PAPANICOLAU METHOD (PAP'S SMEAR)

Question 1

______________ is the SECOND BEST CHOICE for routine cytologic examination, AFTER PAPANICOLAU with a greater possibility for immediate microscopic examination used for hormonal evaluation of gynecologic specimen and for cancer detection

Answer 1

PHASE-CONTRASTE MICROSCOPY

Question 2

APPLICATIONS OF PAPANICOLAU METHOD (PAP’S SMEAR)

Answer 2

• SCREEN CERVICAL CANCER
• To determine the cause of certain infection
• Hormonal cytology
• Medico-legal examination of sexual assault

Question 3

PAP SMEAR PROCEDURE PREPARATION

Answer 3

• PATIENT SHOULD ABSTAIN FROM COITUS
• Do not douche the vagina for at least a day
• Do not apply intravaginal preparations for at least one week before the examination
• SMEARS SHOULD NOT BE TAKEN DURING MENSTRUAL BLEEDING, because contamination with blood, endometrial and tissue debris can obscure the cells in examination

Question 4

Pap smear should be done at least _____ days after the last menstrual period

Answer 4

at least 10 DAYS AFTER THE LAST MENSTRUAL PERIOD

Question 5

STAINS FOR PAP’S SMEAR:

Answer 5

1. Harris hematoxylin
2. Orange green 6 (OG-6) stain
3. Eosin Azure 50 (EA-50) stain

Question 6

Pap smear stain that stains the NUCLEUS:

Answer 6

Harris hematoxylin

Question 7

Pap smear stain that stains the CYTOPLASM OF MATURE CELL and stains KERATIN

Answer 7

ORANGE GREEN 6 (OG-6) stain

Question 8

Pap smear stain that sta8ins the CYTOPLASM OF IMMATURE CELL

Answer 8

EOSIN AZURE 50 (EA-50) stain

Question 9

COMPONENTS OF EA-50 STAIN:

Answer 9

• Light green SF
• Bismarck brown Y
• Eosin Y
• Phosphotungstic acid
• Lithium carbonate

Question 10

Stains the CYTOPLASM OF OTHER CELLS, including non-keratinized squamous cells.

Answer 10

LIGHT GREEN SF

Question 11

STAINS NOTHING and in contemporary formulants it is often omitted

Answer 11

Bismarck Brown Y

Question 12

Stains the superficial epithelial squamous cells, nucleoli, cilia, and red blood cells

Answer 12

EOSIN Y

Question 13

This method provides OPTIMUM NUCLEAR DETAIL information, which is important for cytologic evaluation of PAP’s smears, non-gynecological and FNA cytologic specimens

Answer 13

MODIFIED PAPANICOLAU STAIN

Question 14

In Modified Papanicolau stain, to produce a more distinct color differentiation:

Answer 14

BISMARCK BROWN IS OMOTED from the EA 50 formula

Question 15

Routine Pap’s procedure staining time

FIRST STAIN:

Answer 15

FIRST STAIN:
Stain in Harri’s hematoxylin, 5 minutes

Question 16

Routine Pap’s procedure staining time

SECOND STAIN:

Answer 16

SECOND STAIN:
Stain in OG-6, 2 minutes

OG-6 is the FIRST COUNTERSTAIN in PAP’s smear

Question 17

Routine Pap’s procedure staining time

THIRD STAIN:

Answer 17

THIRD STAIN:
EA-50 is the SECOND COUNTERSTAIN in PAP’s smear

Question 18

PAP’S SMEAR STAINING REACTION:

Nucleus:
CYTOPLASM, Keratinizing cells:
CYTOPLASM, Non-keratinizing cells:

Answer 18

NUCLEUS: BLUE or BLACK

CYTOPLASM, Keratinizing cells: PINK or ORANGE

CYTOPLASM, Non-keratinizing cells: BLUE or GREEN

Question 19

For vaginal hormonal cytology, smears are best taken from the __________________________ because it is more accessible and less likely to be contaminated by cellular debris and vaginal discharge

Answer 19

UPPER LATERAL THIRD OF VAGINAL WALL

Question 20

Estrogen effect:
Progesterone effect:

Answer 20

Estrogen effect: INCREASED SUPERFICIAL CELLS
E—->S

Progesterone effect: INCREASED INTERMEDIATE CELLS
P—->I

Question 21

In hormonal cytology, slide is checked under the ________________ to assess the quality of the smear and staining; quantitative evaluation is done using the ______

Answer 21

Hormonal cytology:

LPO: Quality
HPO: Quantity

Question 22

Different cytologic samples:

Answer 22

1. Upper lateral third of the vaginal wall
2. Ectocervix
3. Endocervix

Question 23

Cytologic sample ideal for vaginal HORMONAL STATUS:

Answer 23

UPPER LATERAL THIRD OF THE VAGINAL WALL

Question 24

MOST COMMON SITE FOR CANCER SCREENING because this is where malignancies arise

Answer 24

ECTOCERVIX

Question 25

For the detection of ENDOCERVICAL AND INTRAUTERIN LESIONS

Answer 25

ENDOCERVIX

Question 26

Tools for gynecologic specimen collection:

Answer 26

- Glass pipette and bulb - Ayre's spatula - Laryngeal cannula

Question 27

Tool used for vaginal aspiration:

Answer 27

Glass pipette and bulb

Question 28

Tool used for swab smears

Answer 28

Ayre's spatula

Question 29

Tool sued for endocervical or endometrial aspiration:

Answer 29

Laryngeal cannula

Question 30

Cells found in cervico-vaginal smear:

Answer 30

1. mature superficial cells 2. Intermediate cells 3. Parabasal cells 4. Endometrial cells 5. Endocervical glandular cells

Question 31

These polyglonal squamous cells measures 45 to 50 um and are identified by the presence of pale, pink-standing cytoplasm and DARK PYKNOTIC NUCLEI

Answer 31

MATURE SUPERFICIAL CELLS

Question 32

Medium-sized polyhedral or elongated cells with BASOPHILIC VACUOLATED CYTOPLASM

Answer 32

INTERMEDIATE CELLS

Question 33

Boat shaped intermediate cells with strong tendency to fold/curl on edges and its presence suggests a combined estrogen-progesteron effect

Answer 33

NAVICULAR CELLS

Question 34

Round/oval boat shaped intermediate cells with translucent basophilic cytoplasm observed greatest at the center of the cell

Answer 34

PREGNANCY CELLS

Question 35

Round or oval cells with small dense basophilic cytoplasm; similar to 'FRIED FRESH EGGS" with sunny-side up 15-30 um

Answer 35

PARABASAL CELLS

Question 36

Small cells, slightly cylindrical with less basophilic cytoplasm occurs in a tightly-packed groups of 3 or more; found during 1-10 DAYS AFTER MENSTRUATION

Answer 36

ENDOMETRIAL CELLS Note: Smears taken during menstruation is UNSATIFACTORY because it will yield to a high level of WBCs, RBCs, and endometrial cells

Question 37

Occur in large groups or small sheets; Cytoplasm stains pale blue/gray and finely vacuolated, often with indistinct cell borders and nuclei with finely granular chromatin; "HONEYCOMB" appearance when viewed on end

Answer 37

ENDOCERVICAL GLANDULAR CELLS

Question 38

Small, round to slightly oval cells with relatively large nuclei normally found in PUBERTY and AFTER MENOPAUSE:

Answer 38

BASAL CELLS

Question 39

Most common organism of the nromal vaginal flora that maintains the ACIDIC pH of the vagina; stains BLUE TO LAVENDER with Pap's method:

Answer 39

DODERLAIN BACILLUS

Question 40

Budding yeast seen in DIABETIC patients, people taking oral contraceptives and immunocompromised patients

Answer 40

Candida albicans

Question 41

Pear-shaped organism that stain BLUE-GREEN with a slit-like eccentric nucleus "PING=PONG DISEASE"

Answer 41

Trichomonas vaginalis

Question 42

Long thin filamentous bacilli, increased in high vaginal pH

Answer 42

Leptothrix spp.

Question 43

Abnormal variation of squamous epithelial cells that suggests the presence of Gardnerella vaginalis

Answer 43

CLUE CELLS

Question 44

Contaminant due to gloves (powder in gloves)

Answer 44

TALCUM

Question 45

Squamous epithelial cell that show the cytopathic effect of Human Papilloma Virus (HPV)

Answer 45

KOILOCYTES

Question 46

Also known as ARBORIZATION and the ferning is due to formation of SALT CRYSTALS in high NaCl concentration in cervical mucus under the influence of estrogen; sign/basis for early detection of EARLY PREGNANCY:

Answer 46

FERN or PALM=LEAF PATTERN

Question 47

Manner of reporting Pap's smear:

Answer 47

1. Class system 2. Bethesda system

Question 48

Reporting of Pap's smear based on the presence of malignant cells; obsolette:

Answer 48

Class system

Question 49

ABSENCE of atypical or abnormal cells Class:

Answer 49

Class I

Question 50

Atypical cytological picture but NO EVIDENCE of malignancy Class:

Answer 50

Class II

Question 51

Cytologic picture SUGGESTIVE BUT NOT CONCLUSIVE of malignancy Class:

Answer 51

Class III

Question 52

Cytologic picture STRONGLY SUGGESTIVE of malignancy Class:

Answer 52

Class IV

Question 53

Cytologic picture CONCLUSIVE of malignancy Class:

Answer 53

Class V

Question 54

New manner of reporting for cervical and vaginal cytologic diagnosis

Answer 54

Bethesda system

Question 55

Format of reporting using Bethesda system:

Answer 55

Specimen adequacy, General categorization, Descriptive diagnosis

Question 56

In collection of sputum, absence of alveolar macrophages suggest ________ rather than sputum and results an UNSATISFACTORY SPECIMEN

Answer 56

SALIVA

Question 57

For respiratory tract specimen, obtain at least _______________ sputum specimen

Answer 57

3 CONSECUTIVE MORING SPUTUM SPECIMEN

Question 58

Collect early morning sputum by DEEP COUGH in a wide-mouthed jar containing _______________________

Answer 58

SACCOMANO'S FLUID (50% Ethyl alcohol and 2% Carbowax)

Question 59

Respiratory tract specimens:

Answer 59

- SPUTUM - Bronchoalveolar lavage (BAL)/ Bronchial washing (BW) - Bronchial brushing (BB)

Question 60

For Gastrointestinal specimen, the patient should have fasted for _________ before gastring washing is performed

Answer 60

8 hours

Question 61

For peritoneal, pleural and pericardial fluid, jelly-like clots may be prevented by adding ___________ for every _______ of aspirate

Answer 61

300 units of heparin for every 100 mL aspirate

Question 62

When breast secretion is BLOODY, a _______________ should be considered clinically

Answer 62

BENIGN INTRADUCTAL PAPILLOMA

Question 63

Preferred urinary tract specimen:

Answer 63

Second urine

Question 64

Urine specimen volume needed to be centrifuged after collection::

Answer 64

at least 50 mL IS NEEDED, which must be CENTRIFUGED

Question 65

For CSF specimens, how much is the minimum volume necessary for cytologic evaluation?

Answer 65

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