APGO Unit 1: Approach to the Patient

Question 1

28 year old, ASCUS, HPV+, no prior history. Next step?

Answer 1

Colposcopy

Question 2

Age for initiating cervical cancer screening?

Answer 2

21

Question 3

Indications for Pap smear in patient with hysterectomy?

Answer 3

Contraindicated unless hysterectomy performed for high-grade cervical dysplasia

Question 4

Discontinue cervical cancer screening?

Answer 4

Between ages 65-70 if 3 consecutive negative Paps

OR 2 consecutive negative cotesting in past 10 years

Question 5

Patient has dowager’s hump. Management?

Answer 5

Increased thoracic spine curvature, likely due to compression fxs 2/2 osteoporosis
Get Bone Density scan
Consider adding bisphosphonates

Question 6

Pap smear testing schedule?

Answer 6

From 30-65 years old, cotesting every 5 years or cytology alone every 3 years.

Question 7

When to do cone biopsy, LEEP, or cryotherapy?

Answer 7

Only after biopsy confirmed diagnosis of cervical dysplasia

Question 8

Young patient with ASCUS. Next step?

Answer 8

HPV-typing => if high risk type => colposcopy w/ biopsies

Alternatively: Repeat Pap in 12 months => if negative, return to normal screening intervals

Question 9

Findings consistent with acute salpingitis/pelvic inflammatory disease?

Answer 9

Fever
Lower abdominal pain
Adnexal tenderness
Cervical motion tenderness
Vaginal discharge

Question 10

Classic gonorrhea presentation

Answer 10

Mucopurulent discharge
Cervicitis
Symptom exacerbation during and after menstruation

Question 11

Classic trichomonas discharge

Answer 11

Yellow
Frothy
Fish-smelling
No abdominal pain
No fever

Question 12

Classic Candida discharge

Answer 12

Cottage-cheese like
No abdominal pain
No fever

Question 13

Treatment for gonorrhea/chlamydia?

Answer 13

Doxycycline 7 days for chlamydia
(Azithromycin for chlamydia if pregnant)
Ceftriaxone for gonorrhea

Question 14

Treat syphilis?

Answer 14

Penicillin G for ALL stages

Question 15

Testing for syphilis?

Answer 15

1st line: Non-treponemal (VDRL or RPR)
2nd line: Treponemal antibody
2nd line: Dark-field microscopy although sometimes difficult

Question 16

Classic herpes presentation?

Answer 16

Initially fluid filled sores, now opened, and crusted over
Painful, causes swelling
Fever
Difficulty voiding

Question 17

Characteristic cervix presentation with trichomoniasis?

Answer 17

Erythematous patches - “strawberry cervicitis”

Question 18

Microscopic evaluation of bacterial vaginosis?

Answer 18

“Clue cells” - adherent coccobacillary bacteria that obscure edges of cell

Question 19

Chemical evaluation of bacterial vaginosis?

Answer 19

Drop of KOH releases amines = fishy smell

Question 20

Diagnose herpes lesion?

Answer 20

Culture is gold-standard
Culture early in outbreak
Can do PCR of lesion scrapings
10-20% false negative

Question 21

Pap smear guidelines in younger population?

Answer 21

Start screening at 21 regardless of sexual activity

21-29 yo: Screen every 3 years

Question 22

Options for colorectal screening

Answer 22

Start at age 50
Hemoccult test yearly
Flexible sigmoidoscopy every 5 years
Colonoscopy every 10 years

Question 23

Risk factors for osteoporosis

Answer 23

Early onset menopause
Glucocorticoid therapy
Sedentary lifestyle
Alcohol
Hyperthyroidism
Hyperparathyroidism
Anticonvulsant use
Vitamin D deficiency
Family History
Chronic Liver Disease
Chronic Kidney Disease

Question 24

Vaccinations contraindicated in pregnancy

Answer 24

MMR and varicella

Question 25

Screening in PCOS?

Answer 25

PCOS => insulin resistance (acanthosis nigricans) => DM

Question 26

Is diet alone adequate for folate levels?

Answer 26

No need supplementation => prevents MI, stroke, and neural tube defects