Cancer cervix screening quiz questions

Reading File

Checking Date & Time

Asking for Preferences

Finding Sources

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

I now have rich material from Berek & Novak's Gynecology and Harrison's. Here are 35 specialist-level MCQs on cervical cancer screening:

Cancer Cervix Screening — MCQ Quiz (Gynecology Specialist Level)

Section 1: Epidemiology & HPV Biology

Q1. Which HPV types together account for approximately 70% of all invasive cervical cancers worldwide?

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

✅ Answer: B — HPV 16 and 18 HPV-16 is the most common type found in invasive cancer and CIN 2/3; combined with HPV-18 these two account for ~70% of cervical cancers. — Berek & Novak's Gynecology

Q2. The malignant transformation of cervical epithelium by high-risk HPV primarily requires expression of which viral oncoproteins?

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

✅ Answer: C — E6 and E7 Malignant transformation requires the expression of E6 and E7 HPV oncoproteins; E6 degrades p53 and E7 inactivates pRb. — Berek & Novak's Gynecology

Q3. In the natural history of HPV infection, in the vast majority of cases the infection clears spontaneously within:

A) 3–6 months
B) 9–15 months
C) 18–24 months
D) 3–5 years
E) It rarely clears without treatment

✅ Answer: B — 9–15 months In the vast majority of cases, HPV infection will clear in 9 to 15 months. Persistent infection is the principal risk factor for CIN progression. — Berek & Novak's Gynecology

Q4. Which of the following HPV types is classified as LOW-risk (non-oncogenic)?

A) HPV 16
B) HPV 18
C) HPV 31
D) HPV 6
E) HPV 45

✅ Answer: D — HPV 6 HPV 6 and 11 are low-risk types associated with condylomata acuminata but not invasive cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 are high-risk oncogenic types.

Q5. Cervical intraepithelial neoplasia (CIN) most commonly originates at which anatomical location?

A) Endocervical canal, distal to the internal os
B) The original squamocolumnar junction (SCJ)
C) The advancing SCJ within the transformation zone
D) The posterior vaginal fornix
E) The lateral angles of the transformation zone

✅ Answer: C — The advancing SCJ within the transformation zone CIN typically originates in the transformation zone at the advancing SCJ. The anterior lip is twice as likely to develop CIN as the posterior lip, and CIN rarely originates in the lateral angles. — Berek & Novak's Gynecology

Section 2: Screening Modalities & Guidelines

Q6. According to ACOG and ASCCP guidelines, at what age should cervical cancer screening be initiated, regardless of onset of sexual activity?

A) 18 years
B) 20 years
C) 21 years
D) 25 years
E) At first sexual intercourse

✅ Answer: C — 21 years Evidence-based guidelines recommend that cervical cancer screening not begin until age 21 years, regardless of sexual history, acknowledging the very low prevalence of invasive cancer in very young women. — Berek & Novak's Gynecology

Q7. For a woman aged 25–29 years with no prior abnormalities, what is the recommended cervical cancer screening strategy?

A) Cytology every year
B) Cytology every 3 years
C) HPV co-testing every 3 years
D) HPV primary testing every 5 years
E) No screening needed until age 30

✅ Answer: B — Cytology every 3 years For women aged 21–29 years, cytology every 3 years is recommended. Co-testing is not recommended in this age group because of the high prevalence of transient HPV infection. — Berek & Novak's Gynecology; Harrison's 22E

Q8. For women aged 30–65 years, what is the preferred co-testing screening interval when both cytology and high-risk HPV testing are negative?

A) Every 1 year
B) Every 2 years
C) Every 3 years
D) Every 5 years
E) Every 7 years

✅ Answer: D — Every 5 years From 30 to 65 years, co-testing with cytology and high-risk HPV testing every 5 years is recommended when results are negative. Cytology alone every 3 years is an acceptable alternative. — Berek & Novak's Gynecology

Q9. A 67-year-old woman has had 3 consecutive negative cytology results and 2 negative co-tests in the previous 10 years. Which of the following is the most appropriate action?

A) Continue annual cytology
B) Perform colposcopy
C) Continue co-testing every 5 years
D) Discontinue cervical cancer screening
E) Perform HPV primary screening only

✅ Answer: D — Discontinue cervical cancer screening After age 65, it is appropriate to discontinue screening in women with documented negative screening history: either 3 negative cytology results or 2 negative co-tests in the previous 10 years. — Berek & Novak's Gynecology

Q10. A 45-year-old woman underwent total hysterectomy (including cervix) for uterine fibroids with no history of CIN 2+ or cervical cancer. What is the recommended screening strategy?

A) Annual vaginal vault cytology
B) Co-testing every 3 years
C) Discontinue cervical/vaginal screening
D) HPV primary screening every 5 years
E) Vaginal cytology every 5 years

✅ Answer: C — Discontinue cervical/vaginal screening In the setting of post-hysterectomy for benign indications, it is reasonable to discontinue screening in the absence of a history of high-grade CIN or cancer. — Berek & Novak's Gynecology

Q11. For an HIV-positive woman aged 25 years, what is the recommended cervical cancer screening protocol at initiation?

A) HPV co-testing annually
B) Cytology alone; if first smear is normal, repeat annually until 3 negatives are obtained
C) Cytology every 3 years
D) Colposcopy at first visit, then cytology every 5 years
E) HPV primary screening every 5 years

✅ Answer: B — Cytology annually until 3 negatives are obtained For HIV-infected women ≤30 years, cervical cytology is preferred; HPV co-testing is not recommended. Screening begins within 1 year of HIV diagnosis. If the first Pap is normal, annual cytology continues until 3 negatives, then every 3 years. — Harrison's 22E

Q12. Which FDA-approved HPV primary screening test correctly identifies women with HPV 16/18 as requiring direct colposcopy (without a cytology reflex)?

A) Hybrid Capture 2
B) APTIMA (TMA-based)
C) Cobas HPV Test
D) Cervista
E) Digene HC2

✅ Answer: C — Cobas HPV Test The cobas HPV Test (Roche), BD Onclarity HPV Assay, and Alinity m HR HPV Assay are FDA-approved for primary HPV screening. A positive result for HPV 16 or 18 has sufficient positive predictive value to proceed directly to colposcopy. — Harrison's 22E

Section 3: Cytology — Bethesda System

Q13. The Bethesda System terminology was developed following the first NCI workshop held in which year?

A) 1975
B) 1980
C) 1988
D) 1993
E) 2001

✅ Answer: C — 1988 In 1988, the first NCI workshop held in Bethesda, Maryland, developed the Bethesda System for cytologic reporting, which standardized reporting and quality assurance. — Berek & Novak's Gynecology

Q14. According to the Bethesda System, koilocytotic atypia (HPV cytopathic effect) is classified as:

A) ASC-US
B) ASC-H
C) LSIL
D) HSIL
E) AGC

✅ Answer: C — LSIL Cellular changes associated with HPV (koilocytosis and CIN 1) are included within the LSIL category because their natural history, HPV type distribution, and cytologic features are the same. — Berek & Novak's Gynecology

Q15. HSIL on the Bethesda System corresponds histologically to which CIN grade(s)?

A) CIN 1 only
B) CIN 1 and CIN 2
C) CIN 2 and CIN 3
D) CIN 3 only
E) Invasive carcinoma

✅ Answer: C — CIN 2 and CIN 3 HSIL encompasses CIN 2 and CIN 3 (moderate dysplasia, severe dysplasia, and carcinoma in situ). The separation of CIN 2 from CIN 3 is not reliably reproducible, and their management is similar. — Berek & Novak's Gynecology

Q16. The sensitivity of conventional Pap cytology for detecting CIN 2 or 3 (as reported in literature reviews) is approximately:

A) 90–95%
B) 75–85%
C) 62–70%
D) 47–62%
E) 20–30%

✅ Answer: D — 47–62% Three literature reviews demonstrated sensitivity of cervical cytology for detecting CIN 2 or 3 ranging from 47% to 62%, with specificity from 60% to 95%. — Berek & Novak's Gynecology

Q17. The introduction of liquid-based cytology (LBC) compared to conventional cytology primarily reduces errors due to:

A) Interpretive false negatives
B) Sampling failure at the transformation zone
C) Poor fixation, air-drying artefacts, and obscuring blood/mucus
D) Inadequate staining quality
E) Inability to detect glandular lesions

✅ Answer: C — Poor fixation, air-drying artefacts, and obscuring blood/mucus LBC obviates preparation errors caused by poor fixation leading to air drying and slide preparations obscured by vaginal discharge, blood, or mucus. It also allows residual material to be used for HPV testing. — Berek & Novak's Gynecology

Section 4: HPV Testing — Triage & Co-testing

Q18. High-risk HPV testing is the recommended triage strategy for which cytology result in women ≥25 years?

A) LSIL
B) HSIL
C) ASC-US
D) ASC-H
E) AGC

✅ Answer: C — ASC-US High-risk HPV testing is well-established for triaging ASC-US cytology. It identifies approximately 90% of patients with CIN 2 or 3 lesions. ASC-H should proceed directly to colposcopy without HPV triage. — Berek & Novak's Gynecology

Q19. A 32-year-old woman has a Pap smear reported as ASC-H. What is the most appropriate next step?

A) Repeat cytology in 6 months
B) High-risk HPV reflex testing; colposcopy only if positive
C) Colposcopy immediately, regardless of HPV status
D) HPV co-test at the next annual visit
E) Reassure and screen in 3 years

✅ Answer: C — Colposcopy immediately, regardless of HPV status Women with ASC-H should be referred directly to colposcopy because of the underlying risk of CIN 2 and/or CIN 3; they should NOT be triaged with high-risk HPV testing. — Berek & Novak's Gynecology

Q20. In primary HPV screening, when a result shows high-risk HPV positivity for types OTHER than 16 or 18, what is the recommended next step?

A) Immediate colposcopy
B) Repeat HPV testing in 12 months
C) Reflex cytology
D) Conization
E) No further action needed

✅ Answer: C — Reflex cytology When primary HPV screening detects high-risk types other than HPV 16 or 18, cytology (reflex) can be obtained to further stratify risk. HPV 16/18 positivity alone warrants direct colposcopy. — Harrison's 22E

Section 5: Colposcopy

Q21. During colposcopy, acetowhite epithelium appears white after application of acetic acid because of:

A) Glycogen precipitation within mature squamous cells
B) Coagulation of nuclear and cytoplasmic proteins in dysplastic cells
C) Keratin dissolving under acidic conditions
D) Destruction of Lactobacillus colonies
E) Vascular stasis in terminal capillaries

✅ Answer: B — Coagulation of nuclear and cytoplasmic proteins in dysplastic cells Acetic acid coagulates nuclear and cytoplasmic proteins, making them opaque and white. Mature glycogen-producing cells are NOT affected because the acid does not penetrate the outer third of the epithelium. — Berek & Novak's Gynecology

Q22. At colposcopy, "mosaic" vascular pattern is characterised by terminal capillaries arranged around blocks of acetowhite epithelium. This finding is most commonly associated with:

A) Normal transformation zone
B) CIN 1
C) CIN 2 and CIN 3
D) Cervical polyp
E) Immature squamous metaplasia

✅ Answer: C — CIN 2 and CIN 3 Mosaicism tends to be associated with high-grade lesions (CIN 2 and CIN 3). Terminal capillaries surround roughly circular/polygonal blocks of acetowhite epithelium in a "basket" configuration. — Berek & Novak's Gynecology

Q23. Leukoplakia on the cervix is visible before application of acetic acid and represents:

A) Immature squamous metaplasia
B) A keratin layer on the surface of the epithelium
C) Glycogen-rich mature squamous epithelium
D) Normal ectropion
E) Columnar epithelium undergoing glycogenation

✅ Answer: B — A keratin layer on the surface of the epithelium Leukoplakia (white plaque visible before acetic acid) results from abnormal keratin production on the cervicovaginal mucosa and is commonly associated with HPV infection and related intraepithelial or invasive lesions. It should always be biopsied. — Berek & Novak's Gynecology

Q24. Dilated capillaries that terminate on the surface of the cervix and appear as a collection of dots on colposcopy describe which finding?

A) Mosaic pattern
B) Leukoplakia
C) Acetowhite epithelium
D) Punctation
E) Atypical vessels

✅ Answer: D — Punctation Dilated capillaries terminating on the surface appear from their ends as a collection of dots — termed punctation. When occurring within a well-demarcated area of acetowhite epithelium, they indicate abnormal epithelium, most often high-grade CIN. — Berek & Novak's Gynecology

Q25. A colposcopy is deemed adequate (satisfactory) when:

A) The entire transformation zone and new SCJ are fully visualised
B) Only the ectocervix is visualised
C) The endocervical canal is sampled
D) Acetowhite epithelium is absent
E) The posterior vaginal fornix is inspected

✅ Answer: A — The entire transformation zone and new SCJ are fully visualised A satisfactory colposcopy requires visualisation of the entire transformation zone including the squamocolumnar junction. If the SCJ retreats into the endocervical canal and cannot be seen, colposcopy is unsatisfactory.

Section 6: CIN Histology & Management

Q26. CIN is graded by the extent of immature cell proliferation and nuclear atypia. CIN 2 is defined as involvement of:

A) Lower third of the epithelium only
B) Lower two-thirds of the epithelium
C) Full-thickness epithelium
D) Upper third only
E) Basal layer with stromal invasion

✅ Answer: B — Lower two-thirds of the epithelium If mitoses and immature cells are limited to the lower third → CIN 1. Involvement of the middle and upper thirds is CIN 2 and CIN 3 respectively. CIN 3 involves more than two-thirds or full thickness without stromal invasion. — Berek & Novak's Gynecology

Q27. Which pathological features are the hallmark criteria for diagnosing cervical intraepithelial neoplasia?

A) Stromal invasion, desmoplastic reaction, necrosis
B) Cellular immaturity, cellular disorganisation, nuclear abnormality, increased mitotic activity
C) Koilocytosis, binucleation, cleared cytoplasm
D) Full-thickness replacement by glandular cells
E) Loss of basement membrane continuity

✅ Answer: B — Cellular immaturity, disorganisation, nuclear abnormality, increased mitotic activity The significant features for diagnosing CIN are cellular immaturity, cellular disorganisation, nuclear abnormality, and increased mitotic activity; their extent determines grade. — Berek & Novak's Gynecology

Q28. Regarding treatment of CIN: the concept that entire glands must be destroyed during ablative therapy relates to which anatomical feature?

A) Nabothian cysts
B) Involvement of cervical gland crypts by CIN
C) Vascular punctation extending into the stroma
D) Extension of metaplasia to the vaginal fornix
E) Lymphovascular space involvement

✅ Answer: B — Involvement of cervical gland crypts by CIN CIN involves the cervical clefts (gland openings) and tends to have the most severe CIN lesions there. The entire gland must be destroyed to eliminate CIN completely — a critical implication for ablative treatment depth. — Berek & Novak's Gynecology

Q29. Which treatment modality for CIN is BOTH diagnostic AND therapeutic?

A) Cryotherapy
B) Laser ablation
C) Loop electrosurgical excision procedure (LEEP/LLETZ)
D) Trichloroacetic acid application
E) Observation and repeat cytology

✅ Answer: C — LEEP/LLETZ Excisional procedures (LEEP, cold knife cone) provide a histological specimen for diagnosis while simultaneously treating the lesion. Ablative methods (cryotherapy, laser) are therapeutic only and should not be used without adequate colposcopic biopsy.

Q30. After treatment for CIN 2 or higher, which of the following surveillance strategies is recommended?

A) Cytology alone every 5 years
B) Annual screening for 20 years
C) Discharge to routine screening after 3 normal smears
D) Colposcopy every year indefinitely
E) HPV vaccination replaces further surveillance

✅ Answer: B — Annual screening for 20 years Women with a history of CIN 2 or greater are recommended annual screening for 20 years, regardless of age, given the ongoing risk of disease recurrence or new high-grade lesions. — Berek & Novak's Gynecology

Section 7: Special Populations & Alternative Screening

Q31. Which alternative screening method is most widely used for cervical cancer screening in resource-limited settings?

A) Self-collected vaginal swab for HPV
B) Liquid-based cytology
C) Visual inspection with acetic acid (VIA)
D) Serum HPV antibody testing
E) Automated digital colposcopy

✅ Answer: C — Visual inspection with acetic acid (VIA) Many low-resource countries rely on VIA for cervical cancer screening. While some studies show reduced cervical cancer mortality, the low specificity of VIA is a major limitation. As HPV DNA detection becomes more available, it may replace VIA. — Harrison's 22E

Q32. A woman who received the HPV vaccine is attending for cervical cancer screening. Which statement is MOST correct?

A) She can stop cervical cancer screening entirely
B) Screening intervals can be extended to every 10 years
C) She should continue Pap smear and HPV screening as per normal guidelines
D) She only needs HPV 16/18 genotype testing
E) Screening is not needed until age 30

✅ Answer: C — Continue Pap smear and HPV screening per normal guidelines Vaccinated females should continue Pap smear and HPV screening because other HPV genotypes not included in the vaccine can still cause cervical cancer. — Sherris & Ryan's Medical Microbiology

Q33. The Pap smear has reduced the incidence of cervical cancer by approximately what percentage since 1950?

A) 30%
B) 50%
C) 65%
D) 79%
E) 95%

✅ Answer: D — 79% Cervical cytology (Pap test) was successful in reducing the incidence of cervical cancer by 79% and mortality by 70% since 1950. — Berek & Novak's Gynecology

Q34. Which of the following groups requires TWICE-FIRST-YEAR then ANNUAL screening rather than the standard interval?

A) Women over age 50
B) DES daughters
C) Women with CIN 1 history only
D) Women who smoke
E) Women with prior HPV vaccination

✅ Answer: B — DES daughters (also HIV-positive women) More frequent screening is recommended for HIV-positive women (twice first year, then annually), immunosuppressed women, DES daughters, and those with a history of CIN 2 or greater. — Berek & Novak's Gynecology

Q35. The ASCCP guideline for LSIL cytology in women ≥25 years is:

A) Repeat cytology in 12 months
B) Immediate colposcopy
C) High-risk HPV reflex testing
D) Conservative management without colposcopy
E) Immediate LEEP

✅ Answer: B — Immediate colposcopy Colposcopy is required for the evaluation of LSIL cytology. Any woman with cytology consistent with high-grade changes (HSIL) also warrants immediate colposcopy. — Berek & Novak's Gynecology

Summary Table

#	Topic	Key Teaching Point
1–5	HPV biology	Oncogenic types, E6/E7, natural clearance, CIN origin
6–12	Screening guidelines	Age thresholds, intervals, special populations, FDA-approved HPV assays
13–17	Bethesda cytology	System history, LSIL/HSIL categories, sensitivity, LBC advantages
18–20	HPV triage	ASC-US, ASC-H, primary HPV screening algorithms
21–25	Colposcopy	Acetowhite, mosaic, punctation, leukoplakia, satisfactory colposcopy
26–30	CIN histology & Rx	Grading criteria, gland crypt involvement, LEEP, post-treatment surveillance
31–35	Special populations	VIA, post-vaccination screening, DES daughters, LSIL management

Sources: Berek & Novak's Gynecology (9781496380357); Harrison's Principles of Internal Medicine 22E (9781265977061); Sherris & Ryan's Medical Microbiology 8E

This is a shared conversation. Sign in to Orris to start your own chat.