Quiz questions on prevention of cervical cancer

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Cervical Cancer Prevention — 20 MCQs (Postgraduate Level)

Q1. HPV DNA is detected in what proportion of cervical cancers?

A) ~50%
B) ~75%
C) ~90%
D) >99%
E) ~85%

Answer & Explanation

D — >99%

HPV infection is detected in >99% of cervical tumours. This near-universal causal association underpins all prevention strategies. — The Washington Manual of Medical Therapeutics

Q2. Which two HPV genotypes account for the majority (~66–70%) of cervical cancers worldwide?

A) 6 and 11
B) 16 and 18
C) 31 and 33
D) 45 and 52
E) 16 and 31

Answer & Explanation

B — HPV 16 and 18

HPV types 16 and 18 account for approximately 66–70% of cervical cancers globally. Types 6 and 11 cause genital warts (low risk), while types 31, 33, 45, 52, and 58 account for a further ~15%. — Goldman-Cecil Medicine; Harrison's Principles of Internal Medicine 22e

Q3. The currently available 9-valent HPV vaccine (Gardasil-9) targets which of the following sets of HPV types?

A) 6, 11, 16, 18
B) 16, 18 only
C) 6, 11, 16, 18, 31, 33, 45, 52, 58
D) 6, 11, 16, 18, 31, 45, 52, 58, 68
E) 16, 18, 31, 33, 45, 52, 58 only

Answer & Explanation

C — 6, 11, 16, 18, 31, 33, 45, 52, 58

Gardasil-9 (9vHPV) covers these nine types. Types 6 and 11 prevent genital warts; the remaining seven are oncogenic and together can theoretically prevent >90% of HPV-attributable cancers. — Goldman-Cecil Medicine; Harrison's Principles of Internal Medicine 22e

Q4. According to current US recommendations, what two-dose schedule is used for HPV vaccination in persons who begin the series before age 15?

A) 0 and 3 months
B) 0 and 6–12 months
C) 0, 2, and 6 months (3-dose only)
D) 0 and 12 months
E) 0 and 4 months

Answer & Explanation

B — 0 and 6–12 months

Persons initiating HPV vaccination before age 15 receive two doses at 0 and 6–12 months. Those initiating at age ≥15 or who are immunosuppressed receive three doses at 0, 1–2, and 6 months. — Goldman-Cecil Medicine

Q5. For which age group is shared clinical decision-making recommended (rather than routine vaccination) for HPV vaccination in the United States?

A) 9–14 years
B) 15–26 years
C) 27–45 years
D) >45 years
E) All adults regardless of age

Answer & Explanation

C — 27–45 years

Routine catch-up vaccination is recommended through age 26. For adults aged 27–45 who are not adequately vaccinated, shared clinical decision-making is recommended, reflecting lower population-level benefit as most will have been exposed to HPV already. — Goldman-Cecil Medicine

Q6. The HPV vaccine is composed of which structural component?

A) Live-attenuated HPV virions
B) Inactivated whole HPV virions
C) L1 capsid protein virus-like particles (VLPs)
D) L2 capsid protein subunits
E) HPV E6/E7 oncoproteins

Answer & Explanation

C — L1 capsid protein virus-like particles (VLPs)

HPV vaccines contain VLPs assembled from the L1 major capsid protein. These are non-infectious (contain no viral DNA) but generate a strong humoral immune response. — Goldman-Cecil Medicine

Q7. Which statement best describes the mechanism of action of the HPV vaccine?

A) It clears pre-existing HPV infections
B) It is prophylactic — preventing new HPV infections
C) It treats CIN 2/3 lesions
D) It enhances cell-mediated immunity against established HPV
E) It prevents integration of HPV DNA into the host genome

Answer & Explanation

B — It is prophylactic — preventing new HPV infections

HPV vaccines are strictly prophylactic; they prevent new infections but do not impact pre-existing infections or established lesions. Vaccinated individuals should still continue Pap smear and HPV screening. — Goldman-Cecil Medicine; Sherris & Ryan's Medical Microbiology

Q8. According to the 2018 USPSTF guidelines, at what age should cervical cancer screening begin?

A) 18 years
B) 21 years
C) 25 years
D) At sexual debut
E) 30 years

Answer & Explanation

B — 21 years

Screening begins at age 21 regardless of sexual history. Women younger than 21 do not require screening even if sexually active. — The Washington Manual of Medical Therapeutics; Robbins, Cotran & Kumar

Q9. For a woman aged 21–29 years, what is the recommended cervical cancer screening interval and method?

A) Cytology every year
B) Cytology every 2 years
C) Cytology every 3 years
D) hrHPV testing alone every 5 years
E) Co-testing (cytology + hrHPV) every 3 years

Answer & Explanation

C — Cytology every 3 years

Women aged 21–29 should receive cervical cytology (Pap test) every 3 years. HPV co-testing is not recommended in this age group because of the high incidence of transient HPV infection and thus very low specificity. — The Washington Manual of Medical Therapeutics; Robbins, Cotran & Kumar

Q10. Which of the following is NOT an accepted screening strategy for women aged 30–65 years per current USPSTF guidelines?

A) Cervical cytology alone every 3 years
B) hrHPV testing alone every 5 years
C) Co-testing (cytology + hrHPV) every 5 years
D) Cytology alone every 5 years
E) All of the above are accepted

Answer & Explanation

A — Cervical cytology alone every 3 years

For women aged 30–65, the accepted options are: cytology alone every 5 years, hrHPV alone every 5 years, or co-testing every 5 years. Cytology every 3 years is the interval used only in the 21–29 age group, not in the 30–65 group. — The Washington Manual of Medical Therapeutics

Q11. Why is HPV DNA testing alone NOT recommended as a primary screening tool in women younger than 30 years?

A) HPV DNA testing is less sensitive than cytology in young women
B) The high prevalence of transient HPV infection yields very low specificity
C) Young women rarely harbour oncogenic HPV types
D) The test is too expensive for routine use
E) Young women are already protected by prior vaccination

Answer & Explanation

B — The high prevalence of transient HPV infection yields very low specificity

The majority of HPV infections in young women are transient and clear spontaneously (90% within 2 years). Therefore, HPV testing has particularly low specificity in this age group, leading to unnecessary colposcopies. — Robbins, Cotran & Kumar; Swanson's Family Medicine Review

Q12. A woman aged 30 with a normal Pap smear tests positive for high-risk HPV DNA. What is the recommended next step?

A) Immediate colposcopy
B) Repeat cervical cytology in 3 years
C) Repeat cervical cytology every 6–12 months
D) LEEP procedure
E) HPV vaccination and routine follow-up

Answer & Explanation

C — Repeat cervical cytology every 6–12 months

A normal cytology result with a positive hrHPV test (discordant co-test) warrants repeat cytology at 6–12 month intervals rather than immediate colposcopy, as many infections will clear. — Robbins, Cotran & Kumar

Q13. Aceto-white areas seen on colposcopy after application of acetic acid most likely represent:

A) Normal cervical ectropion
B) Nabothian cysts
C) Abnormal/dysplastic epithelium
D) Cervical polyps
E) Normal squamocolumnar junction

Answer & Explanation

C — Abnormal/dysplastic epithelium

Application of acetic acid highlights dysplastic epithelium as white spots (aceto-white areas) due to coagulation of nuclear proteins in cells with a high nucleus-to-cytoplasm ratio. These areas are then targeted for biopsy. — Robbins, Cotran & Kumar

Q14. Which of the following management approaches is most appropriate for biopsy-confirmed CIN 1?

A) Immediate hysterectomy
B) Radical trachelectomy
C) Conservative follow-up or local ablation (e.g., cryotherapy) if follow-up reliability is a concern
D) Cervical conization as first-line treatment
E) Chemoradiation

Answer & Explanation

C — Conservative follow-up or local ablation if follow-up reliability is a concern

CIN 1 (low-grade SIL) usually regresses spontaneously and is managed conservatively. Ablation may be considered if reliable follow-up is uncertain. CIN 2/3 (HSIL) is treated with excisional procedures (conization/LEEP). — Robbins, Cotran & Kumar

Q15. What is the standard treatment for high-grade squamous intraepithelial lesion (HSIL / CIN 2–3) of the cervix?

A) Cryotherapy
B) Topical 5-fluorouracil
C) Cervical conization (LEEP or cold knife conization)
D) Radical hysterectomy
E) Observation with repeat cytology at 6 months

Answer & Explanation

C — Cervical conization (LEEP or cold knife conization)

HSIL (CIN 2–3) is treated with cervical conization — a superficial excision of the transformation zone. LEEP (loop electrosurgical excision procedure) is the most commonly used technique. — Robbins, Cotran & Kumar; Harrison's Principles of Internal Medicine 22e

Q16. What is the predominant histological subtype of invasive cervical carcinoma?

A) Adenocarcinoma (~75%)
B) Squamous cell carcinoma (~75–85%)
C) Small cell neuroendocrine carcinoma (~30%)
D) Clear cell carcinoma (~40%)
E) Adenosquamous carcinoma (~50%)

Answer & Explanation

B — Squamous cell carcinoma (~75–85%)

Squamous cell carcinoma accounts for 75–85% of invasive cervical cancers; adenocarcinoma makes up most of the remainder (15–25%). — The Washington Manual of Medical Therapeutics

Q17. Which oncoproteins encoded by high-risk HPV are primarily responsible for cervical carcinogenesis?

A) L1 and L2
B) E1 and E2
C) E6 and E7
D) E4 and E5
E) E3 and E8

Answer & Explanation

C — E6 and E7

E6 targets p53 for proteasomal degradation, while E7 binds and inactivates the Rb tumour-suppressor protein. Together these oncoproteins promote cell cycle progression, inhibit apoptosis, and contribute to genomic instability. — Robbins, Cotran & Kumar

Q18. Vaccinated women should continue routine cervical cancer screening because:

A) The HPV vaccine can cause CIN
B) The vaccine only covers a subset of oncogenic HPV types, leaving residual risk from non-vaccine types
C) The vaccine wanes within 2 years
D) Vaccination is only effective in women under 15
E) Pap smears detect HPV more accurately than serology

Answer & Explanation

B — The vaccine only covers a subset of oncogenic HPV types, leaving residual risk from non-vaccine types

Even 9vHPV does not cover all oncogenic HPV genotypes, so continued Pap/HPV screening remains necessary after vaccination. — Sherris & Ryan's Medical Microbiology

Q19. A 25-year-old woman presents with postcoital bleeding. Pap smear reveals HSIL. Which is the most appropriate immediate next step?

A) Repeat Pap smear in 6 months
B) HPV vaccination
C) Colposcopy with directed biopsy
D) FIGO staging workup without tissue confirmation
E) Empirical LEEP without colposcopy

Answer & Explanation

C — Colposcopy with directed biopsy

An abnormal screening result (HSIL) mandates colposcopic examination of the cervix and vagina, with biopsy of aceto-white or other suspicious areas for histopathological confirmation before any treatment decision. — Robbins, Cotran & Kumar; The Washington Manual

Q20. Which statement regarding cervical cancer screening cessation is correct?

A) Screening should continue indefinitely in all women
B) Women over 65 with adequate prior negative screening do not need further screening
C) Women with prior hysterectomy should be screened every 5 years
D) Screening should stop at age 50 in vaccinated women
E) Post-menopausal women should switch to HPV testing only annually

Answer & Explanation

B — Women over 65 with adequate prior negative screening do not need further screening

The USPSTF recommends discontinuing screening in women >65 who have had adequate prior screening with consistently normal results, and in women who have undergone hysterectomy with removal of the cervix for benign indications. — The Washington Manual of Medical Therapeutics

Topic Coverage Summary

Topic Area	Questions
HPV biology & oncogenesis (E6/E7, genotypes)	2, 7, 17
HPV vaccines (composition, schedule, mechanism, limitations)	3, 4, 5, 6, 7, 18
Screening intervals & methods (Pap, hrHPV, co-testing)	8, 9, 10, 11
Management of screening results (HPV+/cytology−)	12
Colposcopy & biopsy	13, 19
CIN management (CIN 1 vs HSIL)	14, 15
Epidemiology & histology	1, 16
Screening cessation	20

Sources: Robbins, Cotran & Kumar Pathologic Basis of Disease; Goldman-Cecil Medicine; Harrison's Principles of Internal Medicine 22e; The Washington Manual of Medical Therapeutics; Sherris & Ryan's Medical Microbiology

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