An 84-Year-Old Woman Comes to the Office for Evaluation of Bleeding

question 119

Multiple Choice

An 84-year-old woman comes to the office for evaluation of bleeding.  The patient first noticed small amounts of blood on her underwear 2 weeks ago.  She has been wearing pads that require changing once or twice a day with only a small amount of blood accumulating between changes.  Her last Pap test at age 64 was normal.  A small, hyperplastic rectal polyp was removed at age 80.  Vital signs are normal.  BMI is 38 kg/m².  The speculum is difficult to insert; on examination there is mucosal pallor throughout the vagina with epithelial thinning and dryness.  No mass or prolapse is visualized.  Fecal occult blood test is negative.
Which of the following is the best next step in management of this patient?

• A)Colonoscopy
• B)Colposcopy
• C)Reassurance and follow-up in 1-2 weeks
• D)Transvaginal ultrasound
• E)Vaginal estrogen therapy

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Definitions:

Making Eye Contact

The act of looking directly into another person's eyes, which can communicate confidence, sincerity, and engagement.

Dietary Evaluation

The assessment of an individual's dietary intake and habits to identify areas for nutritional improvement.

Blood Glucose

The level of sugar present in the blood, crucial for managing energy supply in the body, significant for those with conditions like diabetes.

Carbohydrates

Organic compounds consisting of carbon, hydrogen, and oxygen, that are one of the main types of nutrients and a primary source of energy for the body.