Master the board step 3

Master the Boards: USMLE Step 3
Step in Workup
When is this step
the answer?
Workup of an Abnormal Papp
Next Step
Repeat Pap − First ASCUS Pap Repeat Pap at 4- to 6-month intervals until there are 2
consecutive, negative Paps
If a repeat Pap is again ASCUS, refer for colposcopy
HPV DNA testing − First ASCUS Pap If liquid-based cytology was used on the initial Pap,
use specimen for DNA testing
Colposcopy and
ectocervical biopsy
Endocervical
curettage (ECC)
Cone biopsy
− An abnormal Pap smear
− Two ASCUS Pap smears
− All NONpregnant patients with
an abnormal Pap smear
− Performed after colposcopy or
ECC if Pap smear and biopsy
findings are not consistent
(suggests abnormal cells were
not biopsied)
− Abnormal ECC histology
− An endocervical lesion
− A biopsy showing microinvasive
carcinoma of the cervix
If conventional methods were used, a second Pap
needs to be performed
Colposcopy is then performed only if HPV 16 and 18
identified
Colposcopy is a magnification of the cervix
(10–12 times)
Abnormal lesions (e.g., mosaicism, inflammatory
punctation, white lesions, abnormal vessels) are
biopsied and sent for histology
All nonpregnant patients undergoing colposcopy for
an abnormal Pap smear must undergo an ECC to
rule out endocervical lesions
NOTE: Deep cone biopsies can result in an
incompetent cervix or cervical stenosis.
Step in
Management
Observation and
follow-up
Management of Abnormal Histologyp
When is this step
the answer?
− CIN 1
− CIN 2 or 3 after ablation or
excision
Ablative modalities − CIN 2 or 3 − Cryotherapy
− Laser vaporization
− Electrofulguration
Details
− Follow-up repeat Pap smears, colposcopy + Pap smear,
or HPV DNA testing every 4 to 6 months for 2 years
Excisional procedures − CIN 2 or 3 − LEEP (loop electrosurgical excision procedure)
− Cold-knife conization
Hysterectomy
− Biopsy-confirmed
− Recurrent CIN 2 or 3
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