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Hirschsprung disease — USMLE Step 2 CK MCQ

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HardPediatricsHirschsprung diseaseUSMLE Step 2 CK

A 30-year-old woman at 18 weeks of pregnancy has colposcopically directed biopsy showing cervical intraepithelial neoplasia grade 2. The colposcopic impression is satisfactory, and there is no clinical or histologic concern for invasive cancer. What is the most appropriate management?

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Correct answer: A — Repeat colposcopy with age-based testing every 12-24 weeks

Histologic CIN2 during pregnancy is managed with surveillance rather than treatment when invasion is not suspected. ASCCP recommends colposcopy and age-based cytology/HPV testing every 12-24 weeks, with interval individualized to gestational age, examiner experience, and follow-up reliability. Excisional treatment is reserved for suspected cancer because treatment of preinvasive disease can harm the pregnancy and progression during one pregnancy is uncommon. Endocervical curettage is unacceptable in pregnancy. Deferring all evaluation for a year is too long; postpartum colposcopy should occur after delivery according to the recommended timetable. Hysterectomy is not treatment for uncomplicated CIN2.

Reference: ASCCP Practice Pearl: Abnormal Cervical Screening in Pregnancy: https://www.asccp.org/clinical-practice/practice-pearls/tips-for-best-practices-on-management-of-abnormal-cervical-cancer-screening-tests-in-pregnancy/