Assalamualaikum and good day,
For next week test, the questions would be based exactly on the questions listed below.
Terminology
1. Describe the importance of terminology for reporting cervical smears.
2. Describe the history of Pap smear reporting systems.
3. Explain the Bethesda 2001 reporting system.
Unsatisfactory smears
1. Define unsatisfactory Pap smear for Conventional smear and liquid-based preparations based on criteria on The Bethesda 2001.
2. Describe the reasons for unsatisfactory smears which include:
a. Sampling causes.
i. Insufficient cellular material.
b. Physiological causes.
i. Obscuring inflammation.
ii. Obscuring blood.
iii. Atrophy.
iv. Cytolysis.
c. Processing causes.
i. Fixation.
ii. Contamination.
iii. Shattered slide.
Normal components of the Pap smear
1. Describe the cytological morphology (cellular presentation, nuclear features and cytoplasmic features) of:
a. Superficial squamous cells.
b. Intermediate squamous cells
c. Parabasal cells
d. Endocervical cells
e. Squamous metaplastic cells.
f. Endometrial cells.
g. Non-epithelial components:
i. Neutrophils
ii. Eosinophils
iii. Lymphocytes
iv. Histiocytes
v. Sperm
2. Explain the squamocolumnar junction and transformation zone.
Smear pattern and hormonal effects
1. Describe the cytological morphology (cellular presentation, nuclear features and cytoplasmic features) of:
a. Oestrogenic smear pattern
b. Non-oestrogenic, non-atrophic smear pattern.
c. Atrophic smear pattern.
Infectious agents in smears
1. Describe the cytological morphology (cellular presentation, nuclear features and cytoplasmic features) of:
a. Bacterial vaginosis
b. Fungal vaginitis
c. Trichomonal vaginitis
d. Actinomyces
e. Herpes simplex virus (HSV)
Benign changes in Smears
1. Describe the cytological morphology (cellular presentation, nuclear features and cytoplasmic features) of:
a. Inflammatory/ infective
i. Acute squamous cell changes
ii. Chronic squamous cell changes
1. Hyperkeratosis
2. parakeratosis
b. cervicitis and repair
c. lymphoid cervicitis
d. radiation effects
i. acute changes
ii. chronic changes
Low grade squamous intraepithelial lesion (LSIL)
1. Describe the cytological morphology (cellular presentation, nuclear features and cytoplasmic features) of:
a. The koilocyte
b. Other features of LSIL
c. ASCUS - *Confident differentiation between benign cellular changes and LSIL may not always be achievable. This may be due to scanty cells, poor preservation or there are features of HPV without the cytoplasmic cavitation. Cell changes that cannot be confidently classified as either benign or LSIL should be reported as ASCUS.
2. Describe the current status of Human Papilloma Virus (HPV) and cervical cancer:
a. Epidemiology of HPV infection.
b. High Risk HPV types.
High-grade squamous intraepithelial lesion (HGSIL)
1. Describe the cytological morphology (cellular presentation, nuclear features and cytoplasmic features) of:
a. HGSIL
b. ASC–H *This category equates to the previously termed “Inconclusive” cytology report. This category is used when there are cells present suggesting the possibility of a HSIL and SCC – however, the changes are insufficient for a confident cytological prediction of a High Grade Squamous Lesion (HSL). Because a high-grade lesion is suspected with this category, the follow-up of these patients is the same as for those with a HSL report. Cells in these smears will exhibit overlapping features of both normal and abnormal cells as well as a lack of criteria for a positive diagnosis of HSL. The diagnosis may also be complicated by cells being sparse in population, poorly preserved and/or obscured by blood and inflammation. This diagnosis should only be used after a careful review of the smear fails to yield more diagnostic material.
The test would consist of 5 main subjective questions of 50 marks in total. It must be answered in 1 hour. Follow the normal lab grouping.
An example of test questions and it answer:
3. Describe the cytological morphology (cellular presentation, nuclear features and cytoplasmic features) of Intermediate squamous cells.
(3 marks)
Answer:
Cellular Presentation (1 mark)
• Present singly or in sheets
• Vary from round to oval in shape
• Range from small to intermediate in size
Nuclear Features (1 mark)
• Nucleus is round, centrally located
• Chromatin is finely granular evenly distributed
Cytoplasmic Features (1 mark)
• Cytoplasm is dense and basophilic
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