Gynec Q - nilkanth

[ArchivalUser]

A 22-year-old woman comes to the
physician for an annual examination.
She has been sexually active since
the age of 15 and has not had regular
Pap smears or examinations. She is
currently sexually active with
multiple partners and intermittently
uses condoms. She has no medical
problems and takes no medications.
Her examination is unremarkable. Her
Pap smear is described as
satisfactory but limited by the
absence of endocervical cells. It is
otherwise within normal limits. Which
of the following is the most
appropriate next step in management?


A. Repeat the Pap smear in 1 year

B. Repeat the endocervical
portion of the Pap test as soon as
possible

C. Perform colposcopy with
colposcopically directed biopsies

D. Perform laparoscopy with
laparoscopically directed biopsies

E. Perform exploratory laparotomy

[ArchivalUser]

AA

[ArchivalUser]

b or c....hmmmm

will go for ccccc

[ArchivalUser]

Explanation:

The correct answer is B. A
Papanicolaou smear should ideally be
a sampling of the transformation
zone. An adequate sample should show
endocervical cells. When endocervical
cells are not present, there is some
question as to whether the
transformation zone was fully
sampled. If a woman has no risk
factors for cervical dysplasia, has
had three normal annual Pap smears in
a row, and has a current Pap that
shows no abnormality other than the
absence of endocervical cells, then
the Pap smear can be repeated in 1
year. This patient, however, has
significant risk factors for cervical
dysplasia, including early initiation
of sexual activity, multiple
partners, and unprotected
intercourse. Therefore, this patient
needs the endocervical portion of the
Pap test to be repeated as soon as
possible.

To repeat the Pap smear in 1 year
(choice A) would be incorrect
management. As noted above, repeating
the Pap smear in 1 year is correct
only in patients who have no risk
factors for cervical dysplasia, three
normal annual Pap smears, and a
present Pap that is normal except for
the lack of endocervical cells.

To perform a colposcopy with
colposcopically directed biopsies
(choice C) would not be correct. This
patient has a normal Pap smear
overall. The lack of endocervical
cells makes the smear incomplete but
not abnormal.

To perform laparoscopy with
laparoscopically directed biopsies
(choice D) would not be correct.
Laparoscopy does not allow evaluation
of the cervix and is not indicated
for abnormal or incomplete Pap
smears.

To perform an exploratory laparotomy
(choice E) is not indicated. Again,
this patient has a normal but
incomplete Pap smear, and major
surgery would not be correct
management.