TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Cervical screening Goto page 1, 2, 3  Next          TEALE FENNING Forum Index -> MRCOG Part 2: EMQs - Extended Matching Questions View previous topic :: View next topic   Author Message Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sun Aug 06, 2006 12:59 pm    Post subject: Cervical screening Options: A Colposcopy B Cervical biopsy C LLETZ D Knife cone E MDT discussion F Vulvoscopy/vaginoscopy G Annual smears for 10 years H Discharge to GP for smear in 6 months I Smear J See and treat K Colposcopy in 6 months L Colposcopy and smear in 6 months M Large loop cone N Large loop cone and hysteroscopy O Simple hysterectomy P Back to normal recall Q HPV testing R Radical hysterectomy S Repeat cone T Colposcopy and smear immediately Thanks to wolverine, Abi, and vani s for the option ideas _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Last edited by Nick Raine-Fenning on Fri Feb 23, 2007 9:23 pm; edited 2 times in total Back to top arunangsude2007 Joined: 22 Feb 2007 Posts: 18 Posted: Fri Feb 23, 2007 8:13 am    Post subject: stem what is the stem of the question here? Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Fri Feb 23, 2007 9:45 am    Post subject: the stem is cervical screening nick will eventually give the whole list of options. we then come up with clinical scenarios that are open to discussion on the forum. _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 10:16 am    Post subject: A 55 year old menopausal woman with severe dyskaryosis smear and normal colposcopy Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 10:19 am    Post subject: A 33 year old woman with CIN3 on biopsies and negative LLETZ Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 10:22 am    Post subject: A 25 year old nulliparus woman with moderate dyskaryosis and a CIN2 colposcopic opinion Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 10:26 am    Post subject: Options. a. Colposcopy b. Cervical biopsy c. LLETZ d. knife cone e. MDT discussion f. Vulvoscopy/vaginoscopy g. annual smears for 10 years h. Discharge to GP for smear in 6 months i. Smear j. See and treat k. colposcopy in 6 months l. colposcopy and smear in 6 months m. Large Loop cone n. large loop cone and hysteroscopy o. Simple hysterectomy p. Back to normal recall q. HPV testing and many more that we can add later, I have to go to theatres now Last edited by wolverine on Fri Feb 23, 2007 9:09 pm; edited 2 times in total Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Fri Feb 23, 2007 10:32 am    Post subject: I hope there is something good showing.... M. Simple hysterectomy N. Back to normal recall O. HPV testing A 25 year old nulliparus woman with moderate dyskaryosis and a CIN2 colposcopic opinion J? or C? I'm not quite sure of the difference. A 33 year old woman with CIN3 on biopsies and negative LLETZ K? or E? A 55 year old menopausal woman with severe dyskaryosis smear and normal colposcopy D (or M?) Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Fri Feb 23, 2007 10:40 am    Post subject: wolverine wrote: A 55 year old menopausal woman with severe dyskaryosis smear and normal colposcopy i'll go for the cone -- D do u guys think there is a place for HPV testing in this woman?? _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Fri Feb 23, 2007 10:45 am    Post subject: wolverine wrote: A 33 year old woman with CIN3 on biopsies and negative LLETZ i'll go for colposcopy in 6 months - K _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Fri Feb 23, 2007 10:53 am    Post subject: wolverine wrote: A 25 year old nulliparus woman with moderate dyskaryosis and a CIN2 colposcopic opinion i'll treat with LLETZ -- C _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 12:17 pm    Post subject: wolverine wrote: A 33 year old woman with CIN3 on biopsies and negative LLETZ colposcopy and smear in 6 months Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 12:19 pm    Post subject: wolverine wrote: A 55 year old menopausal woman with severe dyskaryosis smear and normal colposcopy c. LLETZ Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 12:21 pm    Post subject: wolverine wrote: A 25 year old nulliparus woman with moderate dyskaryosis and a CIN2 colposcopic opinion c. LLETZ Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 12:53 pm    Post subject: any other offers? I don't know the answers really but I can say my opinion Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 12:59 pm    Post subject: wolverine wrote: A 55 year old menopausal woman with severe dyskaryosis smear and normal colposcopy I would discuss in the MDT first. Review the smear. Was it really severe? Sometimes with menopausal women can be misleading. If it is really severe and colposcopy was normal (that means satisfactory as well) I would do vaginoscopy/ vulvoscopy and then a knife cone. If I still can't come up with a result for the source of the abnormal smear the only other thing that needs to be checked is the tubes. Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 1:04 pm    Post subject: wolverine wrote: A 33 year old woman with CIN3 on biopsies and negative LLETZ Well, the LLETZ is more sensitive than the punch so I would go with the LLETZ result (I mean there is no need to discuss in the MDT unless you have half a douzin of the same so you start thinking that something is wrong!) So colp and smear in 6/12 is my answer Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 3:06 pm    Post subject: wolverine wrote: A 25 year old nulliparus woman with moderate dyskaryosis and a CIN2 colposcopic opinion She would qualifiy for sea and treat if she was a multip and 35. She qualifies for LLETZ as well but don't you need a biopsy first? And even with a positive high grade punch one could think of re-colping her or a destructive treatment as she is nullip! Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 5:20 pm    Post subject: wolverine wrote: A 33 year old woman with CIN3 on biopsies and negative LLETZ Well. I checked. The answer should be cytology at 6 months. A smear at 6 months, then at 1yr. Then yearly till completion of 10 years. and then return to routine recall.. • women treated with high grade disease (CIN 2, CIN 3, cGIN) require 6 and 12 month follow-up cytology and annual cytology for the subsequent nine years at least, before returning to screening at the routine interval (high risk follow-up) • women treated for low grade disease require 6, 12 and 24 month follow-up cytology. If all results are negative, then women may be returned to screening at the routine interval (low risk follow-up). There is no clear evidence suggesting that diagnostic performance of cytology in combination with colposcopy for the detection of persistent disease after treatment for CIN is superior to cytology alone. Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Fri Feb 23, 2007 5:37 pm    Post subject: wolverine wrote: A 25 year old nulliparus woman with moderate dyskaryosis and a CIN2 colposcopic opinion If you did not biopsy her, how did you get 'The CIN 2'? 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