CNM Board Exam Review Questions And Correct Answers
what is the 2nd leading cause of death in women ages 20-39 worldwide? - ANSWER
invasive 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? -
ANSWER application of acetic acid reveals transition zone as white
What are the layers of cervical squamous epithelium? - ANSWER basal 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/ -ANSWER A 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)
What is the terminology used in describing cervical cells: 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 is the cytologic appearance of LSIL on pap smear cytology? - ANSWER *
koilocytes
What is the cytologic appearance of HSIL on pap smear cytology? - ANSWER * more
undifferentiated koilocytes
what is the appearance of squamous cell carcinoma on pap smear cytology? - ANSWER
* lymphocytes
* fibroblasts
* old blood
what is the test to be carried out for a female whose pap smear shows LSIL? - ANSWER
* colposcopy
what treatment should be given to a patient whose pap smear shows HSIL? - ANSWER
either
a) immediate loop electrosurgical excision, or
b) colposcopy
what is the appearance of LSIL and HSIL on colposcopy and biopsy? - ANSWER
,what is the management for a female with a biopsy showing CIN 3? - ANSWER excision!
what % of CIN1 regress? what % of CIN 3 progress to cancer? - ANSWER CIN 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?
- ANSWER ASC-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? - ANSWER HPV test!
* why? because HPV prevalence (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 interval
between future screenings
Abnormal Pap Smear Flow Management- 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 hpv vaccine - ANSWER * goal: to prevent hpv infection (6, 11, 16,
18) in naive girls/women & boys/men by inducing antibodies (cervical cancer
prevention)
* does not replace other preventive measures (condoms, etc.)
* vaccine contains vlps (virus-like particles)
, * gardasil protects against types of hpv that can cause genital/anal warts
* NOT used as treatment for existing hpv infection
* DOES NOT alter screening (pap smear) guidelines
what are the etiologies of abnormal uterine bleeding? (mnemonic) ANSWER mnemonic:
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? ANSWER UTERUS:
* endometrial polyp
* pregnancy (normal, ectopic, spontaneous abortion)
* cancer
* trauma
* fibroids
* endometriosis
what are some cervical causes of abnormal uterine bleeding? ANSWER CERVIX:
* cervical cancer (SCC, adenocarcinoma)
what is the 2nd leading cause of death in women ages 20-39 worldwide? - ANSWER
invasive 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? -
ANSWER application of acetic acid reveals transition zone as white
What are the layers of cervical squamous epithelium? - ANSWER basal 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/ -ANSWER A 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)
What is the terminology used in describing cervical cells: 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 is the cytologic appearance of LSIL on pap smear cytology? - ANSWER *
koilocytes
What is the cytologic appearance of HSIL on pap smear cytology? - ANSWER * more
undifferentiated koilocytes
what is the appearance of squamous cell carcinoma on pap smear cytology? - ANSWER
* lymphocytes
* fibroblasts
* old blood
what is the test to be carried out for a female whose pap smear shows LSIL? - ANSWER
* colposcopy
what treatment should be given to a patient whose pap smear shows HSIL? - ANSWER
either
a) immediate loop electrosurgical excision, or
b) colposcopy
what is the appearance of LSIL and HSIL on colposcopy and biopsy? - ANSWER
,what is the management for a female with a biopsy showing CIN 3? - ANSWER excision!
what % of CIN1 regress? what % of CIN 3 progress to cancer? - ANSWER CIN 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?
- ANSWER ASC-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? - ANSWER HPV test!
* why? because HPV prevalence (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 interval
between future screenings
Abnormal Pap Smear Flow Management- 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 hpv vaccine - ANSWER * goal: to prevent hpv infection (6, 11, 16,
18) in naive girls/women & boys/men by inducing antibodies (cervical cancer
prevention)
* does not replace other preventive measures (condoms, etc.)
* vaccine contains vlps (virus-like particles)
, * gardasil protects against types of hpv that can cause genital/anal warts
* NOT used as treatment for existing hpv infection
* DOES NOT alter screening (pap smear) guidelines
what are the etiologies of abnormal uterine bleeding? (mnemonic) ANSWER mnemonic:
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? ANSWER UTERUS:
* endometrial polyp
* pregnancy (normal, ectopic, spontaneous abortion)
* cancer
* trauma
* fibroids
* endometriosis
what are some cervical causes of abnormal uterine bleeding? ANSWER CERVIX:
* cervical cancer (SCC, adenocarcinoma)
