CNM EDUCATIONAL PROGRAM FRAMEWORK
2026 FORMAL TESTING QUERIES AND EXACT
INFORMATION ADVANCED STUDY PACKAGE
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)
⫸ 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?
Answer: either
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?
Answer: excision!
⫸ what proportion of CIN1 regress? what proportion 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 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)
2026 FORMAL TESTING QUERIES AND EXACT
INFORMATION ADVANCED STUDY PACKAGE
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)
⫸ 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?
Answer: either
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?
Answer: excision!
⫸ what proportion of CIN1 regress? what proportion 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 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)
