Author Question: Your 24-year-old female patient comes to the clinic for a routine pelvic exam and Pap smear. It is ... (Read 148 times)

09madisonrousseau09 · **on:** Jun 25, 2018

Your 24-year-old female patient comes to the clinic for a routine pelvic exam and Pap smear. It is recommended that a female of this age obtain a Pap smear:

A. Every year
B. Every 3 years
C. Every 5 years
D. None of the above

Question 2

Your 45-year-old female patient complains of irregular menstrual cycles, severe pain with menses and heavy bleeding every month for the last year. On examination, you palpate an enlarged uterus. Pregnancy test is negative.

A recommended diagnostic test for this patient is:
A. Abdominal CT scan
B. Kidney, ureter, bladder x-ray
C. Pelvic ultrasound
D. Abdominal MRI

ong527 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: B
In March 2012, updated screening guidelines were released by the U.S. Preventive Services Task Force, American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology. These guidelines recommend a Pap smear by age 21 and a Pap smear every 3 years for women ages 21 to 29. Women ages 30 to 65 should be screened every 5 years with Pap and HPV co-testing or every 3 years with Pap smear alone. Recommendations for women with a history of abnormal Pap smears should be adjusted as needed for follow-up (National Cancer Institute, 2012).

Answer to Question 2

ANS: C
Uterine leiomyomas, more commonly known as uterine fibroids, are benign growths consisting mostly of smooth muscle. The etiology is unknown, but their growth is hormone dependent; therefore, they are seen in approximately 25 of women during their reproductive years. Heavy menstrual bleeding (menorrhagia) and irregular bleeding (metrorrhagia) are the most common presenting symptoms, although a large percentage of patients are asymptomatic. Other symptoms include heaviness or fullness in the lower abdomen, pelvic pain, backache, dysmenorrhea, and urinary complaints. Most leiomyomas can be palpated on bimanual examination, and some larger fibroids can be palpated through the abdomen. The uterus may feel enlarged, irregular, or nodular. A pregnancy test should be performed to rule that out as a cause of the symptoms. A CBC is needed in cases of heavy bleeding to determine whether anemia or platelet disorder is present. Pelvic ultrasound or MRI should be performed if symptoms of leiomyoma are present or for any palpable pelvic mass detected on physical examination.