Posts: 3,675,933
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
Q) A healthy 23-year-old Caucasian woman comes to the physician for a routine health maintenance examination. She has no complaints. She has no medical problems. She does not use tobacco, alcohol, or drugs. Her family history is not significant. She takes no medication. Her vital signs are within normal limits. Examination shows no abnormalities. Her Pap smear, performed 3 days ago, reveals "atypical squamous cells of unknown significance" (ASCUS). Which of the following is the most appropriate next step in the management of this patient?
A. Refer for colposcopy
B. Obtain HPV testing on the sample.
C. Treat with doxycycline and repeat Pap smear in 6 weeks.
D. Schedule repeat Pap smear in 3 months.
E. Reassurance and repeat Pap smear in 1 year.
Plz explain ur answers.
Posts: 3,675,933
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
B. the management of ASCUS is getting a HPV-DNA testing. if it turns out to be HPV6,11.... continue with regular pap smear screening. if it turns out to be HPV 16/18/31/33/35... then have to do a colposcopy with enocx curretage and ectocx biopsy.
Posts: 3,675,933
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
A. Colposcopy. Cervical dysplasia in a high risk patient should be investigaed with colposcopy.
Here is notes from UW in thi sregards:
Cervical cancer - 3 questions
1- Risk factors: Young age at first coitus (<20). Young age at mariage and first pregnany. High parity, multiple sex partners, smoking, and low socioeconomic status. ****
2- If pap is dysplasia, perform colposcopy. If it shows inflamatory Atypia then repeat after 4-6 weeks. ****
3- If pt comes in with spotting, and you see the cervix having a gross lesion that bleeds by touching, dont even bother for PAP, go straight to Punch biopsy to rule out cancer.
Posts: 3,675,933
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
I agree with B. Do HPV DNA testing to determine the serotype of HPV.
Posts: 3,675,933
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
Actually I think HPV testing in this case might be the right answer.
Posts: 3,675,933
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
D..schedule repeat papsmear in 3 months. Here is the alibi.. blueprint page 178 topic cervical cancer. ...'the cellular changes in ASCUS may represent benign inflammatory response to infection or trauma but may herald a preinvasive neoplastic syndrome. In patients who are reliable follow up repeat pap smear in 4-6 months. If follow up is a concern,the Pt may proceed immediatly to colposcopy where direct biopsies will be performed.'
