5. Pap Smear

Question 1

Cervical cancer has decreased more than 50% over the last 30 years and is the 4th MC cancer. There are two type of epithelium: columnar and stratified NONkeratinizing squamous epithelia with what in between which is where 90% of neoplasia occurs?

Answer 1

Squamocolumnar Junction (SCJ)

Question 2

What is between the new SCJ and the original SCJ?

Answer 2

Transformation zone

Question 3

Cervical cancer and CIN are caused by HPV, there are 100 types and 30 affect anogenital tract, 15 are associated with cancer and are called high risk?

Answer 3

HPV types

Question 4

What are the 4 HPV strains that cause most of the cervical cancers, with 2 making up 70%?

Answer 4

16 18 31 45

6/11 are genital warts w low grade lesions

Question 5

Risk factors include multiple sex partners, smoking, HIV, organ transplant, Diethystilbestrol exposure (DES), high parity and lower?

Answer 5

socioeconomic status

Question 6

PAP SMEAR: who needs it?
any one under 21 DOES NOT need screening
women aged 21-29 require what?

Answer 6

Cytology alone every 3 years

Question 7

Women aged between 30-65 require what regarding HPV testing?

Answer 7

Cotesting = HPV and cytology every 5 years

Question 8

No screening is required after a hysterectomy and also for what age group, in which there was adequate negative prior screening?

Answer 8

Age 65+

Question 9

2001 Bethesda system is used for pap smears, general categorization of the specimen: negative for intraepithelial lesion or malignancy, epithelial cell abnormality: see result, other: see result, it also can show positive for what?

Answer 9

Organisms such as trichomonas, fungal, shift in flora (bacterial), actinomyces, and cellular change consistent with HSV

Question 10

Other non neoplastic findings in 2001 bethesda system include inflammation, radiation, intrauterine contraceptive device, glandular cells pot hysterectomy and?

Answer 10

atrophy

Question 11

What is the most common epithelial cell abnormality with 2001 bethesda systema, composed of atypical squamous cells of either 1) undetermined significance (ASC-US) or cannot exclude high grade (ASC-H), low grade intraepithelial, high grade (LSIL/HSIL)?

Answer 11

Squamous cell is MC epithelial cell abnl

Question 12

Glandular cells can be atypical either endocervical, endometrial (neoplastic) or glandular (neoplastic), what epithelial cell abnormality can be found in endocervical, endometrial, extrauterine?

Answer 12

Adenocarcinoma

Question 13

If a women has atypical Squamous cells of undetermined significance (ASC-US) on cytology and HPV testing is negative, when should repeat cotesting be done?

Answer 13

3 years

Question 14

Women with low grade squamous intraepithelial lesion LSIL, with negative/positive/no HPV testing, what should be done?

Answer 14

Colposcopy

Question 15

What are the two options for a women with high grade squamous intraepithelial lesions HSIL?

Answer 15

Either Colposcopy or Immediated loop electrosurgical excision

Question 16

A colposcopy with directed biopsy is gold standard for dx and treatment planning, it is a binocular steromicroscope with magnification, cervix is washed with 3% acetic acid which dehydrates cell and large nuclei of abnormal cells and turns them?

Answer 16

White! = Acetowhite changes (AW)

Question 17

A colposcopy must visualize the entire SCJ, looking for AW changes, punctuations, mosaicism, abdnormal vessels and masses (last two are worrisome)… What is the main difference between what a PAP and cytology/tissue gives you?

Answer 17

PAP: Intraepithelial lesions, ASC-US or ASC-H
Tissue: actual staging as carcinoma in situ or carcinoma

Question 18

If acetowhite AW changes are present, there is probably a CIN 1, if punctuations are present, they are most common associated with?

Answer 18

CIN2/3

Question 19

When mosaicism occurs it is bad, looks like red tiles within white, most likely a high grade lesions (CIN3), what is one charcteristic of cervical cancer that Dr. Wooton said?

Answer 19

It smells BAD

Question 20

Treatment includes ablative including cryotherapy and laser ablation as well as excisional treatment with cold knife cone (CKC-apple core like)-done under anethesia, and what?

Answer 20

Loop electrode excisional procedure (LEEP) - done in office

Question 21

There is an increased risk of cervical incompetence and resultant second trimester pregnancy lost, increased risk of preterm premature rupture of membrans PPROM, cervical stenosis and operative risks including infection and?

Answer 21

BLEEDING

Question 22

Death rate from cervical carcinoma is 4% per year, usually 47, 91% of cancer is caused by HPV< 80% SCC, 15% adenocarcinoma… symptoms include watery vaginal bleeding, postcoital bleeding (after sex) and intermittent?

Answer 22

spotting

Question 23

Cervical cancer is spread by either direct invasion or lymphatics and is staged clinically. if the cancer is invasive (Stage 1A/2) radical hysterctomy with LN dissection is good

Answer 23

NO_MEOW

Question 24

Prevention of cervical cancer includes sexual abstinence/ limiting number of partners, protection, regular exams and pap smears, and most importantly?

Answer 24

VACCINATIONS with HPV VAX

Question 25

HPV vax is three injections, 1 dose, 2nd 2 months later and 3rd 6 months from first, recommended for all children 9-26 and men/women 27-45*, not to be given during?

Answer 25

pregnancy but during breastfeeding is fine

Question 26

Gardisil covers 9 strains including 6, 11, 16, 18, 31, 33, 45, 52, 58 and has some side effects including syncope, dizziness, nausea, headache, injection site reactions and?

Answer 26

Fever