Perhaps
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A healthy 60 yo female comes to the physician for a routine examination. She has no history of illness over the past year and has never had an operation. She takes no medications. Menopause occurred 6 years ago. She weighs 57 kg (125 lb) and is 160 cm (63 in) tall. Pelvic examination shows atrophic external genitalia and a small, midpositioned uterus. The left ovary is 3 x 3 cm; the right ovary is not palpable. Which of the following is the most appropriate next step in management?
A) Reexamination in 1 month
B) Reexamination in 1 year
C) Obtain patient's medical records
D) Measurement of serum progesterone level
E) Pelvic ultrasonography
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| Perhaps
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I picked E when answering the q.
But C looks good too.
Please reply. Thanks!
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| MAZI
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I THINK C
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| Perhaps
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emedicine says :
'Finding a cyst in a woman of postmenopausal age should prompt an all out search for ovarian neoplasms. No functional cysts occur in women of this age because they have no corpus luteum or graafian follicle. Furthermore, a normal palpable ovary is not present at this age because the normal postmenopausal ovary shrinks to an undetectable size on physical examination.'
I am wondering if it is supposed to be palpable in this age.
However on here,
A past record maybe pre manopausal and the ovary should shrink anyway.
Still not sure.
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| cbenitesch
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I picked E) while reading. I donīt know about finding past medical record in the U.S., but in my country is difficult, and if we are thinking can be an ovarian cyst or neo, we canīt wait for the records. So we have that the ovary size should decrease around 40 y.o. and usually ovarian tumors are not smaller than 2,5 cm. Is better to get a Endocavitary US. (i hope "pelvic us" reffers to the use of the endovaginal transducer of 7,5MHz, cause the regular 3,5MHz probe used for abdominal scan of the ovary is a pretty bad imaging method!) to evaluate ovary always choose an intracavitary probe.
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| AAAAA
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cbenitesch wrote:
I picked E) while reading. I donīt know about finding past medical record in the U.S., but in my country is difficult, and if we are thinking can be an ovarian cyst or neo, we canīt wait for the records. So we have that the ovary size should decrease around 40 y.o. and usually ovarian tumors are not smaller than 2,5 cm. Is better to get a Endocavitary US. (i hope "pelvic us" reffers to the use of the endovaginal transducer of 7,5MHz, cause the regular 3,5MHz probe used for abdominal scan of the ovary is a pretty bad imaging method!) to evaluate ovary always choose an intracavitary probe.
The United States law requires hospitals and clinics to keep medical records for a minimum of 7 years according to Medicare, Medicaid ruling.
Most US Medical Records have transformed into electronic forms and one click, you can have all the patients CXR CT, and lab and all admissions.
It is amazing. Welcome to the paperless electronic medical records age !
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| cbenitesch
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Thanks AAAAA!!!... I guess thatīs the way! But according to the question, I donīt think getting her medical records is the right answer for this!... But thanks for the information, in my country we keep paper records for 10 years. But we canīt move them from one city to another not even from one hospital to another!.
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| ndspider
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AAAA your wrong. Only a few (rich) hospitals that do not accept poor medicare patients and illegal imigrants have the "digital records." As a US medical student I can tell you there is no way we would wait to get the patients record when they are sitting in a room on the "in-patient" floor that costs +1500 dollars a day. Her PCP could of hand written the record, it could be the weekend...etc... just not time efficent.
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| jvo_md
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Come on guys it's an old lady...jejejeje. If she had a mass premenopausal may have been normal. But at 74, if that mass persist, i'll jump fast to an US. I dont need a past medical record to tell me she had a mass. IT's now!!!!!!!!!!!!!!!!!!!!!!!!!
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| webjeee
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C) Obtain patient's medical records
is better, to get records is quite easy and quick in US, I think, to trace the growth of the mass. If it is new, or grow fast, we do us. didn't waste too much time.
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| nadiabarati
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E
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| ram3
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The answer is choice e pelvic ultrasound after menopause the ovaries are not functioning any growth should have this test done
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| doc_clotaire
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Goljan said :
Palpable ovarian mass in a woman over 50 yo is CANCER until proven otherwise
NSIM ________E) Pelvic ultrasonography
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| klimt
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I chose E too
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