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Cervical & Vag Cyto > Cervical & Vaginal Cytology > Flashcards

Cervical & Vaginal Cytology Flashcards

1
Q

Which of the following guidelines should be followed in order to obtain an ideal Pap smear specimen?
A. A lubricated speculum is favored over a non-lubricated speculum
B. The sample should be obtained after the application of acetic acid
C. Excess mucus or other discharge should be retained for examination
D. An optimal specimen includes cells exclusively from the ectocervix
E. Two weeks after the LMP is the preferred examination time

A

E. Two weeks after the LMP is the preferred examination time

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2
Q

According to the specimen adequacy criteria in the 2014 Bethesda System, which of the following Pap smear specimens is considered unsatisfactory for evaluation?
A. TP smear containing approx 6000 squamous cells
B. Conventional smear containing approx 6000 squamous cells
C. Smear without endocervical cells
D. Smear with 50% of epithelial cells obscured by inflammation
E. Smear with 50% of epithelial cells obscured by drying artifact

A

B. Conventional smear containing approx 6000 squamous cells

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3
Q 
How many well-visualized squames must be present on a liquid-based Pap slide from a healthy woman so that the specimen would be considered to be satisfactory for evaluation? 
A. 1000
B. 2500
C. 5000
D. 8000
E. 10000
A

C. 5000

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4
Q

Pap smear specimens with less than 5000 squamous cells may still be considered adequate in which of the following conditions?
A. Women younger than 21 years
B. Women aged 21-29 years
C. Women who are pregnant
D. Women who received radiation therapy for cervical cancer
E. Women who are on oral contraceptives

A

D. Women who received radiation therapy for cervical cancer

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5
Q

The Pap smear from a 38yo female woman showed cohesive flat sheets of cells with large nuclei, pale chromatin, abundant cytoplasm, and prominent nucleoli. Occasional mitoses were seen. These features are characteristics of which of the following?
A. Atrophy
B. Repair
C. Atypical endocervical cells, not otherwise specified
D. Endocervical adenocarcinoma
E. Squamous cell carcinoma

A

B. Repair

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6
Q

When estimating cellularity on Pap smear slide, what type of cells should be included in the evaluation?
A. Metaplastic squamous cells
B. Squamous cells obscured by neutrophils
C. Endocervical cells
D. Endometrial cells
E. Histiocytes

A

A. Metaplastic squamous cells

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7
Q

Which of the following cytologic features is characteristic of radiation changes seen in a Pap smear?
A. High N/C ratio
B. Abundant isolated cells
C. Cytoplasmic vacuolization and polychromasia
D. Frequent mitoses
E. Coarsely granular and hyperchromatic chromatin

A

C. Cytoplasmic vacuolization and polychromasia

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8
Q 
Women born to mothers who took diethylstilbestrol (DES) during pregnancy would most likely show what type of changes in their vaginal smear specimens?
A. A shift in vaginal flora
B. LSIL
C. HSIL
D. Atrophic vaginitis 
E. Presence of glandular cells
A

E. Presence of glandular cells

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9
Q 
HPV infection is established in which layer of the squamous epithelium?
A. Anucleated surface keratin layer
B. Parakeratotic surface squamous cells
C. Superficial squamous cells
D. Intermediate squamous cells
E. Basal squamous cells
A

E. Basal squamous cells

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10
Q

Which of the following statements is TRUE regarding cervical oncogenesis and the genome of HPV?
A. The E1 and E2 are most responsible for the cervical oncogenesis
B. The E3 and E4 are the principal components of the HPV vaccines
C. L1 binds to the retinoblastoma tumor suppresion protein pRB and abolishes cell-cycle arrest
D. E6 binds to p53 and results in blocking of apoptosis
E. E7 binds to p16 and results in proliferation of cells

A

D. E6 binds to p53 and results in blocking of apoptosis

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11
Q

Which of the following statements is TRUE regarding HPV?
A. HPV is a small RNA virus
B. HPV 6, 11 is the most common subtypes detected in cervical cancer
C. Only a minority of HPV infections persist and lead to cancer
D. Koilocytes are an artifact if fixation and not related to HPV
E. Serology is an accurate way to detect HPV infection

A

C. Only a minority of HPV infections persist and lead to cancer

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12
Q 
Which of the following is the MOST important cytomorphologic feature for HSIL?
A. Prominent nucleoli
B. Syncytial growth 
C. Prominent cytoplasmic vacuoles
D. Large cell size
E. High nuclear-to-cytoplasm ratio
A

E. High nuclear-to-cytoplasm ratio

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13
Q

Which of the following statements is TRUE about the follow-up management after a Pap smear interpretation of LSIL?
A. Adolescents with LSIL are managed less aggressively
B. Postmenopausal women with LSIL are managed more aggressively
C. Pregnant women with LSIL are managed more aggressively
D. HPV testing is recommended for premenopausal women with LSIL
E. Diagnostic excisional procedures are routinely used in women with LSIL

A

A. Adolescents with LSIL are managed less aggressively

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14
Q 
A 30yo woman had a routine Pap smear. The smear showecells of squamous metaplasia with some degree of nuclear atypia, concerning but definitive for the diagnosis of high-grade dysplasia. How these cells are best classified?
A. ASCUS
B. ASCH
C. LSIL
D. HSIL
E. SCC
A

B. ASCH

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15
Q

A 25yo pregnant woman had a Pap smear which was interpreted as HSIL. Which of the following is CORRECT for pregnant women with HSIL?
A. Colposcopy during pregnancy is not recommended
B. The diagnostic excisional procedure should only be performed immediately postpartum
C. Colposcopy and repeat Pap testing should be performed immediately postpartum
D. Biopsy of lesions suspicious for CIN 2 or CIN3, if feasible
E. Endocervical curettage (ECC) should be always performed

A

C. Colposcopy and repeat Pap testing should be performed immediately postpartum

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16
Q

Which of the following is a specific cytomorphologic feature of squamous intraepithelial lesion?
A. Prominent halos
B. Nuclear enlargement
C. Prominent nucleoli
D. Hyperchromasia and irregular nuclear membrane
E. Finely granular chromatin

A

D. Hyperchromasia and irregular nuclear membrane

17
Q 
Which HPV subtype accounts for the majority of cervical squamous cell carcinoma worldwide?
A. HPV 6
B. HPV 11
C. HPV 16
D. HPV 18
E. HPV 31
A

C. HPV 16

18
Q 
Which of the following cytologic features may help distinguish SCC from HSIL?
A. Tumor diathesis
B. High N/C ratio
C. Abundant keratinizing cytoplasm
D. Hyperchromasia
E. Irregular cell shapes
A

A. Tumor diathesis

19
Q 
Prominent macronucleoli are cytologic features of cells classified under which one of the following diagnoses? 
A. LSIL cells
B. HSIL cells
C. Squamous cells in atypical repair
D. Parabasal squamous cells in atrophy
E. Benign endometrial cells
A

C. Squamous cells in atypical repair

20
Q

“Feathering” is a term used to describe Pap smear findings in which of the following entities?
A. Tubal metaplasia
B. Endocervical adenocarcinoma in-situ (AIS)
C. Exfoliated endometrial cells
D. HSIL
E. Invasive adenocarcinoma

A

B. Endocervical adenocarcinoma in-situ (AIS)

21
Q 
Which of the following features is more typical of neoplastic endocervical cells (AGUS or AIS) than reactive/ reparative endocervical cells?
A. Flat sheet arrangement
B. Prominent nucleoli
C. Marked variation in nuclear size
D. Elongated and hyperchromatic nuclei
E. Presence of mitosis
A

D. Elongated and hyperchromatic nuclei

22
Q 
When differentiating endocervical adeno from endometrial adeno, which of the following features favor endometrial rather than endocervical adeno?
A. Prominent nucleoli
B. Mitoses
C. Tumor diathesis
D. Intracytoplasmic neutrophils
E. Abundant cytoplasm
A

D. Intracytoplasmic neutrophils

23
Q 
Which of the following represents the MOST common metastatic tumor to the cervix?
A. MET breast ca
B. MET melanoma
C. MET rectal ca
D. MET ovarian ca
E. MET urothelial ca
A

D. MET ovarian ca

24
Q

A 30yo woman had a Pap test showing HSIL at the time of her annual gyn exam. She underwent a colposcopic examination. A biopsy of the cervix showed moderate squamous dysplasia (CIN 2). What is the MOST appropriate management recommendation for this woman?
A. Repeat the Pap test in 6 months
B. Perform the loop electrosurgical excision procedure (LEEP)
C. High-risk HPV test
D. Hysterectomy
E. Endocervical curretage

A

B. Perform the loop electrosurgical excision procedure (LEEP)

25
Q 
What is the MOST common anatomic location of cervical squamous intraepithelial neoplastic (CIN) lesions? 
A. Lateral side of ectocervix
B. The T-zone/squamocolumnar junction
C. Lower end of the endocervical canal
D. Upper end of the endocervical canal
E. Vaginal fornix
A

B. The T-zone/squamocolumnar junction

26
Q

Which of the following statements is TRUE about the currently used HPV vaccine Gardasil?
A. The vaccine covers all high-risk HPV subtypes
B. Women are no protected if they have been infected by the same HPV types prior to vaccination
C. The vaccine is approved for use in sexually active women of all ages
D. The vaccine contains inactivated live viruses subtypes 16 and 18
E. The vaccine is given orally in 3 doses over a 6-month period

A

A. The vaccine covers all high-risk HPV subtypes

27
Q

Dark blue or purple calcific spheres with concentric laminations are rarely encountered in Pap smears. What is the clinical significance of the finding?
A. It represents a rare contaminant of no clinical significance
B. It represents a rare microorganism
C. It may be associated with endometriosis
D. It may be associated with an endocrine disorder
E. It may be associated with an ovarian neoplasm

A

E. It may be associated with an ovarian neoplasm

28
Q 
What is the recommended initial workup for women with a Pap smear diagnosis of atypical endometrial cells? 
A. Reflex high-risk HPV testing
B. Immediate repeat Pap smear
C. Colposcopic examination
D. Endometrial and endocervical sampling
E. Simple hysterectomy
A

D. Endometrial and endocervical sampling

29
Q 
Hyperchromatic crowded groups (HCGs) seen in a Pap smear under low power are helpful diagnostic features for which of the following conditions or diseases?
A. ASCUS
B. LSIL
C. HSIL
D. Repair
E. Radiation changes
A

C. HSIL

30
Q 
When differentiating endocervical adeno from endometrial adeno, which positive IHC stain favors the diagnosis of endocervical adeno?
A. ER
B. Vimentin
C. p16
D. Pancytokeratin
E. Beta-catenin
A

E. Beta-catenin

31
Q 
According to the current (pub in 2012) joint recommendations of the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology, cervical cancer screening for women in the general population should begin at what age? 
A. The age of sexual initiation
B. The age of 1st pregnancy
C. Age 21
D. Age 30
E. Age 35
A

C. Age 21

32
Q

A 35yo woman presents for her well woman exam. Which of the following statements is TRUE regarding her cervical cancer screening according to the current ASCCP screening guideline?
A. She can be screened every year with Pap smear alone
B. She can be screened every year with an HPV test alone
C. She can be screened every year with Pap smear and HPV co-testing
D. She can be screened every three years with Pap smear and HPV co-testing
E. She can be screened every five years with Pap smear and HPV co-testing

A

E. She can be screened every five years with Pap smear and HPV co-testing

33
Q 
Which of the following is an acceptable management choice for women > age 30, who are cytology negative but HPV positive?
A. Repeat cytology in 6 months
B. Repeat cytology in 12 months
C. Repeat co-testing in 6 months
D. Repeat co-testing in 12 months
E. Refer for immediate colposcopy
A

B. Repeat cytology in 12 months

34
Q

A Pap smear was performed on a 42yo woman and reported atypical endocervical cells NOS. What is the appropriate management for her?
A. Reflex HPV testing
B. Repeat cytology in 12 months
C. Endocervical sampling
D. Colposcopy
E. Colposcopy with endocervical sampling and endometrial sampling

A

C. Endocervical sampling

35
Q

In which of the following populations that cervical cancer screening is not necessary?
A. Women who are vaccinated against HPV
B. Women who are postmenopausal
C. Women who are younger than 21 years
D. Women who underwent total hysterectomy five years ago and had CIN II
E. Women older than 65 years with a history of CINN III 10 years ago

A

C. Women who are younger than 21 years

36
Q

A 68yo women had a recent Pap smear reported as ASCUS and the reflex HPV test is negative. Her two previous Pap smears were negative. Which of the following statements is CORRECT regarding her management?
A. She is allowed to exit from screening because she is over 65 years
B. She should be referred to colposcopy
C. She should be further tested for HPV 16 and HPV 18
D. She should repeat screening in 3 years
E. She should repeat screening in 1 year

A

E. She should repeat screening in 1 year

Cervical & Vag Cyto (1 decks)

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