UWISE Complete QBank latest completely Answered
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A 28-year-old G2P2 woman returns today for follow up on her abnormal Pap test which
... [Show More] reveals atypical
squamous cells of undetermined significance (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
{{Correct Ans- 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.
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 testC. Obtain DNA probes for gonorrhea and chlamydia
D. Initiate treatment with doxycycline and ceftriaxone
E. Order a pelvic
{{Correct Ans- 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. Guidelines for initiation of cervical cancer screening is recommended at
age 21 regardless of coitarche. A pelvic ultrasound would not be indicated at this time especially since
the pregnancy test is negative and given her lack of menstrual or pelvic symptoms. [Show Less]