Question

A 21-year-old G0 presents with severe menstrual pain. She takes 600 mg of ibuprofen every four to six hours to control the pain, but this does not relieve the discomfort. She is sexually active with one present partner and has four lifetime partners. She uses condoms for contraception. Past medical history is unremarkable, except for breast cancer in her father's sister. Examination is normal. In addition to a Pap smear, what is the most appropriate additional test needed for this patient?

A. Baseline mammography
B. Chlamydia testing
C. HIV testing
D. HPV DNA typing
E. Lipid profile

Answer 1

The most appropriate additional test for this patient is HPV DNA typing due to the potential risk of HPV infection and its association with cervical cancer.

Step-by-step explanation:

The most appropriate additional test needed for this patient is HPV DNA typing.

Severe menstrual pain can be a symptom of endometriosis, a condition in which endometrial tissue grows outside the uterus. The patient's family history of breast cancer could indicate a genetic predisposition to certain conditions. Since the patient is sexually active, the risk of sexually transmitted infections (STIs) should also be considered.

HPV DNA typing is important because the patient's symptoms, as well as her sexual history, suggest a potential risk for HPV infection. HPV is the leading cause of cervical cancer, and identifying the specific HPV strains can help with early detection and appropriate management.

Answer 2

The most appropriate additional test needed for this patient is D. HPV DNA typing

Step-by-step explanation:

Severe menstrual pain in a sexually active young woman raises concerns about gynecological health. While a Pap smear is essential for cervical cancer screening, the most appropriate additional test for this patient is HPV DNA typing (Option D). This test helps identify specific high-risk strains of human papillomavirus (HPV) that can lead to cervical dysplasia and cancer. Given the patient's sexual history and the family history of breast cancer, focusing on cervical cancer screening through HPV DNA typing is crucial.

HPV is a common sexually transmitted infection, and certain high-risk strains are strongly associated with cervical cancer. The patient's use of condoms for contraception reduces the risk of many sexually transmitted infections but may not fully protect against HPV. This test provides valuable information about the presence of high-risk HPV types, guiding further management and surveillance. Considering her age and the potential long-term consequences of untreated HPV infection, HPV DNA typing is the most pertinent choice among the options.

Other options, such as baseline mammography (Option A), chlamydia testing (Option B), HIV testing (Option C), and a lipid profile (Option E), are not indicated based on the patient's current symptoms, history, and examination findings. The focus should be on addressing the specific concerns related to gynecological health and the potential risk of cervical cancer, making HPV DNA typing the most appropriate next step in the evaluation of this patient.