Select pre-operative tests  

Medical History:

A 55-year-old post-menopausal caucasian woman presents to your office who has a history of vulvar intraepithelial neoplasia treated by carbon dioxide laser ablation on November 19, 1997. She has been having regular exams with frequent Pap smears and evaluations. She had a normal Pap smear in 1997 and the abnormal Pap smear in May 1998 and then had colposcopic biopsies that showed only cervicitis. She came in for repeat colposcopy and evaluation on December 2, 1998, at which time malignancy was noted and a biopsy obtained. Of note, she had vaginal spotting that developed in November 1998, but denied any back pain, chest pain, change in GI or GU symptoms, post-coital bleeding or lower extremity edema. She denies any history of sexually transmitted diseases. She was a smoker in the past but quit approximately 15 years ago. She went through spontaneous menopause at approximately age 45 and is on Premarin 0.625 mg p.o. q.d. and Provera 2.5 mg p.o. q.d.

Family History:

Negative for gynecologic, gastrointestinal and breast malignancies.

Social History:

She previously smoked greater than a pack per day but discontinued it 15 years ago. She is here with her husband. She is recently retired. She worked at Upjohn.

Allergies:

None known.

Medication:

Premarin 0.625 mg p.o. q.d., Provera 2.5 mg p.o. q.d.

Past Medical History:

Negative for hypertension, diabetes and asthma.

Past Surgical History:

Laser of the vulva.

Physical Exam:

Blood pressure was 120/60, weight was 150 pounds. Her lymph node survey is negative. Her lungs are clear. Her heart has regular rate and rhythm. Her breasts are without palpable masses, skin changes or nipple discharge bilaterally. Her abdomen is soft, nontender without palpable masses, hepatosplenomegaly or obvious fluid wave. Her extremities are nonedematous. Her pelvic examination reveals normal external genitalia with no aceta-white lesions, smooth vaginal vault, a cervix that has apparent tumor centrally and a approximately 1 x 1 cm portion on the anterior lip but is otherwise approximately 2.5 to 3 cm in maximum diameter and not particularly firm. On bimanual exam she has a mobile anteverted nontender uterus and no parametrial or adnexal thickening. Her stool is hemoccult negative.