Investigation of choice in postcoital bleeding in a 60 years old lady is -
Ans-B Colposcopy directed biopsy (Ref : Shaws, 13/e, p 384 (12/e, p 289)).For a patient with post coital bleeding the best investigation would be colposcopy directed biopsy. Pap smear will not be of much help because even if the pap smear is negative in this case, we will still have to confirm it with colposcopy directed biopsy. Post coital bleeding in a 60 year old indicate carcinoma cervix and you cannot rule it out only with a normal cytological report. It is mandatory to confirm it with histological report.Cone biopsy is not needed here. If we have a lesser destructive method of biopsy available at our disposal why should we opt for a more destructive procedure of biopsy i.e. cone biopsy.Remember -Pap smear is a screening procedure and we all know very well that screening procedures are performed in apparently healthy persons (not in those who come with signs and symptoms of carcinoma).
Papsmear
Colposcopy and biopsy
Pelvic ultrasound
Cone excision of cervix