A 29-year-old G1P0 presents to her obstetrician for her first prenatal care visit at 12 weeks gestation by last menstrual period. She states that her breasts are very tender and swollen, and her exercise endurance has declined. She otherwise feels well. She is concerned about preterm birth, as she heard that certain cervical procedures increase the risk. The patient has a gynecologic history of loop electrosurgical excision procedure (LEEP) for cervical dysplasia several years ago and has had negative Pap smears since then. She also has mild intermittent asthma that is well controlled with occasional use of her albuterol inhaler. At this visit, this patient’s temperature is 98.6°F (37.0°C), pulse is 69/min, blood pressure is 119/61 mmHg, and respirations are 13/min. Cardiopulmonary exam is unremarkable, and the uterine fundus is just palpable at the pelvic brim. Pelvic exam reveals normal female external genitalia, a closed and slightly soft cervix, a 12-week-size uterus, and no adnexal masses. Which of the following is the best method for evaluating for possible cervical incompetence in this patient?
ATransabdominal ultrasound in the first trimester
BTransvaginal ultrasound in the first trimester
CSerial transvaginal ultrasounds starting at 16 weeks gestation
DTransabdominal ultrasound at 18 weeks gestation
ETransvaginal ultrasound at 18 weeks gestation
A 32-year-old HIV-positive man presents with multiple flesh-colored, pedunculated lesions on his penis. Biopsy shows koilocytes and increased mitotic figures. Which of the following viral proteins is responsible for the cellular changes observed?
ATax protein
BE6 and E7 proteins
CL1 protein
DEBNA-1
A 38-year-old G2P2 presents to her gynecologist to discuss the results of her diagnostic tests. She has no current complaints or concurrent diseases. She underwent a tubal ligation after her last pregnancy. Her last Pap smear showed a high-grade squamous intraepithelial lesion and a reflex HPV test was positive. Colposcopic examination reveals areas of thin acetowhite epithelium with diffuse borders and fine punctation. The biopsy obtained from the suspicious areas shows CIN 1. Note the discordancy between the cytology (HSIL) and histology (CIN 1) results. Which of the following is an appropriate next step in the management of this patient?
ATest for type 16 and 18 HPV
BCryoablation
CCold-knife conization
DLoop electrosurgical excision procedure
ERepeat cytology and HPV co-testing in 6 months
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