Pap Smear, Cerical Dysplasia, Cercical Cancer

Question 1

Where is the site where we have the greatest prevalence of cervical neoplasia and why?

Answer 1

Squamocolumnar junction

Stratified non keratinizing squamous epithelia and then columnar

Question 2

Cervical cancer and CIN are caused by what?

Answer 2

HPV

Question 3

What are the high risk HPV types and what are the two most common causes of cervical cancer?

Answer 3

16,18, 31, 45

16,18

Question 4

6 top common risk factors for cervical neoplasia?

Answer 4

Multiple sex partners or sexual partner with multiple partners
Smoking
Organ transplant/HIV/immunocompromised
STI
Young age of first sex
Infrequent or absent pap smear

Question 5

At what age do we start screening for cervical cancer?

Answer 5

21

Question 6

What is the recommendation for 21-29 years of age as far as cervical screening?

Answer 6

Cytology alone every 3 years

Question 7

What is the recommendation for 30-65 years of age for cervical screening?

Answer 7

HPV and Cytology testing every 5 years

Question 8

What happens with cervical screening at age 65?

Answer 8

Stop screening if there is an adequate negative prior screening

Question 9

When the pathologist is mentioning in the report that there is ASCUS, what does that mean?

Answer 9

Atypical squamous cells of undetermined significance

Question 10

What if the pathologist in the report says ASCH? What does this mean?

Answer 10

Atypical squamous cells and cannot exclude high grade

Question 11

What are the 4 things that can come back for a squamous cell abnormality?

Answer 11

Atypical cells, low grade, high grade, carcinoma

Question 12

What is the correct management for ASCUS? 2 things.

Answer 12

Repeat cytology in 1 year and if negative, continue routine. If positive, colposcopy.
Check HPV. If negative repeat in 3 years. If positive, colposcopy.

Question 13

What is the preferred management for a lady with Low grade with a negative HPV test? low grade with no HPV test? Low grade with positive HPV test?

Answer 13

Repeat contesting in 1 year.
Colposcopy
Colposcopy

Question 14

2 treatment options for high grade?

Answer 14

Leep or colposcopy

Question 15

What is the gold standard for diagnosis and treatment planning for cervical lesions?

Answer 15

Colposcopy with direct biopsy

Question 16

What does the doctor do to visualize the abnormal cells better?

Answer 16

Cervix is washed with acetic acid and the abnormal cells’ nuclei turn white.

Question 17

What different visual cues are we looking for when performing a colposcopy that will clue us in on severity? 5 things.

Answer 17

Acetowhite changes, punctuations, mosaicism, abnormal and large blood vessels, masses.

Question 18

What is the Bethesda progression of cervical cancer?

Answer 18

negative IEN, ASCUS, ASCH, low grade, high grade, squamous cell carcinoma

Question 19

What is the CIN for low grade and high grade?

Answer 19

CIN 1 is low grade typically (can sometimes have 2) and CIN 2 and 3 is high grade

Question 20

2 excisonal techniques for lesions?

Answer 20

Cold knife cone and LEEP

Question 21

What would be 3 indications for excisional techniques for lesions/masses?

Answer 21

Endocervix is affected
Can’t see SCJ on colposcopy
Report says high grade but you cant see it when looking

Question 22

What are three common symptoms of a patient presenting with cervical cancer and which one did she say is most common of the three?

Answer 22

Watery vaginal bleeding
After sex bleeding (most common)
Intermittent spotting

Question 23

Number 1 side effect for HPV vaccine?

Answer 23

Syncope