The Daily PANCE PANRE Question 6

A 27 year-old nulliparous female presents because she's been trying to get pregnant for two years, but has failed. She relates a history of a misdiagnosis of appendicitis that lead to abscess formation when she was 14 years old. Which of the following diagnostic studies would be most helpful at this point in her evaluation? A TSH level B hysterosalpingogram C laparoscopy D PAP smear E pelvic ultrasound Answer: B While I would disagree that an invasive procedures like HSG should be done first-line, the thing to remember in this question is that the patient has reason to have tubal scarring from adhesions (and there is no better answer listed to choose), so, for a board exam I would choose this answer. The TSH level would not be indicated (she has not had a pg loss), lap could diagnose the tubal scarring but would be done after an abnormal HSG. Pap smear is screening for cervical cancer and not indicated in this case of infertility; and pelvic US would yield nothing diagnostically about the tubes. Note: * This is part of the Daily PANCE and PANRE in your inbox email series: 60 days of PANCE and PANRE Questions and Answers delivered directly to your inbox. It is a great and fun way to learn! If you haven't already you can sign up by clicking Here. The Daily PANCE PANRE Question 6 A 27-year-old nulliparous female presents because she's been trying to get pregnant for two years, but has failed. She relates a history of a misdiagnosis of appendicitis that lead to abscess formation when she was 14 years old. Which of the following diagnostic studies would be most helpful at this point in her evaluation? TSH level Hysterosalpingogram Laparoscopy PAP smear Pelvic ultrasound Answer: B Hysterosalpingogram While I would disagree that an invasive procedure like HSG should be done first-line, the thing to remember in this question is that the patient has reason to have tubal scarring from adhesions (and there is no better answer listed to choose), so, for a board exam I would choose this answer. The TSH level would not be indicated (she has not had a pg loss), lap could diagnose the tubal scarring but would be done after an abnormal HSG. Pap smear is screening for cervical cancer and not indicated in this case of infertility, and the pelvic US would yield nothing diagnostically about the tubes. Know Your Content BlueprintInfertility is part of the NCCPA Content Blueprint Reproductive System(8%). Read more atSmarty PANCE Infertility. Note: * This is part of the Daily PANCE and PANRE in your inbox email series: 60 days of PANCE and PANRE Questions and Answers delivered directly to your inbox. 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I work in pediatrics for the past 20 years. I used your site and a review book to prepare. I think your site is fantastic and a bargain . I just found out I passed.  Thank you! Mark Leinwand, PA-C Dear Stephen, I wanted to thank you for your excellent website. I have been a physician assistant for 18 years and recently passed my panre again.   I was really nervous this time, as I have been working in the field of hematology oncology for the last four years. Prior to that I had worked in primary care.   Your daily questions, quizzes and websites reassurance was of tremendous help to me!   Keep up the good work. You are a treasure to the PA profession! Sasha CarlislePA – C