A 45 years old lady complains of contact bleeding. She has positive pap smear. The next line of management is :
Ans. is a i.e. Colposcopy directed biopsy 45 years old patient presenting with post coital bleeding and positive pap smear raises suspecion of carcinoma cervix / CIN which needs to be confirmed (as pap smear is only a screening procedure). In the question it is not mentioned whether lesion is visible nor the size of lesion is given so we take it to be invisible. As already discussed for invisible lesion, colposcopy should be done to confirm the diagnosis.
Colposcopy directed biopsy
Cone biopsy
Repeat pap smear
Hysterectomy