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Cervical cancer — MCCQE Part 1 MCQ

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ModerateAbnormal BleedingCervical cancerMCCQE Part 1

39-year-old woman presents with post-coital bleeding. She has a friable cervical lesion on speculum examination. Which of the following is the most appropriate next step?

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Correct answer: B — Refer urgently for colposcopic/gynecologic assessment and biopsy

Refer urgently for colposcopic/gynecologic assessment and biopsy is best because visible cervical lesion and post-coital bleeding require diagnostic evaluation. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Screening algorithms do not replace biopsy of a suspicious lesion.

Reference: SOGC cervical cancer guidance