Engorgement is treated with analgesic therapy, warm compresses, and the continuation of breast-feeding (choice C) . Engorgement typically presents with bilateral breast tenderness and generalized breast swelling. These patients are typically afebrile and lack the systemic symptoms that the patient in this case suffers from. A plugged duct is often treated with analgesic therapy, warm compresses, and a breast pump (choice D) . A plugged duct is characterized by unilateral breast tenderness and localized swelling. Patients with a plugged duct are afebrile, and lack systemic symptoms unlike the woman in this case. Vitamin A and D ointment (choice E) is part of the typical nipple care for all breast-feeding women with tender nipples. Breast-feeding women often complain of nipple tenderness and they should be given water-based creams, vitamin A and D ointment, and should be encouraged to continue breast- feeding. Fever, generalized body aches, and a unilateral tender breast are usually signs of an infection. They are not a normal part of breast-feeding. You have been taking care of a 27-year-old female attorney for many years. She had one spontaneous abortion at 8-weeks gestation 2 years ago, and is currently on triphasic oral contraceptives for contraception. She is in a monogamous relationship with her husband of 4 years. She has no medical problems and has never had surgery. She drinks alcohol socially on weekends and does not use tobacco or street drugs. Three months ago her routine Pap smear returned with a pathological diagnosis of high grade squamous intraepithelial lesion. You called her back for a colposcopy, ECC, and cervical biopsies, which confirmed the initial reading. You now would like to perform a loop electrosurgical excision procedure in your office to treat this finding. She asks you about the most common risk associated with this procedure. The most appropriate answer is A. alteration of menses B. bladder injury
C. infection D. postoperative bleeding E. vaginal wall injury Explanation: The correct answer is D. Once a biopsy diagnosis of cervical intraepithelial neoplasm has been made, an appropriate treatment option is a loop electrosurgical excision procedure. This is a relatively simple outpatient procedure done under local anesthesia. This procedure usually includes the entire transformation zone, which reduces the risk of missing invasive cancer. The complication rate is approximately 7%, with the most common complication being postoperative bleeding, with approximately 2% of patients presenting with delayed bleeding (within the first 4 weeks after procedure). Pelvic infection and pregnancy increase the risk of this type of bleeding. Menstrual cycle (choice A) should not be altered. There is no entry into the uterine cavity or manipulation of hormones. In addition, the procedure should not adversely affect fertility or future pregnancies.
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