Gynae Cytology FRCPath Part 1 Course
Question 1 You are delivering a course for nurses who are undertaking smear taker training for liquid based preparations. Following your presentation one of the nurses asks the age at which frequency of call for a routine smear changes from 3 yearly to 5 yearly. Select the most appropriate answer. • A. 45 • B. 30 • C. 40 • D. 50
Answer You are delivering a course for nurses who are undertaking smear taker training for liquid based preparations. Following your presentation one of the nurses asks the age at which frequency of call for a routine smear changes from 3 yearly to 5 yearly. Select the most appropriate answer. • A. 45 • B. 30 • C. 40 • D. 50
Risk factors of cervical cancer • Viral infection • Sexual behaviour • Smoking • Immunosuppression • Non-attendance for cervical screening
Question 2 A cytoscreenerbrings a cervical screening sample to you for your opinion. The patient is a 37 year old woman who has had a previous cone biopsy for CIN3 6 months ago. There are crowded groups of hyperchromatic cells which you believe represent lower uterine segment sampling. The screener asks if testing for Human Papilloma Virus (HPV) may help to ascertain if residual CIN is present. What HPV type would you recommend testing for? • A. 1. • B. 3. • C. 6. • D. 8. • E. 16.
Answer A cytoscreener brings a cervical screening sample to you for your opinion. The patient is a 37 year old woman who has had a previous cone biopsy for CIN3 6 months ago. There are crowded groups of hyperchromatic cells which you believe represent lower uterine segment sampling. The screener asks if testing for Human Papilloma Virus (HPV) may help to ascertain if residual CIN is present. What HPV type would you recommend testing for? • A. 1. • B. 3. • C. 6. • D. 8. • E. 16.
• HPV vaccination programme • Two types of vaccine in use in the UK • 2008-Cervarix-Bivalent (HPV 16, 18) • 2012-Gerdasil-quadrivalent (HPV 6, 11, 16, 18) • In England, from September 2019, all boys and girls aged 12 to 13 will be routinely offered the firsthuman papillomavirus (HPV) vaccination when they're in Year 8 at school. The second dose is usually offered 6 to 12 months after the first.
• HR HPV Testing in NHSCSP • HPV primary screening-December 2019 • Test of Cure for treated CIN & CGIN • Cervical sample taken in exactly same way • HPV test with reflex cytology • All samples HPV tested • If HR HPV positive, sample processed for cytology (10-15% screening population)
Question 3 You are auditing a case of invasive carcinoma of the cervix. A cervical smear 3 years before she presented with cervical carcinoma was reported as borderline nuclear changes with a repeat smear requested in 6 months. Who is responsible for operating failsafe for this abnormal result? • A. The general practitioner. • B. The laboratory. • C. The colposcopy clinic. • D. The hospital based programme co-ordinator. • E. Central operations (call/recall) office.
Answer You are auditing a case of invasive carcinoma of the cervix. A cervical smear 3 years before she presented with cervical carcinoma was reported as borderline nuclear changes with a repeat smear requested in 6 months. Who is responsible for operating failsafe for this abnormal result? • A. The general practitioner. • B. The laboratory. • C. The colposcopy clinic. • D. The hospital based programme co-ordinator. • E. Central operations (call/recall) office.
Question 4 A trainee cytoscreener who is screening the days work notices simple, unbranched fungal hyphae and spores in a liquid based cervical screening sample. He asks you what the significance of this is. Select the most appropriate answer. • A. Artefactual overgrowth which should be discounted. • B. A harmless commensal which is of no clinical significance. • C. An invasive infection which is likely to lead to tubo-ovarian abscesses. • D. An unusual infection suggesting immunosuppression. • E. A notifiable disease which should be reported to the director of public health.
Answer A trainee cytoscreener who is screening the days work notices simple, unbranched fungal hyphae and spores in a liquid based cervical screening sample. He asks you what the significance of this is. Select the most appropriate answer. • A. Artefactual overgrowth which should be discounted. • B. A harmless commensal which is of no clinical significance. • C. An invasive infection which is likely to lead to tubo-ovarian abscesses. • D. An unusual infection suggesting immunosuppression. • E. A notifiable disease which should be reported to the director of public health.
Dyskaryosis Features• Abnormal chromatin pattern • Increased N:C ratio • Hyper or hypochromasia • Irregular nuclear membrane • Nuclear pleomorphism • Nucleoli • Evidence of HPV infection
Dyskaryosis Grading
References • https://www.gov.uk/government/publications/cervical-screening-primaryhpv-screening-implementation • NHS Cervical Screening Programme Colposcopy and Programme Management NHSCSP Publication number 20 • Achievable standards, Benchmarks for reporting and criteria for evaluating cervical cytopathology, NHSCSP Publication No.1, 2013 • Guidelines on failsafe actions for the follow up of cervical cytology reports • Audit of Invasive cervical cancers. Publication no 28. • Denton K.J. et al. The revised BSCC terminology for abnormal cervical cytology. Cytopathology 2008, 19, 137-157.