Screening

Question 1

Which qualities are most desirable in the stain used for studying cervical cells?

Answer 1

Good definition of the nucleus (and the amount of space it takes up in the cell)
Way of determining the relative maturity of each cell

Question 2

What does an unsatisfactory screening result mean?

Answer 2

Too few cells
or
Too much blood on the slide

Question 3

Would a woman over 65, who has never been screened need to be invited for a cervical smear?

Answer 3

No, but screened opportunistically if the occasion arises

Question 4

Would a woman that has never had heterosexual intercourse need to be screened?

Answer 4

yes

Question 5

Why are women under 25 not screened?

Answer 5

too many false positives

cervix changes rapidly during puberty and early 20s, changes often indistinguishable from low-grade abnormality

Question 6

At what age is the screening programme stopped and why?

Answer 6

65, if had 3 normal smears

cervical carcinoma very rare ever 65

Question 7

What solutions are applied to the surface of the surface during a colposcopy and why?

Answer 7

acetic acid

• turns areas of dysphagia white (higher nuclear to cytoplasm ratio)
• the greater the intensity f white refection, the greater the level of dyskaryosis

iodine solution

• after the acetic acid, cervix washed with water. then iodine applied
• normal squamous epithelium appears dark brown (lots of glycogen)
• dysplasia and metaplasic feel appear yellow/orange (less glycogen)

Question 8

Abnormal smear, showing borderline change in squamous or endocervical cells/ low grade dyskaryosis.
How is this managed?

Answer 8

HPV test

if positive - colposcopy - 6 week wait

if negative - return to routine screening

Question 9

Abnormal smear, Hugh grade dyskaryosis (moderate/severe). How is this managed?

Answer 9

colposcopy - 2 week wait

Question 10

Abnormal smear, suspected invasive cancer or glandular neoplasia. How is this managed?

Answer 10

colposcopy - week wait

Question 11

What is included in the Wilson criteria?

Answer 11

1. important health problem
2. natural history understood
3. recognisable latent/early symptom stage
4. least easy to perform, interpret, acceptable, accurate, reliable, sensitive, specific
5. accepted treatment
6. treatment more effective started early
7. policy on who should be treated
8. diagnosis and treatment cost effective
9. continuous case finding