This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
[{'content': 'A 35-year-old lady with post coital bleeding management is: \nSelect and explain. \nA. Clinical examination and pap smear, B. Visual examination with lugol iodine, C. Visual examination with acetic acid, D. Colposcopy', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Patient is 35 years old and presenting with post coital bleeding - raises the suspicion of cervical cancer because\n\nCIN is usually asymptomatic. - CGDT 10th /ed p 836\nCa cervix presents with watery; blood tinged vaginal discharge. Intermittent vaginal bleeding that follows coitus i.e. post coital bleeding is a very specific symptom of cervical cancer.\nNow in patients suspected of having cervical cancer, management is:\n"In those with suspected cervical cancer, a thorough external genital and vaginal examination should be should be performed, looking for concomitant lesions" \xa0 \xa0 ... Williams Gynae 1st /ed p 653\nSo the first step should be thorough clinical and vaginal examination.\n\nPapanicolaou Smear —\n"Histologic evaluation of cervical biopsy is the primary tool used to diagnose cervical cancer.\nAlthough pap smears are performed extensively to screen for this cancer, this test does not always detect cervical cancer. Specifically,\nPap smear testing has only a 55- 80% sensitivity for detecting high grade, lesions on any given single test. Thus, the preventive power of Pap smear testing lies in a regular serial screening.\nMoreover, in women who have stage-I cervical cancer, only 30 to 50% of single cytologic smears obtained are read as positive for cancer hence, the use of pap smear alone for evaluation of suspicious lesion is discouraged. Importantly, these lesions should be directly biopsied." \xa0 \xa0... Williams Gynae 1st /ed p 653\nThis means whenever a patient comes with specific complaint like post coital bleeding pap smear is not the initial test colposcopy should directly be done.\nThis rules out pap smear. Now read what Novaks has to say on this issue -\n"When obvious tumor growth is present, a cervical biopsy is usually sufficient for diagnosis. If gross disease is not present, a colposcopic examination with cervical biopsies and endocervical curettage is warranted. If the diagnosis cannot be established conclusively with colposcopy and directed biopsies, cervical conization may be necessary." \xa0 \xa0... Novak 14th /ed p 1405\nNote: Colposcopy findings suggestive of invasive cancer cervix:\n\n\nAbnormal blood vessels (abnormal reticular vessels)\nIrregular surface contour with loss of surface epithelium.\nColour of the cervix changes from pink to yellowish orange.', 'role': 'assistant'}]