal-fibronectin","tag-fetal-monitoring","tag-labor-triage","tag-maternal-health","tag-obstetric-ultrasound","tag-obstetrics","tag-pregnancy-care","tag-pregnancy-complications","tag-pregnancy-evaluation","tag-preterm-birth","tag-preterm-labor","tag-sterile-vaginal-exam"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day:\u00a0L&amp;D triage - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day:\u00a0L&amp;D triage - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A pregnant patient with contractions and minimal cervical dilation requires careful evaluation. Measuring cervical length via endovaginal ultrasound is key to distinguishing preterm labor.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2026-01-28T08:02:04+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-06-30T22:22:54+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/USMLE-step-2-question-of-the-day-L-and-D-triage.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-l-and-d-triage\"},\"author\":{\"name\":\"Rowan Bell, MD &amp; 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