Q.

A 42-year-old G4P4 has had postcoital bleeding for the past four months. She has not had a Pap test since the delivery of her last child 7 years ago. Speculum examination shows a vaginal discharge and a 1 cm exophytic lesion of the posterior cervical lip. The most appropriate next step is:

A. Perform a Pap smear
B. Perform a cold-knife conization
C. Give the patient a course of intravaginal Metronidazole gel followed by reexamination in 6 weeks
D. Perform a punch biopsy of the lesion
E. none
Answer» D. Perform a punch biopsy of the lesion
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