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Self-Assessment Questions

Obstetrics & Gynecology

Management of Abnormal Cervical Cytology: Review Questions

Teresa E. Baker, MD, and Sean S. Tedjarati, MD, MPH

Dr. Baker is an assistant professor and Dr. Tedjarati is an associate professor;
both are at the Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, TX.




Choose the single best answer for each question.

1.  According to the American College of Obstetricians and Gynecologists (ACOG) guidelines, when should cervical cancer screening begin?
  1. Age 16 years
  2. Age 18 years
  3. Age 21 years or 3 years after initiation of sexual contact
  4. A year after initiation of sexual contact regardless of age
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2.  A 17-year-old woman presents to her gynecologist for a well-patient examination. She states that she is currently sexually active and has been since age 16 years. She has had 2 lifetime sexual partners. The patient admits that she and her current partner use condoms sporadically. She desires a more reliable form of reversible contraception. She smokes about 10 cigarettes per week and drinks alcohol on the weekends but denies any illicit drug use. She takes no medications. All of the following are appropriate recommendations for this patient EXCEPT

  1. Empiric treatment for gonorrhea and chlamydia
  2. Human papillomavirus (HPV) vaccine
  3. Testing for sexually transmitted diseases (STDs) with cervical cultures
  4. Tobacco cessation
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3. A 36-year-old woman presents to her gynecologist for an annual examination. The patient is currently on a low-dose oral contraceptive medication. She has had 5 lifetime sexual partners and 4 successful pregnancies. She has never had an STD and has no history of abnormal cervical cytology. She smokes 10 cigarettes daily. A pelvic examination is performed, and a Papanicolaou (Pap) smear reveals high-grade squamous intraepithelial lesions (HSILs). What is the next step in the management of this patient?

  1. Colposcopy with cervical biopsy and endocervical assessment
  2. Cryotherapy
  3. Reflex HPV typing
  4. Repeat Pap smear in 6 months
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4. A 60-year-old obese woman with type 2 diabetes and hypertension presents to the gynecologist for an annual examination with complaints of irregular vaginal bleeding. She has been experiencing hot flashes for the past 6 months. Her family practitioner performed a Pap smear 3 years ago and told her it was “mildly abnormal.” A repeat Pap smear done at this visit reveals atypical glandular cells (AGCs) not otherwise specified. What is the most appropriate next step in this patient’s management?

  1. Colposcopy with cryotherapy
  2. Colposcopy with endocervical assessment and endometrial biopsy
  3. Immediate hysterectomy
  4. Pelvic ultrasound
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Figure. An exophytic lesion found on the cervix of the patient described in question 5.

 

5. A 50-year-old woman presents to her primary care physician asking to be tested for STDs. She reports recently leaving an abusive relationship and is concerned about her previous partner’s sexual history. On pelvic examination, an exophytic lesion is noted on the cervix (Figure). What is the next step in this patient’s management?
  1. Biopsy the cervical lesion
  2. Cervical cone biopsy
  3. Cryotherapy or laser ablation of the cervix
  4. Perform a Pap smear and obtain cervical cultures
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6. A 32-year-old woman recently diagnosed with HIV presents to a clinic for an annual examination. Her last CD4 cell count was 450 cells/mm3, and her viral load was 10,000 copies/mL. She has never had abnormal cervical cytology and is asymptomatic. On examination, the patient’s genital tract, cervix, and uterus appear normal; no adnexal masses are noted. What is the most appropriate approach to cervical cancer screening for this patient?

  1. HPV viral typing
  2. Perform annual Pap smears for 2 years and, if normal, every 3 years thereafter
  3. Perform Pap smear every 3 months
  4. Perform Pap smear every 6 months for 1 year and manage according to results
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