Cervical Cancer Screening

Question 1

what is the cause of virtually all cases of cervical cancer?

Answer 1

HPV

Question 2

how does the anatomy of the cervix change as a patient ages?

Answer 2

squamocolumnar junction moves closer to the external os

Question 3

NILM

Answer 3

negative for intraepithelial lesions or malignancy

Question 4

ASCUS

Answer 4

atypical squamous cells of undetermined significance

Question 5

LSIL

Answer 5

low-grade squamous intraepithelial lesion

Question 6

ASC-H

Answer 6

atypical squamous cells, cannot exclude HSIL (high grade)

Question 7

HSIL

Answer 7

high-grade squamous intraepithelial lesion

Question 8

AGC

Answer 8

atypical glandular cells

Question 9

lesion in which part of the epithelium is replaced by cells showing varying degrees of atypia

Answer 9

dysplasia

Question 10

low-grade lesion with low risk of progression; mild atypia in lower third of epithelium

Answer 10

CIN 1

Question 11

moderately atypical cells confined to the lower 2/3 of epithelium

Answer 11

CIN 2

Question 12

strong predictor for progression to cervical cancer; severely atypical changes where over 2/3 of the epithelial thickness and includes full-thickness lesions

Answer 12

CIN 3

Question 13

at what age should cervical cancer screening begin?

Answer 13

21

Question 14

what is used to screen for HPV?

Answer 14

cytology (pap smear) q 3 years

Question 15

what patients need testing for STIs?

Answer 15

< 25 and sexually active

Question 16

what is not considered a risk factor for cervical cancer?

Answer 16

family history

Question 17

what HPV type has the highest carcinogenic potential (#1 cause) and associated with squamous cell carcinoma?

Answer 17

HPV-16

Question 18

what HPV type has the 2nd highest carcinogenic potential (#2 cause) and associated with adenocarcinoma?

Answer 18

HPV-18

Question 19

what are 3 known factors that increase the likelihood of persistent HPV?

Answer 19

smoking
immunocompromised state
HIV

Question 20

what age does HPV vaccination start and up to what age?

Answer 20

as early as 9
up to 45 yo

Question 21

at what age, regardless of sexual status or partner gender, does pap smear begin?

Answer 21

age 21

Question 22

31 year old comes to clinic for an annual exam. She thinks her last pap was 2-3 years ago and she thinks she had an abnormal pap 10 years ago that resolved without treatment. how often should cervical cancer screening be done? what tests should you order?

Answer 22

every year

cytology (pap smear)
co-testing

Question 23

for patients aged 21-30, how often should cytology (pap smear) be done?

Answer 23

every 3 years

Question 24

for patients aged 30 and older, how often should cytology (pap smear) and HPV be done?

Answer 24

every 5 years

Question 25

at what age can pap smear be stopped if patient has not had any abnormal findings?

Answer 25

65

Question 26

how often should patients with HIV and immunocompromised patients receive a pap smear?

Answer 26

annually for 3 yrs, then q 3 years for life if normal

Question 27

how often should patients with exposure to DES in utero receive a pap smear?

Answer 27

annually

Question 28

how often should a patient with a history of CIN2 receive a pap smear/HIV test?

Answer 28

every year x 3 years, then q3 years x 25 years

Question 29

if patient does not have a _____, you should not perform a pap smear

Answer 29

cervix

Question 30

a 28 yo patient has a pap that returns as ASC-US (atypical squamous cells of undetermined significance). Has never had an abnormal pap. what is the next step?

Answer 30

colposcopy (biopsy)

Question 31

a 28 yo patient has a pap that returns as ASC-US (atypical squamous cells of undetermined significance). Has never had an abnormal pap. After getting a colposcopy, it reveals a CIN3 on several biopsies. what is our management?

Answer 31

diagnostic excisional procedure

Question 32

a 40 yo presents for her well-woman visit and during the pelvic exam, you see the following:
what should we do?

Answer 32

biopsy