Widstrom: PAP Smear

Question 1

ASC-US

Answer 1

Atypical squamous cells of undetermined Signifiance

Question 2

LSIL

Answer 2

Low grade Squamous intra-epithelial neoplasia

Question 3

HSIL

Answer 3

High grade Squamous intraepithelial neoplasia

Question 4

ASC-H

Answer 4

Atypical squamous cells of undetermined significance (can’t exclude high grade)

Question 5

AGS-NOS

Answer 5

atypical glandular cells-NOS

Question 6

AGS

Answer 6

favor neoplasia

Question 7

AIS

Answer 7

adenocarcinoma in situ

Question 8

CIN 1, 2, 3

Answer 8

Cervical intraepithelial neplasia (mild, mod, severe)

Question 9

What are the high risk types of HPV?

Answer 9

16 and 18 (identified in 99.7% if all cases of cervical cancer)

Question 10

What happens to most HPV cases?

Answer 10

Most HPV regress, body takes care of it

Question 11

What are high RF for cervical cancer?

Answer 11

HIV positive
Immunosuppresed
Hx of abnormal tests in past 10 years
Hx of cervical cancer
HIstory of CIN2/3/CIS
History of DES exposure

Question 12

Who should be screened for HPV?

Answer 12

pap at age 21 or within 3 years of onset of sexual activity

Question 13

Should you screen a woman under 21 for cervical cancer? What else should you discuss w/ a woman <21?

Answer 13

NO (regardless of sexual initiation or other RF)

Discuss HPV vaccine
90% of HPV cases resolve w/in 24 mos
CIN is common
Cancer is rare

Question 14

Woman 21-29

Answer 14

screened w/ cervical cytology every 3 years

HPV testing is NOT receommended

Question 15

If a woman 21-29 has an ASC-US result, what should be done?

Answer 15

Use HPV to triage

ANNUALLY if immunosuppressed, HIV positive, or DES exposed

Question 16

What type of screening should be done for women 30-65?

Answer 16

Screen w/ a combo of cytology and HPV testing every 5 years (preferred) or cytology alone every 3 years

Question 17

What type of screening should be done for a woman 30-65 yrs who is HIV positive or has a hx of CIN 1/2/3?

Answer 17

Screen w/ cytology alone every 3 years or cytology + HPV every 5 years

Question 18

What type of screening should women over 64 receive?

Answer 18

DO NO screen woman who have had adequate prior screening who are NOT otherwise at risk for cervical cancer, or who have evidence of prior screening and no history of CIN 2 w/in past 20 years

Question 19

What is adequate prior screening?

Answer 19

3 consecutive negative cytology screenings (at 3 year intervals) w/in last 10 years

2 consecutive negtive cotests w/in the past 10 years

Question 20

What type of screening should be done for someone who is HIV positive?

Answer 20

Screen at 6 mo intervals until 2 PAP test are negative than annual screening (begin screening at time of dx regardless of age)

Question 21

Do you screen women who ahve undergone removal of the cervix and have NO hx of CIN 2 or cervical cancer?

Answer 21

NO

Question 22

Following a total hysterectomy, what patients should you continue to screen for vaginal cancer?

Answer 22

Hx of CIN 2/3/CIS, adenocarcioma-in situ or

cancer

Question 23

What does gardasil protect aginst?

Answer 23

HPV 16, 18, 6 and 11 (given at ages 9-26 @ 0, 2, 6 mos)

Question 24

What variations of HPV are responsible for 90% of genital warts?

Answer 24

6 and 11

Question 25

What should you do if HPV is negative and cytology is normal or ASC-US?

Answer 25

repeat co-testing in 5 years

Question 26

What should you do if HPV is positive and cytology is normal/ASC-US or HPV is positive or negative and cytology is higher than LSIL?

Answer 26

Do colposcopy

Question 27

What should you do if cytology is negative and HPV is postivie for HPV 16/18?

Answer 27

colposcopy

Question 28

What should you do if cytology is negative and HPV is positive but NOT for 16/18?

Answer 28

repeat HPV test and cytology in 1 year

Question 29

What type of routine screening should women get who have a hx of CIN grade 2 or higher?

Answer 29

routine screening for at least 20 years (even if it expends past 65)