CNM Board Exam Review Exam Questions With Verified Answers.

CNM Board Exam Review Exam Questions With Verified Answers. What is the 2nd leading cause of death in women ages 20-39 worldwide? - answerinvasive cervical carcinoma what is the purpose of the pap smear? - answer* to detect treatable precancerous lesions in the cervix * used for screening and diagnosis (complementary to biopsy) what is the gross appearance of the cervical transformation zone on colposcopy? - answerapplication of acetic acid reveals transition zone as white what are the layers of cervical squamous epithelium? - answerbasal to apical: * basal * parabasal * intermediate * superficial what are the normal histological appearances of the various layers of cervical squamous epithelium? - answer* basal: more cuboidal, dark blue, large nucleus * parabasal: beginning to flatten out, more visible cytoplasm, still blue * intermediate: flattened, squamous, shrunken nucleus, lighter blue * superficial: very flat, nucleus disappearing, pink what is a koilocyte? what does one look like/ - answerA Koilocyte is a squamous epithelial cell that has undergone a number of structural changes, which occur as a result of infection of the cell by HPV: * Nuclear enlargement * Irregularity of the nuclear membrane contour * A darker than normal nucleus (Hyperchromasia) * A clear area around the nucleus (perinuclear halo) in describing cervical cells, what terms are used in pap smear cytology? biopsy/histology? - answer* pap smear cytology: LSIL, HSIL * biopsy/histology: CIN 1 (mild dysplasia), CIN 2 (moderate dysplasia), CIN 3 (severe dysplasia to carcinoma in situ) what does LSIL look like on pap smear cytology? - answer* koilocytes what does HSIL look like on pap smear cytology? - answer* more undifferentiated koilocytes what does squamous cell carcinoma look like on pap smear cytology? - answer* lymphocytes * fibroblasts * old blood what test should be done for a woman whose pap smear indicates LSIL? - answer* colposcopy how should a patient with a pap smear indicating HSIL be treated? - answereither a) immediate loop electrosurgical excision, or b) colposcopy how do LSIL and HSIL appear on colposcopy and biopsy? - answer what is the treatment for a woman with a biopsy indicating CIN 3? - answerexcision! what proportion of CIN1 regress? what proportion of CIN 3 progress to cancer? - answerCIN 1: 57% regress spontaneously CIN 3: 12% progress to cancer what is ASC-US? what test should automatically follow a pap smear indicating ASC-US? - answerASC-US: atypical squamous cells of undetermined significance (Borderline or atypical abnormalities on Pap smear that do not fit into normal, LSIL, HSIL, or cancer categories) * follow up: HPV test for women 30 years old, what test should always be administered along with a pap smear? why? - answerHPV test! * why? because the prevalence of HPV (the main risk factor for cervical cancer) is lower in women 30 and is therefore a more meaningful surrogate marker for cancer risk * a normal pap combined with a negative HPV test allows a woman to increase the interval between future screenings what is the flow of management for abnormal pap smears? - answer do we do routine screening for HPV in all women? why or why not? - answer* HPV screening is only done as a primary screen for women over 30 * why? because HPV a) is so common in young people and b) most often is self-resolving, that it is a much less meaningful test for younger women than for older women important points about the HPV vaccine - answer* goal: prevent HPV infection (6, 11, 16, 18) in unexposed girls/women & boys/men via induction of antibodies (cervical cancer prophylaxis) * does not replace other prevention strategies (condoms, etc.) * contains VLPs (virus-like particles) * Gardasil protects against strains of HPV that can cause genital/anal warts * NOT used as therapy for existing HPV infection * DOES NOT change screening (pap smear) recommendations what are the most common causes of abnormal uterine bleeding? (mnemonic) - answermnemonic: PALM COEIN * Polyp (endometrial) * Adenomyosis * Leiomyosis (fibroids) * Malignancy (cancer) * Coagulopathy * Ovulatory dysfunction * Endometrial * Iatrogenic * Not yet classified what are some uterine causes of abnormal uterine bleeding? - answerUTERUS: * endometrial polyp * pregnancy (normal, ectopic, spontaneous abortion)