OBGYN Flashcards: Abnormal Pap Smear

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Questions and Answers

What is the next best step in the management of a 28-year-old woman with abnormal pap smear and positive HPV testing?

Repeat co-testing with Pap and HPV in one year

Routine screening

Repeat Pap smear in one year

Repeat HPV testing in one year

Colposcopy (correct)

What is the next best step in the management of a 17-year-old sexually active patient requesting confidentiality?

Initiate treatment with doxycycline and ceftriaxone

Obtain a Pap smear

Obtain DNA probes for gonorrhea and chlamydia (correct)

Order a pelvic ultrasound

Obtain a serum Beta-hCG level

Which of the following tests is not necessary for a 68-year-old woman who has had a hysterectomy?

Mammogram

Colonoscopy

Pap smear (correct)

Bone density

Annual bimanual and recto-vaginal exam

What is the most appropriate screening recommendation for cervical cancer in a 32-year-old woman with a normal Pap smear?

Pap smear and HPV testing in five years Signup and view all the answers

What is the most appropriate next step in the management of a 25-year-old woman with ASCUS on Pap smear?

HPV typing Signup and view all the answers

What is the most likely diagnosis for a 19-year-old woman with abdominal cramping, fever, and cervical motion tenderness?

Acute salpingitis Signup and view all the answers

What is the most appropriate next step in the management of a 39-year-old woman with elevated plaques on the vulva and a brown macular rash on palms?

Obtain a treponemal-specific test Signup and view all the answers

What further testing should be offered to a 24-year-old woman with multiple painful ulcers on the vulva?

All of the above Signup and view all the answers

What is the most likely finding in a pelvic examination of a patient with trichomoniasis?

Motile ovoid protozoa with flagella Signup and view all the answers

What is the first trimester screen detection rate?

85% Signup and view all the answers

Which medication should be discontinued because of potential teratogenicity?

Warfarin Signup and view all the answers

How do you explain the negative culture in a patient suspected of having recurrent genital herpes?

Herpes cultures have a 10-20% false negative rate Signup and view all the answers

What is the most likely diagnosis for a 23-year-old woman at 38 weeks gestation with lower abdominal pain?

Braxton-Hicks contractions Signup and view all the answers

Which of the following is true regarding informed consent in an emergency situation?

Informed consent is unnecessary in an emergency situation if a delay in treatment would risk the patient's health/life Signup and view all the answers

What is the next best step in management for a 22-year-old pregnant woman with decreased fetal movements?

Discharge home with labor warnings Signup and view all the answers

What is the initial step in assessing a 38-year-old woman in early labor?

Physical examination Signup and view all the answers

What is the most appropriate next step for a patient with contractions and a visible fetal scalp?

Apply a fetal scalp electrode Signup and view all the answers

What is the most appropriate next step for a patient with umbilical cord prolapse?

Use ultrasound to assess the fetal heart rate Signup and view all the answers

What is the most appropriate step in managing a woman in active labor with umbilical cord visible?

Elevate the fetal head and call for a Cesarean delivery Signup and view all the answers

What is the most likely cause for variable decelerations in labor?

Umbilical cord compression Signup and view all the answers

What is the most appropriate management option for a woman wishing to avoid anal incontinence during delivery?

Vaginal delivery with no episiotomy Signup and view all the answers

What findings were noted on the infant born to a 19-year-old woman in labor?

Flattened nasal bridge and small, slightly rotated ears. Signup and view all the answers

Which of the following is the safest method of lactation suppression in a patient who does not wish to breastfeed?

Breast binding, ice packs and analgesics Signup and view all the answers

Breastfeeding decreases the risk of which of the following for a patient with a family history of certain cancers?

Ovarian cancer Signup and view all the answers

What is the most likely cause of cracked nipples in a breastfeeding mother experiencing pain from a tubal ligation?

Poor positioning of infant Signup and view all the answers

Which hormone is responsible for the synthesis of milk in breastfeeding?

Prolactin Signup and view all the answers

What is the most appropriate treatment for mastitis in a breastfeeding mother?

Antibiotics Signup and view all the answers

Which hospital policy promotes breastfeeding?

Unlimited access of mother to baby Signup and view all the answers

What is the hormone that needs to be cleared for breast milk to come in after delivery?

Estrogen and progesterone Signup and view all the answers

What organism is most likely responsible for intense nipple pain in a breastfeeding mother?

Candida Signup and view all the answers

Based on their African-American descent, which blood test would you recommend?

Hemoglobin electrophoresis and CBC Signup and view all the answers

Carrier screening should be performed for all of the following conditions except:

Beta thalassemia anemia Signup and view all the answers

Which genetic disease is most likely to affect the future children of a Jewish Ashkenazi woman and her Irish husband?

Cystic fibrosis Signup and view all the answers

Based on her medication exposure, her infant is at greatest risk of which anatomical defect?

Neural tube defects Signup and view all the answers

What structural anomaly is the fetus at highest risk of developing due to poorly controlled diabetes?

Cardiac anomalies Signup and view all the answers

In addition to obtaining a karyotype, which of the following can be detected with chorionic villus sampling (CVS)?

Cystic fibrosis Signup and view all the answers

Which screening test will provide the highest detection rate for trisomy 21?

Sequential screen Signup and view all the answers

What is the risk of miscarriage associated with CVS?

1% Signup and view all the answers

The most common cause of inherited mental retardation in this patient's child would be?

Fragile X syndrome Signup and view all the answers

What is the most appropriate next step in establishing this pregnancy's gestational age?

Obstetrical ultrasound Signup and view all the answers

Which test is most effective in screening for Down syndrome in the second trimester?

Quadruple screen Signup and view all the answers

What is the most appropriate next step in the management of this patient post-glucose tolerance test?

Begin a diabetic diet and blood glucose monitoring Signup and view all the answers

She is at risk for all the following complications due to gestational diabetes, except:

Intrauterine growth restriction Signup and view all the answers

What is the appropriate recommended dose of folic acid for a woman with a previous pregnancy complicated by a fetal neural tube defect?

4 mg Signup and view all the answers

What is the most common anomaly associated with prenatal exposure to valproic acid?

Neural tube defects Signup and view all the answers

Nutritional counseling for a pregnant woman with high carbohydrate intake should include which of the following?

Folic acid supplementation Signup and view all the answers

What is the recommended weight gain for an obese woman with a singleton pregnancy?

11-20 pounds for the entire pregnancy Signup and view all the answers

What is the next best step in managing a patient concerned about increased nuchal translucency?

Detailed ultrasound and fetal echocardiogram at approximately 18-20 weeks gestation Signup and view all the answers

Why was amniocentesis not performed?

Patient is 19 years old with no specific risk factors. Signup and view all the answers

What is the most likely complication to be encountered in an infant born to a 37-year-old woman diagnosed with preeclampsia?

Respiratory distress Signup and view all the answers

Which of the following findings is most likely in the newborn of a woman with type 1 diabetes?

Small and hypoglycemic Signup and view all the answers

What will be the expected appearance of the baby at delivery if the mother presents with chorioamnionitis?

Lethargic, pale with high temperature Signup and view all the answers

What is the most likely finding in twins where twin A is large and plethoric and twin B is small and pale?

Twin A is at high risk for polycythemia Signup and view all the answers

What condition is an infant born to a mother with gestational diabetes at immediate risk for?

Polycythemia Signup and view all the answers

What is the most appropriate next step in managing a limp unresponsive infant delivered from a mother who used meperidine?

Give positive pressure ventilation and prepare to intubate Signup and view all the answers

What is the most appropriate next step in managing a live infant delivered from an HIV-positive mother?

Treat the infant with zidovudine (AZT) immediately after delivery Signup and view all the answers

Which technique can impede positive pressure ventilation in a newborn?

Adjusting head position to modified flex position Signup and view all the answers

What is the APGAR score for an infant with a heart rate greater than 120 beats/minute, crying, acrocyanosis, gags when suctioned, and vigorously moving all extremities?

9 Signup and view all the answers

What is the most likely cause of postpartum hemorrhage in a woman with a history of previous Cesarean section?

Uterine atony Signup and view all the answers

What is the most likely diagnosis for a woman showing signs of fatigue and depression after delivery, with a negative pregnancy test?

Sheehan Syndrome Signup and view all the answers

Which factor places a patient at the greatest risk for developing postpartum infection?

Protracted labor Signup and view all the answers

What is the most likely diagnosis in a patient with fever after Cesarean delivery?

Endometritis Signup and view all the answers

What are the most likely causative agents of endometritis following a Cesarean delivery?

Aerobic and anaerobic bacteria Signup and view all the answers

What is the most likely diagnosis for a woman exhibiting signs of depression after delivery who has a history of anxiety?

Postpartum depression Signup and view all the answers

What is the most significant risk factor for postpartum depression in a woman with a history of depression?

Personal history of depression Signup and view all the answers

What should you do when a patient requests a Cesarean section without wanting to undergo labor?

Explain your reasons for the recommended Cesarean section and elicit the patient's reasons for not wanting to undergo the procedure. Signup and view all the answers

What is the most appropriate next step in the counseling of a patient requesting a Cesarean section?

Agree with her decision after proper counseling and perform a Cesarean section at 41 weeks gestation if she has not gone into labor by then Signup and view all the answers

Which statement about patient privacy is correct?

Patient privacy is the responsibility of physicians; physicians may be fined and/or assessed criminal penalties for violating the privacy of a patient's protected health information Signup and view all the answers

The physician's decision not to monitor the baby's heart rate during labor in case of an anencephalic infant is justified by which concept?

Non-maleficence to the patient Signup and view all the answers

Who should make the decision about whether to put Mary back on the ventilator?

Mary Signup and view all the answers

When a husband acts as a surrogate decision-maker, what should he base his decisions on?

What Mary would have chosen Signup and view all the answers

Which ethical principle is violated when a physician discourages an infertility treatment for financial reasons?

Justice Signup and view all the answers

What is true about conflict of interest in regard to pharmaceutical companies?

Pharmaceutical companies can support the costs of medical conferences in which physicians receive continuing medical education credits Signup and view all the answers

What is the most appropriate next step in the management of a patient requesting an abortion?

Support her decision for abortion after appropriate counseling Signup and view all the answers

At what age should a woman have her first Pap smear according to recommendations?

Pap smear at age 21 Signup and view all the answers

Regarding breast cancer screening, what is recommended for an 18-year-old with no family history of breast cancer?

Yearly starting at age 50 Signup and view all the answers

What screening test should be offered to a patient with a significant family history of breast cancer?

Mammogram Signup and view all the answers

What is the most appropriate next step for a patient with a family history of colon cancer?

Recommend a colonoscopy at age 50 and, if normal, repeat every 10 years Signup and view all the answers

What is the most effective method of birth control for a 16-year-old patient?

Depo-Provera Signup and view all the answers

What are the odds that an African-American couple will have a child with sickle cell anemia, given the carrier rate is 1/10?

1 in 60 Signup and view all the answers

Study Notes

Abnormal Pap Smear and Management

A 28-year-old woman with ASCUS shows positive reflex HPV testing for high-risk type; next step is colposcopy.
Routine screening or repeat Pap smear in one year is not warranted due to positive HPV result.

Gynecologic Examination for Teens

A 17-year-old with reported sexual activity requires counseling on contraception and screening for STIs.
Pap smear not indicated due to guidelines recommending it starting at age 21.

Health Maintenance in Older Women

A 68-year-old woman with a hysterectomy does not require a Pap smear unless done for cervical issues.
Yearly exams, bone density testing, colonoscopy at age 50, and mammograms annually are necessary for health maintenance.

Cervical Cancer Screening Recommendations

For a 32-year-old with normal Pap and HPV negative, the recommended screening interval is every five years for women aged 30-65.
Cotesting with cytology and HPV is preferred over cytology alone.

ASCUS Management

In a 25-year-old with ASCUS, HPV typing is the most appropriate initial management step.
Colposcopy is warranted if a high-risk HPV type is found; otherwise, close surveillance may continue.

Acute Salpingitis Diagnosis

A 19-year-old presents with symptoms consistent with acute salpingitis (PID): lower abdominal pain, fever, and cervical motion tenderness.
Diagnosis includes associated STIs like gonorrhea and chlamydia.

Syphilis Diagnosis in High-Risk Patients

A 39-year-old HIV-positive woman with vulvar lesions should undergo treponemal-specific testing for syphilis.
Serologic testing is crucial given her high-risk status due to IV drug abuse.

Genital Herpes Testing

A 24-year-old with painful ulcers likely has primary herpes; comprehensive STI screening is indicated.
Testing for additional STIs (RPR, HIV, herpes culture) is appropriate given her symptoms.

Trichomoniasis Identification

A 38-year-old woman with yellow, frothy discharge and vulvar irritation likely has trichomoniasis; characteristic motile protozoa detected under the microscope.
Symptoms have persisted despite treatment with over-the-counter anti-fungal medication.

Recurrence of Genital Herpes

A 23-year-old experiencing recurrent vulvar lesions may have a false-negative herpes culture, which is common (10-20% rate).
Culturing early in the infection is key for accurate diagnosis.

In emergency situations, informed consent may not be required if delaying treatment poses a risk to the patient's life.
Conducting an emergency Cesarean section without consent is not advisable; the patient's autonomy should be respected.

Counseling for Elective Cesarean Section

A 27-year-old patient desiring elective Cesarean section should receive counseling on risks and complications.
The decision ultimately lies with the patient, despite any concerns from her partner regarding future pregnancies.### Patient Privacy and Ethics
Patient privacy is a responsibility of physicians, who may face fines or penalties for breaches.
A nurse's negligence in leaving a chart open resulted in an HIV status disclosure, raising legal implications.
In medical ethics, non-maleficence underlines the duty to avoid harm, as demonstrated in a case of an anencephalic infant where a Cesarean section may cause unnecessary harm to the mother.

Decision Making in Healthcare

Patients have the right to make their own healthcare decisions if they are competent, as seen with Mary, who opted for mechanical ventilation despite her husband's preference against it.
Surrogates, like a husband with power of attorney, should base decisions primarily on what the patient would have chosen in their best interest.

Access to Care and Justice

Justice in healthcare ethics demands equitable treatment options, regardless of socioeconomic status; a physician should inform patients about all treatment possibilities without bias.

Conflicts of Interest

Physicians must be aware of conflicts of interest, such as financial ties to pharmaceutical companies which could influence professional decisions; however, accepting support for medical education is acceptable if it does not compromise ethical standards.

Contraception and Pregnancy

For a young woman seeking contraception, the most effective method outside of abstinence is Depo-Provera, showcased in discussions surrounding various contraceptive options.
Patients requesting abortions should receive counseling free from biases regarding decision-making, highlighting a physician's ethical duty to respect patient autonomy.

Cancer Screening Guidelines

American Congress of Obstetricians and Gynecologists (ACOG) recommends starting Pap smear screening at age 21, irrespective of sexual history, to address the low incidence of cervical cancer in younger women.
Screening for breast cancer via mammogram is advised starting at age 40 for women with no significant family risk, ensuring timely detection without unnecessary procedures.
Colon cancer screening should commence at age 50 for average-risk individuals, despite family history not elevating risk significantly unless more direct relations with colon cancer are involved.

Genetic Counseling and Carrier Screening

For African-American couples, hemoglobin electrophoresis is recommended for carrier screening related to sickle cell disease due to a higher prevalence in the population.
In Ashkenazi Jewish populations, certain conditions such as Tay-Sachs, Fanconi anemia, and Gaucher's disease are prioritized for carrier screening, while beta-thalassemia is mainly relevant in Mediterranean backgrounds.
Non-Hispanic white individuals are notably at risk for cystic fibrosis, highlighting the genetic considerations that must guide preconception counseling.

Risk Assessment in Pregnant Patients

Women on specific medications (insulin, valproic acid) pre-pregnancy are assessed for risks of anatomical defects, such as neural tube defects, emphasizing the need for comprehensive medication review during preconception counseling.### Omphalocele and Maternal Health Factors
Valproic acid increases the risk for neural tube defects, hydrocephalus, and craniofacial abnormalities; insulin and methyldopa do not cause fetal defects.
No increased risk of omphalocele or duodenal atresia in type 1 diabetic mothers.
Poorly controlled diabetes (A1C >9%) during conception increases fetal structural anomalies risk 4-8 times, particularly affecting the CNS and cardiovascular system.

Genetic Testing and Diagnosis

Chorionic villus sampling (CVS) is performed at 10-12 weeks for karyotyping and can test for cystic fibrosis, but not neural tube defects or omphalocele.
First trimester combined test has an 85% detection rate for trisomy 21 while sequential screening achieves up to 93%.
Quadruple screen is most effective for Down syndrome detection in the second trimester with an 80-85% detection rate.

Pregnancy Management and Complications

CVS carries a miscarriage risk of approximately 1%.
Fragile X syndrome is the leading inherited cause of mental retardation, affecting 1 in 3,600 males and 1 in 4,000-6,000 females.
Women with a previous child with anencephaly should take 4 mg of folic acid daily to reduce neural tube defect rates by 85%.

Screening and Interpretation during Pregnancy

Women with obesity (BMI >30) should aim for weight gain of 11-20 pounds during pregnancy.
Gestational diabetes prevalence varies from 1.4% to 14%, with risk factors including prior large babies and ethnicity.
For abnormal glucose tolerance tests, initiate dietary management and blood glucose monitoring without immediate need for insulin or medication.

Interventions for Abnormal Findings

In cases of elevated fetal nuchal translucency, detailed ultrasound and fetal echocardiogram should occur at 18-20 weeks to investigate potential anomalies.
Non-invasive prenatal testing is preferred for assessing risks associated with genetic disorders in early pregnancy.

Teratogenic Risks

Valproic acid is linked to neural tube defects, particularly lumbar meningomyelocele. Other malformations include craniofacial abnormalities.
Warfarin is teratogenic and should be avoided; heparin is safe during pregnancy for anticoagulation needs.

Labor and Delivery Management

Braxton Hicks contractions are characterized by irregular, weak contractions, and are not indicative of true labor.
In cases of decreased fetal movement with reassuring fetal heart rate, discharge home with warning signs is appropriate, as further intervention may not be needed.
Initial assessment for patients in labor includes thorough physical examinations and history review, making use of appropriate diagnostic tests as needed.

Nutritional Support during Pregnancy

Pregnant women, particularly those with a high BMI or other health concerns, should receive nutritional counseling focusing on protein supplementation and balanced diets to ensure proper fetal growth and maternal health. Folic acid supplementation is especially emphasized.

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Description

This quiz focuses on the management of abnormal pap smears, specifically case scenarios involving ASCUS and HPV testing. It aims to enhance understanding of follow-up procedures for gynecological health. Perfect for students and professionals in OB/GYN.