04-06-2009, 04:40 PM
A 67-year-old woman comes to the physician
because of vaginal
bleeding for 10 days. She has been soaking one
sanitary pad daily.
Menopause was 10 years ago. Her last Pap smear 5
years ago showed normal
findings. Her temperature is 37 C (98.6 F), blood
pressure is 128/78 mm
Hg, pulse is 70/min, and respirations are 12/min.
Pelvic examination
shows a normal-appearing cervix and a small amount of
blood at the
cervical os. There is moderate thinning of the
vaginal mucosa. The uterus
is irregular and consistent in size with a 10-week
gestation. There
are no adnexal masses. Rectovaginal examination shows
no abnormalities.
Test of the stool for occult blood is negative. Which
of the following
is the most appropriate next step in diagnosis?
A
) Transvaginal ultrasonography of the pelvis
B
) Colposcopic-guided biopsy
C
) Endometrial biopsy
D
) Endometrial ablation
E
) Culdocentesis
because of vaginal
bleeding for 10 days. She has been soaking one
sanitary pad daily.
Menopause was 10 years ago. Her last Pap smear 5
years ago showed normal
findings. Her temperature is 37 C (98.6 F), blood
pressure is 128/78 mm
Hg, pulse is 70/min, and respirations are 12/min.
Pelvic examination
shows a normal-appearing cervix and a small amount of
blood at the
cervical os. There is moderate thinning of the
vaginal mucosa. The uterus
is irregular and consistent in size with a 10-week
gestation. There
are no adnexal masses. Rectovaginal examination shows
no abnormalities.
Test of the stool for occult blood is negative. Which
of the following
is the most appropriate next step in diagnosis?
A
) Transvaginal ultrasonography of the pelvis
B
) Colposcopic-guided biopsy
C
) Endometrial biopsy
D
) Endometrial ablation
E
) Culdocentesis