- 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
- a)
- 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Women who have been vaccinated may be withdrawn from cervical screening programmes.
- a)
- 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.
- a)
- 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.
- a)
- 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.
- a)
- 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.
- a)
- 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?
- a)
- 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.
- a)
- 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.
- a)
- 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.
- a)
- 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.
- a)
- 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.
- a)
- 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.
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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.
- a)
- 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.
- a)
- 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
- a)
- 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.
- a)
- 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.
- a)
- 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.
- a)
- 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
- a)
- 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.
- a)
- 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.
- a)
- 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
- a)
- 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.
- a)
- 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
- a)

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