Colposcopy and Cervical Pathology: Multiple Choice Questions For Vol. 25, No. 5

  • 1.

    The following statement(s) is/are true about human papillomavirus (HPV) infection:

    • a)

      It can cause lesions in domestic rabbits so they provide a good research model

    • b)

      There are less than 40 types of HPV

    • c)

      Most women will have HPV infection at some time in their lives

    • d)

      Genital warts may be pre-malignant and may cause cervical cancer

    • e)

      HPV types mutate from low to high risk

  • 2.

    With regard to HPV vaccines:

    • a)

      They are available against types 6, 11, 16 and 18.

    • b)

      They must be given before the onset of sexual activity.

    • c)

      There is a small risk that the vaccines can cause cervical cancer.

    • d)

      Although they do prevent genital warts, they are not very effective against development of pre-malignant cervical lesions.

    • e)

      Women who have been vaccinated may be withdrawn from cervical screening programmes.

  • 3.

    When counselling about HPV vaccination, the following statement(s) is/are true:

    • a)

      You will not develop cervical cancer if you only ever have one sexual partner.

    • b)

      There will never be a need to vaccinate boys or men.

    • c)

      The vaccine has been tested in thousands of women, and no serious side-effects have been found.

    • d)

      The vaccine is safe for people with egg allergy.

    • e)

      The vaccine can help abnormal smears return to normal.

  • 4.

    Alternative methods of screening for cervical neoplasia include:

    • a)

      Cervicography.

    • b)

      Test for the consistency of the ectocervix.

    • c)

      Low current electric conductivity of the cervix.

    • d)

      Methylene blue staining of the cervix.

    • e)

      Acetic acid application to the cervix with visual inspection.

  • 5.

    With respect to a screening test’s characteristics, the following is/are true:

    • a)

      A high sensitivity of the test will increase the true negatives

    • b)

      A low sensitivity of the test will increase the false negatives

    • c)

      A high specificity will increase the true positives

    • d)

      A low specificity will increase the false positives

    • e)

      A decreasing sensitivity only slightly affects the predictive value of a positive test.

  • 6.

    With respect to the influence of disease prevalence in screening:

    • a)

      It is of no importance.

    • b)

      If the disease is common, more false–positive cases will be identified.

    • c)

      If the disease is common, more false–negative cases will be identified.

    • d)

      If the disease is rare, more false–positive cases will be identified.

    • e)

      If the disease is rare, more false–negative cases will be identified.

  • 7.

    To justify a screening programme, which of the following should be asked:

    • a)

      Is the disease to be screened for an important health problem?

    • b)

      Is the natural history of the disease known?

    • c)

      Is there an effective treatment?

    • d)

      Is the screening test valid and reliable?

    • e)

      Is there capacity to confirm and treat everyone diagnosed?

  • 8.

    Which of the following statement(s) is/are true concerning cytology-based population screening programmes to prevent cervical cancer?

    • a)

      Frequent screening is more effective than comprehensive population coverage.

    • b)

      Women who are HIV positive should be screened annually.

    • c)

      Women who have multiple sexual partners should be screened more frequently.

    • d)

      They are of limited value in the prevention of adenocarcinoma of the cervix.

    • e)

      They have high sensitivity and high specificity.

  • 9.

    Which of the following statement(s) is/are true of liquid-based cervical cytology?

    • a)

      It is easier to carry out in the clinical setting than conventional cytology.

    • b)

      It results in improved sensitivity for detection of cervical intraepithelial neoplasia.

    • c)

      It results in fewer inadequate samples.

    • d)

      Specimen adequacy is easily assessed.

    • e)

      It improves laboratory productivity.

  • 10.

    In a 29-year old woman presenting for the first time with borderline nuclear changes in squamous cells (atypical squamous cells in the Bethesda system), which of the following is/are correct management options?

    • a)

      Immediate referral for colposcopy.

    • b)

      Repeat test in 6 months.

    • c)

      Repeat and if negative return to routine screening.

    • d)

      Test for high risk human papillomavirus and if positive refer to colposcopy.

    • e)

      Test for high risk human papillomavirus and if negative repeat test in 6 months.

  • 11.

    Which of the following is/are true of automated screening?

    • a)

      It is only possible on liquid-based cytology specimens.

    • b)

      It is less sensitive but more specific than conventional cytology for the detection of high grade cervical intraepithelial neoplasia.

    • c)

      Laboratory staff will lose their interpretative skills.

    • d)

      It will increase laboratory productivity.

    • e)

      It will be unnecessary in a progressively HPV-vaccinated population.

  • 12.

    The following statement(s) is/are true about human papillomavirus (HPV) and cervical cancer.

    • a)

      HPV16 and 18 account for around 70% of cervical cancer globally.

    • b)

      Cervical intraepithelial neoplasia can be treated by HPV vaccination.

    • c)

      Oncogenic HPVs are associated with a proportion of oro-pharangeal cancer.

    • d)

      The incidence of cervical cancer in the developing world is expected to decrease in the next 5 years.

    • e)

      The safety of HPV vaccination is still in doubt. It is associated with higher than expected occurrence of deaths in adolescents.

  • 13.

    The following is/are true about HPV vaccination:

    • a)

      The quadrivalent HPV vaccine has been approved by the US Food and Drug Adminstration for the primary prevention of anal cancer.

    • b)

      Introducing HPV vaccination to a country with an effective cervical screening programme is not cost-effective.

    • c)

      In the USA, a developed country, more than 80% of young women have been immunised with HPV vaccines.

    • d)

      The World Health Organization does not recommend routine HPV vaccination to be included in national immunisation programmes in developing countries.

    • e)

      In developed countries where teenagers are offered HPV vaccination, parents cannot override the teenager’s decision to have the vaccine.

  • 14.

    Cervical cytology is widely used:

    • a)

      Only in the developed world

    • b)

      To triage women with high-risk HPV infection

    • c)

      To prevent cervical cancer

    • d)

      To determine whether a woman is infected with HPV 16

    • e)

      To follow-up women treated for cervical lesions

  • 15.

    HPV testing should be implemented in primary screening because:

    • a)

      It is more specific than cytology

    • b)

      It detects more high-grade disease than any other cervical screening technique

    • c)

      It is an objective test

    • d)

      It allows increasing the interval between screens

    • e)

      Cytology does not work on vaccinated women

  • 16.

    HPV vaccination will:

    • a)

      Eliminate the need for cervical screening by 2020

    • b)

      Have a substantial impact on the sensitivity of cytology

    • c)

      Reduce the positive predictive value of HPV testing

    • d)

      Have a greater (relative) impact on low-grade cytology than on high-grade cytology

    • e)

      Have no impact unless screening continues for the foreseeable future

  • 17.

    Following a positive HPV test:

    • a)

      All women should be treated

    • b)

      Women should be invited to screening five years later

    • c)

      Women should be triaged with cytology or other test

    • d)

      Women should have a second HPV test three months later

    • e)

      Women positive for HPV16 and/or HPV18 should not be treated because they will be vaccinated

  • 18.

    Excisional treatment is indicated

    • a)

      In women with biopsy-proven cervical intraepithelial neoplasia (CIN)

    • b)

      In women with Pap smears classified as low-grade squamous intraepithelial lesion (LSIL)

    • c)

      In pregnant women with CIN2 and 3

    • d)

      In women with biopsy-proven CIN1 and HSIL on cytology

    • e)

      In women with frank invasive cancer

  • 19.

    Regarding women with LSIL cytology results who are referred to colposcopy, the following is/are true:

    • a)

      A management based on targeted punch biopsies with subsequent treatment of CIN2 and 3, and cytological surveillance of CIN1 or less, offers the best balance between benefits and harms.

    • b)

      Management should not be based on targeted punch biopsies because punch biopsies miss a significant number of underlying CIN2 and 3.

    • c)

      The most cost-efficient management is immediate loop excision under colposcopical guidance.

    • d)

      A management based on human papillomavirus (HPV) testing with subsequent treatment of HPV 16/18 positive lesions and cytological surveillance of HPV 16/18 negative CIN offers the best balance between benefits and harms.

    • e)

      Management should not be based on HPV testing because HPV testing misses a significant number of underlying CIN2 and 3.

  • 20.

    Patients with biopsy-proven CIN3

    • a)

      Should be treated with cryotherapy because this method is not associated with obstetrical complications in subsequent pregnancies.

    • b)

      Should be treated with LLETZ or laser-conisation because these methods show the best balance of efficacy and complications.

    • c)

      Should be treated with cold-knife conisation because this method allows for an optimal histopathological evaluation of specimen margins.

    • d)

      Should be treated with LLETZ only when the lesion is located in a type III transformation zone.

    • e)

      Should be treated with cryotherapy or laser vaporisation in pregnant women.

  • 21.

    Colposcopy with immediate LLETZ (‘see and treat’) is evidence-based practice in

    • a)

      Women with biopsy-proven CIN and satisfactory colposcopy.

    • b)

      Women with atypical Pap results.

    • c)

      Women with HSIL results and visible lesion on colposcopy.

    • d)

      Women with positive HPV test results, normal cytology but signs of CIN3 on colposcopy.

    • e)

      Women with biopsy-proven CIN3

  • 22.

    Colposcopy in pregnancy:

    • a)

      Increases the risk of preterm delivery and so should be deferred until the postpartum period.

    • b)

      May result in early miscarriage.

    • c)

      Is safe and necessary for the management of cervical intraepithelial neoplasia (CIN).

    • d)

      Colposcopic-directed biopsies are mandatory in the management of CIN in pregnancy.

    • e)

      CIN progresses due to the relative immune-suppression of pregnancy.

  • 23.

    Antiretroviral therapy (ART) and human immunodeficiency virus (HIV)

    • a)

      Reduces the risk of CIN in HIV-positive women

    • b)

      Reduces the risk of cervical cancer in HIV-positive women

    • c)

      Has no effect on the progression or regression of CIN.

    • d)

      The effects remain unclear.

    • e)

      Increases the risk of multifocal disease.

  • 24.

    The Menopause:

    • a)

      Is associated with a higher prevalence of human papillomavirus (HPV) infection than in younger women.

    • b)

      The prevalence of HPV depends on the number of lifetime sexual partners.

    • c)

      Is associated with a low rate of unsatisfactory colposcopy.

    • d)

      CIN requires hysterectomy in postmenopausal women.

    • e)

      Post-treatment cervical stenosis can be prevented by taking hormone-replacement therapy for 2–3 months.

  • 25.

    Which of the following are true risk factors for developing cervical cancer or pre-cancer?

    • a)

      Smoking

    • b)

      Age

    • c)

      Human papillomavirus infection (HPV)

    • d)

      Family history of breast cancer

    • e)

      Obesity

  • 26.

    In terms of histological diagnosis of cervical intra-epithelial neoplasia (CIN), indicate which of the following statement(s) is/are true or false?

    • a)

      CIN is a rare lesion

    • b)

      High inter-observer reproducibility among pathologists is produced for CIN2 lesions.

    • c)

      CIN3 lesions demonstrate abnormal cells in the full thickness epithelium

    • d)

      p16 is a useful marker in the diagnosis of CIN.

    • e)

      About 30% of CIN3 lesions progress to invasive cancer.

  • 27.

    In relation to biomarkers and their utility for diagnosing CIN, which of the following statement(s) is/are true?

    • a)

      Ki-67 is a proliferation marker specific for cervical cancer.

    • b)

      p16 INK4a expression is strongly associated with expression of HPV E6 and E7 oncogenes.

    • c)

      p16 INK4a only stains dysplastic cells.

    • d)

      HPV DNA testing is the most specific biomarker test for detecting high-grade disease

    • e)

      HPV genotyping of CIN lesions is useful as the risk of progression of CIN lesions is influenced by persistence of high-risk HPV types.

  • 28.

    The following features during a colposcopic examination are important variables in diagnosing grade of cervical intraepithelial neoplasia (CIN):

    • a)

      Degree of aceto-whiteness

    • b)

      Presence of nabothian follicles

    • c)

      Size of the lesion

    • d)

      Presence of mosaic or punctuation

    • e)

      Appearance of cervical mucus

  • 29.

    Colposcopy as a diagnostic technique:

    • a)

      Is generally better for low-grade abnormalities than high-grade abnormalities.

    • b)

      Single colposcopic-directed biopsies are generally adequate for confirming grade of CIN.

    • c)

      Can have adverse emotional effects on the woman.

    • d)

      Can be omitted for those women presenting with high-grade cytological abnormality as they will all require treatment.

    • e)

      Appropriate training is essential before independent practice.

  • 30.

    Regarding the utility of detection of high-risk HPV DNA it is considered useful in the following circumstances

    • a)

      As a primary screening tool alone

    • b)

      As a primary screening tool in combination with cytology

    • c)

      As a triage test to decide which minor cytological abnormalities need referral for colposcopy

    • d)

      Ongoing management of women referred for colposcopy in whom no high-grade lesion is found

    • e)

      For follow up of treatment as a test of cure

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Nov 9, 2017 | Posted by in OBSTETRICS | Comments Off on Colposcopy and Cervical Pathology: Multiple Choice Questions For Vol. 25, No. 5

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