CIN Flashcards
The squamocolumnar junction (SCJ) is the area on the cervix where:
A) Only columnar epithelium is present.
B) Only squamous epithelium is present.
C) Squamous and columnar epithelium meet.
D) Nabothian cysts are most likely to form.
C) Squamous and columnar epithelium meet.
Explanation: The SCJ is the dynamic transition zone between the squamous epithelium of the ectocervix and the columnar epithelium of the endocervical canal. Its location changes over a woman’s lifetime in response to hormonal influences.
Which type of cervical epithelium is most susceptible to HPV infection and subsequent development of CIN?
A) Mature squamous epithelium.
B) Endocervical columnar epithelium.
C) Metaplastic squamous epithelium within the transformation zone.
D) Basal cells of the squamous epithelium.
C) Metaplastic squamous epithelium within the transformation zone.
Explanation: The transformation zone, with its actively changing metaplastic epithelium, is particularly vulnerable to HPV infection and is where most CIN lesions develop.
In a postmenopausal woman, the transformation zone is most likely located:
A) Far out on the ectocervix.
B) At the external os.
C) Within the endocervical canal.
D) In the vagina.
C) Within the endocervical canal.
Explanation: As women age, the transformation zone tends to migrate inward, toward the endocervical canal, making colposcopic visualization more challenging.
CIN is best described as:
A) A cytological diagnosis based on Pap smear findings.
B) An invasive cancer of the cervix.
C) A histopathological diagnosis indicating pre-cancerous changes in the cervical epithelium.
D) A normal finding in reproductive-age women.
C) A histopathological diagnosis indicating pre-cancerous changes in the cervical epithelium.
Explanation: CIN is a histological diagnosis after biopsy and is graded (CIN 1, 2, 3) based on the proportion of the epithelium showing dysplastic changes. Dysplasia refers to the changes resembling cancer cells.
According to the Bethesda system, which Pap test result represents the greatest concern for high-grade disease?
A) ASC-US
B) ASC-H
C) LSIL
D) NILM (Negative for Intraepithelial Lesion or Malignancy)
B) ASC-H
Explanation: ASC-H (Atypical Squamous Cells - Cannot Exclude High-grade Squamous Intraepithelial Lesion) carries a higher risk of underlying high-grade CIN (CIN 2 or 3) compared to ASC-US or LSIL.
Which of the following best describes LSIL (Low-grade Squamous Intraepithelial Lesion) in the Bethesda system?
A) Moderate to severe dysplasia
B) Changes associated with HPV infection or mild dysplasia
C) Invasive squamous cell carcinoma
D) Atypical glandular cells of undetermined significance
B) Changes associated with HPV infection or mild dysplasia
Explanation: LSIL typically encompasses changes related to HPV infection and CIN 1.
What is the primary causative agent of cervical intraepithelial neoplasia (CIN) and cervical cancer?
A) Chlamydia trachomatis
B) Neisseria gonorrhoeae
C) Human papillomavirus (HPV)
D) Trichomonas vaginalis
C) Human papillomavirus (HPV)
Explanation: HPV, particularly high-risk types, is the overwhelming cause of cervical cancer and its precursor lesions.
Which of the following is NOT a risk factor for developing CIN?
A) Early age at first intercourse.
B) Multiple sexual partners.
C) Regular cervical cancer screening.
D) Immunodeficiency (e.g., HIV).
C) Regular cervical cancer screening.
Explanation: Regular screening is a preventative measure, not a risk factor.
A woman has an ASC-US Pap test result. What is the MOST appropriate next step in management (assuming she is over 30)?
A) Repeat Pap smear in 6 months.
B) HPV testing
C) Colposcopy.
D) Endometrial biopsy.
B) HPV testing
Explanation: The general guidance for management of these patients is to follow ASCCP guidelines for patients based on their age and prior testing.
What is considered the “gold standard” diagnostic procedure for evaluating CIN?
A) Pap smear
B) HPV testing
C) Colposcopy with biopsy
D) LEEP
C) Colposcopy with biopsy
Explanation: Colposcopy allows for direct visualization of the cervix, and biopsy allows for a histological diagnosis of CIN grade.
Which colposcopic finding is MOST suggestive of high-grade CIN or invasive cancer?
A) Nabothian cysts
B) Smooth, pink epithelium
C) Atypical vessels
D) Acetowhite epithelium with distinct margins.
C) Atypical vessels
Explanation: Atypical vascular patterns (irregular, distorted vessels) are a sign of angiogenesis and increased vascularity associated with more advanced disease.
Which of the following treatments is considered ablative?
A) LEEP (Loop Electrosurgical Excision Procedure).
B) Conization
C) Hysterectomy.
D) Cryotherapy.
D) Cryotherapy.
Explanation: Cryotherapy destroys tissue in situ, whereas LEEP and conization excise tissue for histological evaluation.
What is the most effective primary prevention strategy for cervical cancer?
A) Regular Pap smear testing.
B) HPV vaccination.
C) Smoking cessation.
D) Using condoms.
B) HPV vaccination.
Explanation: HPV vaccination targets the most common high-risk HPV types, significantly reducing the risk of infection and subsequent CIN and cervical cancer.
