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Bonjour tout le monde,

Two questions for this one


How Should a Postmenopausal Woman Be Examined?

Question 1
You are following up on the results of routine testing of a 68-year-old G4P3 for her well-woman examination. Her physical examination was normal for a postmenopausal woman. Her Pap smear revealed parabasal cells, her mammogram was normal, lipid profile was normal, and the urinalysis shows hematuria. Which of the following is the most appropriate next step in the management of this patient?

a- Colposcopy
b- Endometrial biopsy
c- Renal sonogram
d- Urine culture
e- No further treatment/evaluation is necessary if the patient is asymptomatic

Pap smear = Frottis Cervico-Vaginal (Pap = Papanicolaou, smear = frottis)


Question 2
A 74-year-old woman presents to your office for well-woman exam. Her last Pap smear and mammogram were 3 years ago. She has hypertension, high cholesterol, and osteoarthritis. She stopped smoking 15 years ago, and denies alcohol use. What is the leading cause of death in women of this patient's age?

a- Alzheimer's disease
b- Breast cancer
c- Cerebrovascular disease
d- Heart disease
e- Lung cance
f- Trauma

osteoarthritis = arthrose (et non pas arthrite car arthrite = arthritis)
Breast = sein
Lung= poumon


Answer 01 :
The answer is d, Urine culture [1,2]
>>> A urinalysis that is positive for blood should be followed up with a urine culture to detect an asymptomatic urinary tract infection before further workup is done or referral to a urologist is made. Parabasal cells on a Pap smear indicate lack of estrogen and are a normal finding in postmenopausal women.

Answer 02 :
The answer is d, heart disease.[1,2]
>>> In order of decreasing incidence, the leading causes of death in women over 65 years old are the following: diseases of the heart, cancer, cerebrovascular diseases, chronic obstructive pulmonary diseases, pneumonia and influenza, diabetes mellitus, accidents, and Alzheimer's disease.

References
1- Stenchever MA, Droegemueller W, Herbst AL, Mishell DR, ed. Comprehensive Gynecology. 4th ed. St. Louis: Mosby; 2002: 138-154.
2- American College of Obstetricians and Gynecologists. Primary and preventive care: periodic assessments. Committee opinion 292. November 2003