A 28-year-old G2P2 woman returns today for follow up on her abnormal Pap test which
reveals atypical squamous cells of undetermined significance
... [Show More] (ASCUS). Reflex HPV
testing is positive for high risk type. She has never had a prior abnormal Pap test, and
has been following the recommended screening guidelines. She is asymptomatic. Her
pelvic exam reveals a normal cervix with a small amount of cervical mucous. What is
the next best step in the management of this patient?
A. Routine screening
B. Repeat Pap test in one year
C. Repeat HPV testing in one year
D. Repeat co-testing with Pap and HPV in one year
E. Colposcopy - Answer- E. Colposcopy is indicated for all abnormal Pap test results
including ASCUS Pap test when HPV is positive. Reflex HPV testing for high-risk DNA
types should be performed in patients with ASCUS. If negative, then co-testing with
cytology and HPV can be repeated in three years. Repeat cytology in one year is also
an acceptable option for ASCUS if HPV testing cannot be done.
http://www.asccp.org/Portals/9/docs/ASCCP%20Updated%20Guidelines%20Algorithms
%206.3.13.pdf
A 17-year-old G0 high school student is brought in by her mother for her first
gynecologic examination. She began her menses at age 12 and has had regular
periods for the past three years. Her last menstrual period was one week ago. For
privacy, you ask to examine the patient without her mother. Further history is obtained
in the examination room. She admits that she has been sexually active with her
boyfriend for the past three years. She uses condoms occasionally and is fearful about
possible pregnancy. She requests that her mother not be informed about her sexual
activity. On physical examination, she is anxious, but normally developed. Her pelvic
examination reveals no vulvar lesions, minimal non-malodorous discharge, and a
nulliparous appearing cervix. The bimanual examination reveals a normal size uterus,
and her adnexa are non-tender and not enlarged. Urine pregnancy test is negative. In
addition to discussing contraception. What is the next best step in the management of
this patient?
A. Obtain a serum Beta-hCG level
B. Obtain a Pap test
C. Obtain DNA probes for gonorrhea and chlamydia
D. Initiate treatment with doxycycline and ceftriaxone
E. Order a pelvic - Answer- C. Counseling about and screening for sexually transmitted
infections is the best next step. This patient does not require treatment due to a lack of
diagnostic criteria. A serum Beta-hCG is not indicated in the setting of normal menstrual
cycles with last menstrual period a week ago and a negative urine pregnancy test. [Show Less]