View source for WBR1119

{{WBRQuestion
|QuestionAuthor={{M.P}}
|ExamType=USMLE Step 3
|MainCategory=Primary Care Office
|SubCategory=Obstetrics & Gynecology
|MainCategory=Primary Care Office
|SubCategory=Obstetrics & Gynecology
|MainCategory=Primary Care Office
|SubCategory=Obstetrics & Gynecology
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Obstetrics & Gynecology
|MainCategory=Primary Care Office
|SubCategory=Obstetrics & Gynecology
|MainCategory=Primary Care Office
|SubCategory=Obstetrics & Gynecology
|MainCategory=Primary Care Office
|SubCategory=Obstetrics & Gynecology
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Obstetrics & Gynecology
|Prompt=A 23 year old female present to the office for routine health check up and currently has no complaints.  She is sexually active with her boyfriend for the past 3 years and does not use any contraception.  Her menses are regular every 28 days and lasts for 3-4 days.  She is currently not on any medications.  She is a non-smoker, but consumes alcohol occasionally.  Her past history and family history is unremarkable.  Her vitals are within normal limits and all system examinations are normal.  Pap smear is done and the results come back as atypical squamous cells of undetermined significance.  Which is the most appropriate next step in the management of this patient?
|Explanation=Atypical squamous cells of undetermined significance (ASC-US) are cells that display abnormalities more marked than simple reactive changes but do not display a squamous intraepithelial lesion (SIL).  The risk of invasive [[cervical cancer]] in women with atypical squamous cells, particularly atypical squamous cells of undetermined significance (ASC-US), is low, because one to two-thirds of cases are not associated with high-risk [[human papilloma virus]] (HPV) infection.  Mangement of atypical squamous cells of undetermined significance (ASC-US) differ according to the age-group.  For 21-24 years of age: Repeat Pap smear at 12 months.  If Pap smear is negative or reveals ASC-US or LSIL, repeat pap smear at 12 months.  If the repeat cytology is again negative the patient should be put on routine screening schedule.  If a repeat cytology reveals a more severe cells, immediate colposcopy should be performed.  For > 25 years of age: Immediate [[colposcopy]], HPV DNA testing, and repeat Pap smear at 6 months should be performed. 
|AnswerA=Pap smear at 6 months


|AnswerAExp=For patients with ASC-US, between 21-24 years of age, a repeat pap smear is done at 12 months and not at 6 months.
|AnswerB=Pap smear at 12 months

|AnswerBExp=In this patient, a [[pap smear]] should be done at 12 months to assess the severity.
|AnswerC=Loop electrosurgical excision procedure (LEEP)

|AnswerCExp=Loop electrosurgical excision procedure is done for patients with high grade intraepithelial neoplasia.
|AnswerD=Colposcopy at 12 months

|AnswerDExp=For patients with ASC-US, between 21-14 years of age, if a repeat pap shows a higher grade change, than an immediate [[colposcopy]] is performed.
|AnswerE=HPV DNA testing at 6 months
|AnswerEExp=HPV DNA testing is done in patients with ASC-US for > 25 years of age.
|EducationalObjectives=Mangement of atypical squamous cells of undetermined significance (ASC-US) differ according to the age-group.
|RightAnswer=B
|WBRKeyword=[[Cervical intraepithelial neoplasia]]
|Approved=No
}}