[CLMD] The Pap smear, Cervical Dysplasia and Cancer [Wootton]

Question 1

Where do 90% of cervical neoplasia arise?

Answer 1

Squamocolumnar junction (SCJ)

Question 2

What are the two types of epithelium that are NORMALLY found in the cervix?

Answer 2

Columnar and stratified non keratinizing squamous epithelia

Question 3

What are the two phases of life when the transformation zone is located INSIDE the cervix?

Answer 3

Neonatal

Postmenopausal

Question 4

What are the 4 most significant cancer specific HPV varients?

Answer 4

16, 18, 31, 45

Question 5

What HPV subtypes are associated with genital warts?

Answer 5

6, 11

Question 6

What are the risk factors for cervical neoplasia?

Answer 6

• Multiple sexual partners
• HIV
• Smoking
• STIs
• Organ transplant
• Diethylstilbestrol exposure

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Question 7

What are the guidelines for screening for cervical cancer in the following ages?

Under 21

21-29

30-65

65 and over

After Hysterectomy

Answer 7

Under 21 = NO SCREENING

21-29 = Cytology alone every 3 years

30-65 = HPV and cytology COTESTING every 5 years

65 and over = No screening folowing adequate negative prior screening

After Hysterectomy = NO screening

Question 8

What is the stepwise progression from NORMAL cervical tissue to cervical cancer?

Answer 8

Normal –> LSIL –> HSIL–> Cervical cancer

Question 9

What does ASC-US stand for?

Answer 9

Atypical squamous cells of undetermined significance

Question 10

What does LSIL stand for?

Answer 10

Low grade squamous intraepithelial lesions

Question 11

If your patient presents with LSIL, what is the next best step?

Answer 11

Colposcopy

Question 12

What does HSIL stand for?

Answer 12

High grade squamous intraepithelial lesions

Question 13

What is a colposcopy?

Answer 13

Directed biopsy for diagnosis and treatment planning of the cervix

Question 14

During a colposcopy, the cervix is washed with a _______________ which dehydrates cell and large nuclei of abnormal cells and turns them white

Answer 14

During a colposcopy, the cervix is washed with a 3% acetic acid which dehydrates cell and large nuclei of abnormal cells and turns them white

Question 15

What are the specific visual changes OB/GYNs are looking for during a colposcopy?

Answer 15

Acetowhite changes

Punctuations

Mosaicism

Abnormal vessels

Masses

Question 16

Pregnancy is a contraindication for what procedure?

Answer 16

Endocervical curettage (ECC)

Question 17

Describe the image

Answer 17

Normal cervix (young)

Question 18

Describe the image

Answer 18

Normal cervix (older)

Question 19

Describe the image

Answer 19

Acetowhite changes

Question 20

Describe the image

Answer 20

Punctuations

Question 21

Describe the image

Answer 21

Mosaicism

Question 22

Describe the image

Answer 22

Atypical vessels

Question 23

Describe the image

Answer 23

Low grade lesion (CIN1-2)

Question 24

Describe the image

Answer 24

High grade lesions (CIN3)

Question 25

Describe the image

Answer 25

Cervical cancer

Question 26

What is the 2 BEST treatments option for cervical cancer?

Answer 26

Cold knife cone (CKC) Loop electrode excisional procedure (LEEP)

Question 27

What are the symptoms of cervical cancer?

Answer 27

Watery vaginal bleeding Postcoital bleeding Intermittent spotting

Question 28

How do you prevent cervical cancer?

Answer 28

- Limit sexual partners/abstinence - Barrier protection - Regular exams/paps - HPV vaccine