An 18-year-old single white female at 30 weeks gestation presents to the hospital with uterine contractions 10 minutes apart. Her previous pregnancy 18 months ago resulted in a preterm birth at 29 weeks gestation.
The most accurate test to determine whether this patient will need hospitalization and tocolysis would be:
Correct Answer E: Of the biochemical markers listed, the most clinically useful test to differentiate women who are at high risk for impending preterm delivery from those who are not is the fetal fibronectin in cervical or vaginal secretions. In symptomatic women, this is most accurate in predicting spontaneous preterm delivery within 7 - 10 days. It is less accurate in those who are asymptomatic. If the fetal fibronectin is negative, it may be possible to avoid interventions such as hospitalization, tocolysis, and corticosteroid administration.
Which one of the following agents used for tocolysis has the unique adverse effect of respiratory depression?
Correct Answer A: Magnesium sulfate (choice A) infusions must be carefully monitored because respiratory depression is a potential lethal side effect. Reflexes are usually lost first.
→ Terbutaline (choice C) and ritodrine (choice B) have the potential to cause respiratory distress in the form of pulmonary edema. They do not cause respiratory depression.
→ Indomethacin (choice D) and nifedipine (choice E) are rarely used tocolytics that do not depress respiration.
A 32-year-old sexually active female has a Pap smear that shows Atypical Glandular Cells.
What is the next step?
Correct Answer A: All women who have a pap smear that shows Atypical Glandular Cells (AGC), Atypical Endocervical Cells, or Atypical Endometrial Cells should have a colposcopy and/or endometrial sampling.
At a routine physical examination, the Pap smear of a 27-year-old woman shows evidence of marked inflammation suggestive of moderate dysplasia (HGSIL). Her last Pap smear 2 years ago was normal. Pelvic examination today is normal. She has never been pregnant and her menstrual periods are regular. She has been in a stable relationship with the same man for 3 years and she uses a diaphragm with spermicidal jelly for contraception.
The best next step is to:
Correct Answer B: The Papanicolaou smear is a screening test for precancerous cells. Any cervical dysplasia (formerly cervical intraepithelial neoplasia IIII, now low-grade and high-grade squamous intraepithelial lesion) necessitates colposcopy for definitive diagnosis. The diaphragm has not been associated with abnormal Pap smears, so changing the method of contraception would not be of any use. Conization of the cervix is always preceded by a colposcopy, and is indicated for unsatisfactory colposcopy, inconsistency of colposcopic findings with Pap smear findings, an endocervical curettage with abnormal cells, or a lesion on colposcopy extending into the endocervix. Reassurance and repeating the Pap smear in three months can be used for ASCUS (atypical squamous cells of undetermined significance); two serial ASCUS Pap smears necessitate colposcopy.
The appropriate next step in a 25-year-old woman found to have one abnormal Pap smear showing HSIL is:
Correct Answer D: High-Grade Squamous Intraepithelial Lesion (HSIL) on cytology should be managed with colposcopy (choice D).
Cervical cancer is usually a squamous cell carcinoma that is caused by human papillomavirus infection or an adenocarcinoma. Early cancer is asymptomatic; the 1st symptom of later cancer is usually postcoital vaginal bleeding. Diagnosis is by screening cervical Papanicolaou (Pap) test and biopsy.
CIN is graded as 1 (mild cervical dysplasia), 2 (moderate dysplasia), or 3 (severe dysplasia and carcinoma in situ).
CIN I (LSIL) treatment:
CIN II and CIN III (HSIL) treatment: