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128 Cards in this Set
- Front
- Back
pap smear
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actinomyces, associated with IUD - IUD cells can mimic HSIL but have smooth nuclear membranes, washed out chromatin
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pap smear
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actinomyces IUD assoc- IUD cells can mimic HSIL but have smooth nuclear membranes, washed out chromatin
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pap smear
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AIS - feathering, rosettes, gland like
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pap smear
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AIS - feathering, rosettes, gland like
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pap smear
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AIS - feathering, rosettes, gland like
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pap smear
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ariasstella, pregnancy
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pap smear
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atrophy - dark blue blobs, degenerated parabasals, granular background
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pap smear
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atrophy - dark blue blobs, degenerated parabasals, granular background
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pap smear
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atrophy - dark blue blobs, degenerated parabasals, granular background
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pap smear
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atypical parakeratosis - in regular parakeratosis - pyknotic nuclei and hypereosinophilic cytoplasm
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pap smear
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benign keratin pearl
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pap smear
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candida - skewered
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pap smear
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chronic follicular cervicitis
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pap smear
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chylamydia
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pap smear
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cockleburr crystals - no clinical significance, found with pregnancy
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pap smear
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cockleburrs - no clinical significance, found with pregnancy
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pap smear
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endometrial cells - occasional kidney bean shaped nuclei
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pap smear
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endometrial cells- occasional kidney bean shaped nuclei
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pap smear
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endometrial ca - usu no tumor diathesis on Pap, single cells, vacuoles, prominent nucleoli
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pap smear
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endometrial ca- usu no tumor diathesis on Pap, single cells, vacuoles, prominent nucleoli
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pap smear
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endometrial ca- usu no tumor diathesis on Pap, single cells, vacuoles, prominent nucleoli
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pap smear
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endometrial cells - occasional kidney bean shaped nuclei
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pap smear
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clue cells - usu relatively clean backgroun, treatment is metronidazole
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pap smear
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granuloma
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pap smear
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HSIL - 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
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pap smear
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HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
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pap smear
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HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
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pap smear
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HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
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pap smear
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HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
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pap smear
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HSIL- 3x nuclei of intermediate cell, 1 nuclei fits into cytoplasm
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pap smear
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HSV
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pap smear
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HSV
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pap smear
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HSV
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pap smear
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IUD effect - mimics HSIL, but round nuclear membranes, fine chromatin pattern
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pap smear
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lactobacilli - often bare nuclei
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pap smear
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leptothrix- often found with trich
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pap smear
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LSIL - 3 x nuclei of intermediate cell with 2 or more nuclei fitting into cytoplasm, perinuclear cavity, rolled up thick cytoplasm
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pap smear
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LUS
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pap smear
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endocervical cells
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ovarian
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ovarian serous borderline
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ovarian
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ovarian serous ca
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pap smear
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postpartum - can be yellow staining glycogen or single parabasals
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pap smear
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psammoma
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pap smear
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radiation - two tone cytoplasm, increase cellular size, increase nuclei but also cytoplasm, multinucleation, vacuolization of cytoplasm and increased pmns (last two go away with time)
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pap smear
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radiation- two tone cytoplasm, increase cellular size, increase nuclei but also cytoplasm, multinucleation, vacuolization of cytoplasm and increased pmns (last two go away with time)
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pap smear
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repair - no hyperchromasia persay but increase nuclear size, school of fish, not really single cells
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pap smear
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repair no hyperchromasia persay but increase nuclear size, school of fish, not really single cells
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pap smear
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repair - no hyperchromasia persay but increase nuclear size, school of fish, not really single cells
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pap smear
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invasive scca - tadpoles, single cells, tumor diathesis, prominent nucleoli
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pap smear
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squamous metaplasia - dense cytoplasm, fine chromatin, interlocking parabasals, active nuclei (chromocenters present),streaming but cookie cutter
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pap smear
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squamous metaplasia - dense cytoplasm, fine chromatin, interlocking parabasals, active nuclei (chromocenters present),streaming but cookie cutter
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pap smear
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squamous metaplasia - dense cytoplasm, fine chromatin, interlocking parabasals, active nuclei (chromocenters present),streaming but cookie cutter
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pap smear
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surepath, sedimentation
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pap smear
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thinprep liquid based smear
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pap smear
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transitional metaplasia
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pap smear
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trich- reactive type haloes, associated with leptothrix, treated with metronidazole, fuzzy pear shapes
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pap smear
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tumor diathesis
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sufficient number of cells for liquid based Pap smear
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5000
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sufficient number of cells for conventional Pap smear
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10,000
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where is the HPV virus in invasive SCCa
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integrated into genome
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what is the nuclear size of LSIL cells compared to intermediate cell
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3x
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how many nuclei fit into the cytplasm in a LSIL cell
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two or more
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how many nuclei fit into the cytoplasm in an HSIL cell
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1
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what is the nuclear size of an HSIL cell compared to an intermediate cell
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3x
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learn the cyto stains
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diffiquik, etc and their artifacts
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describe the Digene II process
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RNA probe targets vDNA with an antibody to these together with an associated light emission probe
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learn the recommendations for screening
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for Pap vs. HPV
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when to report endometrial cells
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>40 years, >12 days past LMP
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what is the frequency of progression to invasive ca for LSIL
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<1%
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what is the frequency of progression to invasive SCCa from HSIL
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CIN II - 5%
CIN 3 - 12% |
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when is the earliest one should colpo postpartum
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>6 weeks
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what are the daughters of DES use at risk for
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vaginal adenosis, clear cell carcinoma
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of HPV early genes, what binds what
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E6 binds p53
E7 binds rb |
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low risk HPV types
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6, 11, 42-44, 53,54, 57, 66
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high risk HPV types
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16, 18, 31-35, etc
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how to distinguish on Pap between mets to cx vs. direct extension to cx
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mets to cx - no tumor diathesis
direct extension to cx - tumor diathesis can be seen |
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one useful identifier of mesothelial cells in pelvic washing
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mesothelial cells have a prominent nucleoli
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what is the mesothelial skirt made of
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made of ectoplasm and endoplasm (perinuclear organelles)
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how does HMBE-1 compare to calretinin in staining mesothelial cells
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HMBE1 is less specific but as sensitive as calretinin
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learn more about thin prep/sure path
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- process
- differences |
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what affect does alcohol fixation in a Pap smear have on cells
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smaller cellular size
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compare histologic fx of HSIL vs. invasive SCCa on Pap smear
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in HSIL you really shouldn't see prominent nucleoli and definitely not tumor diathesis
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what is the specificity and sensitivity of a Pap
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sensitivity - 47%
specificity 95% |
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where might you see a reallly granular/dirty background
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atrophic vaginitis
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what percent of cases should be ASCUS coming out of an individual lab
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5%
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what should the ASCUS/SIL ratio be coming out of a lab
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less than or equal to 3:1
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three indications for colpo
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LSIL, HSIL, ASC-H
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compare histologic fx of repair vs. invasive SCCa
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repair - fine chromatin, flat sheets but cohesive cells
invasive SCCa - coarse chromatin, marked crowding, single cells |
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How often does ASCUS lead to HSIL on biopsy
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10-20%
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what percent of Paps are nl
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91%
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compare exfoliated EM cells vs. HSIL
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HSIL cells are larger and in flatter sheets
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what % of LSIL cells will regress
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50%
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what is the most common cause of small cell ca of the cx
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HPV 18
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maturation indices for 1 hour old child
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95-5 - Intermediate and superficial
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maturation indices for child
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80- parabasals
20- intermediates |
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maturation indices for menstruating females
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40-60 intermediate-superficial if premenses
70-30 intermediate-superficial if in menses |
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maturation indices for OCP use
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95-5 intermediate-superficial
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maturation indices for postmenopausal
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100 -0-0 parabasal/intermediate vs. superficial
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what's a normal vaginal pH
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4.5
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what do anucleated squames mean
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contamination from vulva or leukoplakia in vagina
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describe nuclei and cytoplasm of endocervical cells
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definite chromatin detail is seen and nucleoli are evident; cytoplasm is more delicate and foamy but size of endocervical nuclei are slightly larger than seen for squames (2n intermediate cell)
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most accurate e2 indices come from where
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lateral wall of vagina
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what is leptothrix
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filamentous bacteria - strings of spaghetti
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fx you might find in a histological picture with trich
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- associated inflammation
- reactive haloes - shot gun pmns - grey background |
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if you hear a clinical story of a pregnant woman in her 3rd trimester and see radiation-like changes in her Pap smear, what should you think of
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folate deficiency
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if you've had radiation, how long should you wait before a pap smear
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~2 months
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what histo fx should you think of with OCP
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parakeratosis
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if you see parakeratosis, what should you think of clinically
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OCP use
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what histologic fx do you see with Chylamydia
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- intracytoplasmic bugs
- lymphocytic cervicitis (+ tingible body macs) |
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where do you find alternaria
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water contaminant
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what is the depth of invasion required to call an invasive scca microinvasive
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less than or equal to 3 mm
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appearance of air-dried artifact
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hazy, grey
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compare repair vs endocervical adenocarcinoma
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repair - macronucleoli; endocervical adenoca - micronucleoli
repair fine granular chromatin; endocervical adenoca - coarse repair cellular aggregates; endocervical adenoca - isolated or syncytial repair - inflammation, endocervical adenoa - more clean background repiar - often well-defined cell borders, endocervical adenoca - overlapping of cells with little cytoplasm |
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compare repair to large cell in situ
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repair - aggregates, fine chromatin, macronucleoli, cell borders
large cell in situ - isolated, coarse chromatin, less common macronucleoli, less distinct cell border |
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criteria for ASCUS
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1. nucleus 2-3 x cross diameter of intermediate cel
2. chromatin: increased, even, no granularity 3. number of affected cells 3-5 |
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specimen adequacy
satis for evaluation |
1. appropriate labeling, clinical data
2. adequate # cells (covers >10% slide) 3. adequate t zone (2 clusters of 5 or more cells) 4. endocervicals or lots of metaplasitics |
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specimen adequacy:
satis but limited by can include |
- lack of pertinent info.
- partially obscuring blood, inflammation, thick area (precluding interpretation of 50-75% of slide) - no endocervical cells |
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if see a psammoma, what should you do
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look further - may see papillary clusters s/o ovarian
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tricky slide: melanoma
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may hide pigment, grey background
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when to start screening
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21 years, 3 years post first intercourse
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how often to screen - age dependent
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21-30: conventional/q year, LBP every 2
30-70: if nl 3x/q 3yrs (if HPV), q 2yrs if not HPV 70: can stop if negative for 10 years can stop if no uterus if DES/iC must do every year |
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when testing HR or LR HPV types
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HR only
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in whom do you do HPV genotyping?
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30+
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what are the two relevant parameters for reporting endometrial cells
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>12 days post LMP
>40 years |
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if see clue cells, what do you treat with
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metronidazole
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if see trich, what treat with
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metronidazole (+sexual partner) - remember,with trich can see small halo
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what buys an adolescent a colpo
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HSIL (arguable with ASC-H)
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when do you colpo a pregnant person
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ONLY if invasive cancer; no colpo until 6 wks postpartum
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