😀 EASY

Data suggests that cervical cancer screening saves 1000 lives per year.   It is, therefore, vital to advocate for and to give your patients the best information to make informed choices about their health.  Straight from the hands of NICE CKS on Cervical Screening and Smear Tests, test your knowledge on some fundamental tenants of this success story … 

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cervical screening

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Question 1
When should the first invitation for a cervical screening be delivered?
A
24.5YO
B
25.0YO
C
25.5YO
D
26.0YO
E
26.5YO
Question 1 Explanation: 
NICE: Age 24.5 years — first invitation to ensure women can be screened before they are aged 25 years.
Question 2
Which type of HPV is most responsible for cervical cancer incidence?
A
HPV15
B
HPV16
C
HPV17
D
HPV18
E
HPV19
Question 2 Explanation: 
Studies show that HPV-16 is responsible for >50% of all cases. Combined with HPV-18, this rises to 75% of all cases.
Question 3
Mason is a 55YO transgender male who has retained his cervix. He has opted into the NHS Cervical Screening Programme (NHSCSP). In this light, which is the most appropriate referral type?
A
No referral is necessary
B
Screen every 10 years
C
Screen every 3 years
D
Screen every 4 years
E
Screen every 5 years
Question 3 Explanation: 
NICE: Transgender men who have retained their cervix — these men should be included in the NHSSCP unless they have made an informed decision to opt out.
Question 4
Annabeth is a 32 year old female who wishes to not be a part of the NHSCSP. What steps can she take?
A
She can give oral assent to remove
B
She can give oral consent to remove
C
She can give written consent to remove
D
She would not be approached without opting-in by default
E
The test is mandatory.
Question 4 Explanation: 
NICE: Women can withdraw from the programme voluntarily by written request. However, they should be provided with sufficient information to enable them to make an informed decision.
Question 5
Which of the following are contraindications of cervical screening on the day of arrival?
A
Active menses period
B
A month after termination of pregnancy
C
Has suprapubic pain, amenorrhoea and vaginal spotting.
D
Is 67 with a recent moderate dyskaryotic finding
E
Within the puerperium period
Question 5 Explanation: 
Patients over 65 can be invited for further screening tests if they have had recent abnormal findings, or their last test was aged 50YO or younger.
Question 6
How can the transitional zone be located on speculum examination?
A
The area is very smooth in appearance
B
The area is granular in appearance
C
The area is pale in appearance
D
The area is pink in appearance
E
The area is very shiny in appearance
Question 6 Explanation: 
The reddish, granular endocervix of columnar epithelium marks the squamocolumnar junction and sampling should be undertaken throughout the T zone here.
Question 7
Arunima is a 29YOF who rings her GP to confirm her NHSCSP appointment next tuesday. She is asked whether she is pregnant, to which she confirms that she is about 5 months pregnant. She has no history of abnormal pap tests. What is the next best step?
A
Keep the appointment for next Tuesday
B
Reschedule the appointment for month seven
C
Reschedule the appointment for 1 month postpartum
D
Reschedule the appointment for 2 months postpartum
E
Reschedule the appointment for 3 months postpartum
Question 7 Explanation: 
NICE: If a woman has been called for routine screening and she is pregnant — reschedule the test for when she is at least 3 months post-partum.
Question 8
A patient’s NHSCSP results are faxed through to surgery. The result is designated CIN-2. Which is the best-matched definition of this classification?
A
Atypical cells are full thickness of the epithelium
B
Spread has occurred via the uterosacral ligament
C
The obturator nerve has been implicated in metastatic spread
D
Upper third of epithelium are normal, atypical cells occupy lower two thirds.
E
Upper two thirds of epithelium are normal with the basal third atypical.
Question 9
Following radical hysterectomy, which finding is most likely to occur?
A
Paraesthesia of the hypogastrium
B
Paraesthesia of the labia majus
C
Paraesthesia of the mons pubis
D
Paraesthesia of ASIS to lateral thigh
E
Paraesthesia of medial thigh
Question 9 Explanation: 
The obturator nerve is often removed in a radical hysterectomy, alongside the upper 2-3cm of the vagina, the uterus and associated ligaments and lymphatics. The obturator nerve innervates the major adductors of the thigh and medial thigh sensory supply also.
Question 10
Which of the following anatomical labels are correct?
A
Pain in region A would be felt suprapubically
B
Region B is the most common site of implantation of the blastocyst
C
Region C is the external os of the cervix
D
Region D contains three layers of columnar epithelium
E
Region E is the site that must be sampled on speculum examination for a "pap" smear
F
Region F partially drains into the iliac lymphatics
Question 10 Explanation: 
A) Uterine fundus ; B) Uterine body/corpus ; C) cervical internal os ; D) Endocervix ; E) T zone ; F) ectocervix ;
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There are 10 questions to complete.
Take-home message

Some key points to remember about screening:

  • Generally the invite should be sent out by 24.5YO
  • There should be an invite every three years between 35-49YO
  • There should be an invite every five years between 50-64YO
  • At age 64 routine C-screening should stop.
  • A vaccine for HPV should be offered to all 12-13YO females.
  • CIN grading is on the basis of how invasive the dyskaryosis is: from basal, to basal + mid to basal + mid + superficial as CIN 1, 2 and 3 respectively.  At the point of CIN 3, this is in situ carcinoma.  When the basement membrane is compromised we are in the maligiant phase.

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