A 28-year-old white female consults you with a complaint of irregular heavy menstrual periods. Her general physical examination, pelvic examination, and Papanicolaou test are normal and she has a negative pregnancy test. A CBC and chemistry profile are also normal.
The next step in her workup should be:
Correct Answer E: Abnormal uterine bleeding is a relatively common disorder which may be due to functional disorders of the hypothalamus, pituitary, or ovary, as well as uterine lesions. However, the patient who is younger than 30 years of age will rarely be found to have a structural uterine defect. Once pregnancy, hematologic disease, and renal impairment are excluded, administration of intramuscular or oral progesterone will usually produce definitive flow and control the bleeding. No further evaluation should be necessary unless the bleeding recurs.
Endometrial aspiration, dilatation and curettage, and other diagnostic procedures are appropriate for recurrent problem or for older women. Estrogen would only increase the problem, which is usually due to anovulation with prolonged estrogen secretion, producing a hypertrophic endometrium.
When performed during pregnancy, which one of the following imaging procedures would expose the fetus to the highest radiation dose?
Correct Answer D: While no single diagnostic imaging procedure would result in a radiation dose that would threaten the well-being of a developing embryo or fetus, and fetal risk is considered negligible at 5 rad or less, certain imaging procedures do carry a higher radiation dose than others.
A 32-year-old white female at 16 weeks gestation presents to your office with right lower quadrant pain.
Which one of the following imaging studies would be most appropriate for initial evaluation of this patient?
Correct Answer C:
CT has demonstrated superiority over transabdominal ultrasonography for identifying appendicitis, associated abscess, and alternative diagnoses. However, ultrasonography is indicated for the evaluation of women who are pregnant and women in whom there is a high degree of suspicion for gynecologic disease.
A 26-year-old primigravida is at 20 weeks gestation by dates but her fundal height is consistent with a 26-week gestation. She has had episodes of vomiting during the pregnancy that were more severe than the physiologic vomiting typically seen in pregnancy. A sonogram performed at about 5 weeks gestation for vaginal bleeding was normal and showed a single fetus.
Which one of the following would be most appropriate at this point?
Correct Answer B:
Ultrasonography is the initial test of choice for evaluating the possibility of multiple gestation. It should be done if uterine size is larger than expected, or if pregnancy-associated symptoms are excessive. It should also be done in women who received fertility treatment. An initial sonogram that shows a single pregnancy does not rule out multiple gestation. In one study, 30 of 220 twin pregnancies had an original sonogram which showed a single pregnancy. Serum HCG and MRI would not be indicated at this stage of the evaluation.
You are evaluating a 28-year-old primigravida for an abnormal Papanicolaou (Pap) test.
Which one of the following procedures would be contraindicated?
Of the choices listed, only endocervical curettage is contraindicated in pregnancy. Colposcopy, cervical biopsy, cervical staining, and HPV testing can all be safely performed during pregnancy.
Click to expand