Tests that have never been abnormal and has been in a

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tests that have never been abnormal, and has been in a monogamous relationship for 12 years. The most appropriate next step is toA. advise her that she needs increased monitoring, and that you will perform a repeat Pap smear in 6 monthsB. advise her that since she is at very low risk for an 41
abnormality, she can wait until her annual exam next year for a re-sample of her endocervixC. explain to her that although the reading of the exocervix is valid, you need to re-sample her endocervixD. explain to her that she needs to repeat the Pap test, asthese results are not validE. perform a colposcopic examination of her cervixExplanation: The correct answer is B. The presence of endocervical cells on a Pap test is regarded as evidence of adequate sampling of thetransformation zone during cytologic screening of the cervix. When these cells are absent, it indicates that this area may not have been sampled. This is considered a satisfactory, but limited smear. In patients with no known risk factors (i.e., priorabnormal Pap test, multiple sexual partners, smoking) the American College of Obstetricians and Gynecologists recommends that the physician may defer to repeating the Pap test in 12 months.It is inappropriate to tell her that she needs increased monitoring (choice A) because these results do not indicate any abnormality. It is simply sampling error.If this were a high risk patient (i.e., prior abnormal Pap test, multiple sexual partners, smoking), a re-sampling only of the endocervix (choice C) only would be the appropriate next step.However, since she is not at high risk, you can wait for 1 year.It is inappropriate to tell her that the results of this test are not valid (choice D) because they are valid, just not complete.A colposcopic examination of the cervix (choice E) would be appropriate if this patient had abnormal cells on her smear indicating a pre-cancerous lesion.A 3-day-old male infant in the neonatal unit has bilious vomiting for 24 hours. The child is inconsolable and will not feed. Vital signs are: temperature 38 C (100.4 F), pulse 110/min, blood pressure 80/50 mmHg, and respirations 20/min. Abdominal examination is unremarkable. A barium enema demonstrates the cecum to be in the left upper quadrant. There is no right lower quadrant mass on abdominal x-ray. Intravenous antibiotics and Ringer's solution are administered. The next step in treating this patient isA. bowel restB. intussusception reduction with airC. intussusception reduction with contrast42
D. laparotomyE. repeat barium enema in 24 hoursExplanation: The correct answer is D. Bilious vomiting in an infant means that there is a malrotation with volvulus until proven otherwise. The radiographic findings of the cecum in the left upper quadrant confirms this clinical diagnosis. An upper gastrointestinal series would likely show a bird-beak deformityof the midgut where there is volvulus of the gut around a mesenteric "Ladd" band. About 20% of malrotation with volvulus is associated with duodenal atresia, annular pancreas, or a duodenal diaphragm. About 33% of cases

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