CNM EXAMS BUNDLE CERTIFICATION
SET 2026 QUESTIONS WITH SOLUTIONS
GRADED A+
>> what is the 2nd leading cause of death in women ages 20-39 worldwide?
Answer: invasive cervical carcinoma
>> what is the purpose of the pap smear?
* used for screening and diagnosis (complementary to biopsy)
Answer: * to detect treatable precancerous lesions in the cervix
>> what is the gross appearance of the cervical transformation zone on
colposcopy?
Answer: application of acetic acid reveals transition zone as white
>> what are the layers of cervical squamous epithelium?
* basal
* parabasal
* intermediate
* superficial
Answer: basal to apical:
>> what are the normal histological appearances of the various layers of cervical
squamous epithelium?
* parabasal: beginning to flatten out, more visible cytoplasm, still blue
* intermediate: flattened, squamous, shrunken nucleus, lighter blue
* superficial: very flat, nucleus disappearing, pink
Answer: * basal: more cuboidal, dark blue, large nucleus
,>> what is a koilocyte? what does one look like/
* Nuclear enlargement
* Irregularity of the nuclear membrane contour
* A darker than normal nucleus (Hyperchromasia)
* A clear area around the nucleus (perinuclear halo)
Answer: A Koilocyte is a squamous epithelial cell that has undergone a
number of structural changes, which occur as a result of infection of the cell
by HPV:
>> in describing cervical cells, what terms are used in pap smear cytology?
biopsy/histology?
* biopsy/histology: CIN 1 (mild dysplasia), CIN 2 (moderate dysplasia), CIN 3
(severe dysplasia to carcinoma in situ)
Answer: * pap smear cytology: LSIL, HSIL
>> what does LSIL look like on pap smear cytology?
Answer: * koilocytes
>> what does HSIL look like on pap smear cytology?
Answer: * more undifferentiated koilocytes
>> what does squamous cell carcinoma look like on pap smear cytology?
* fibroblasts
* old blood
Answer: * lymphocytes
>> what test should be done for a woman whose pap smear indicates LSIL?
Answer: * colposcopy
>> how should a patient with a pap smear indicating HSIL be treated?
a) immediate loop electrosurgical excision, or
b) colposcopy
,Answer: either
>> what is the treatment for a woman with a biopsy indicating CIN 3?
Answer: excision!
>> what proportion of CIN1 regress? what proportion of CIN 3 progress to
cancer?
CIN 3: >12% progress to cancer
Answer: CIN 1: 57% regress spontaneously
>> what is ASC-US? what test should automatically follow a pap smear
indicating ASC-US?
* follow up: HPV test
Answer: ASC-US: atypical squamous cells of undetermined significance
(Borderline or atypical abnormalities on Pap smear that do not fit into
normal, LSIL, HSIL, or cancer categories)
>> for women >30 years old, what test should always be administered along with
a pap smear? why?
* why? because the prevalence of HPV (the main risk factor for cervical cancer)
is lower in women > 30 and is therefore a more meaningful surrogate marker for
cancer risk
* a normal pap combined with a negative HPV test allows a woman to increase
the interval between future screenings
Answer: HPV test!
>> do we do routine screening for HPV in all women? why or why not?
* why? because HPV a) is so common in young people and b) most often is
self-resolving, that it is a much less meaningful test for younger women than for
older women
Answer: * HPV screening is only done as a primary screen for women over
30
, >> important points about the HPV vaccine
* does not replace other prevention strategies (condoms, etc.)
* contains VLPs (virus-like particles)
* Gardasil protects against strains of HPV that can cause genital/anal warts
* NOT used as therapy for existing HPV infection
* DOES NOT change screening (pap smear) recommendations
Answer: * goal: prevent HPV infection (6, 11, 16, 18) in unexposed
girls/women & boys/men via induction of antibodies (cervical cancer
prophylaxis)
>> what are the most common causes of abnormal uterine bleeding? (mnemonic)
* Polyp (endometrial)
* Adenomyosis
* Leiomyosis (fibroids)
* Malignancy (cancer)
* Coagulopathy
* Ovulatory dysfunction
* Endometrial
* Iatrogenic
* Not yet classified
Answer: mnemonic: PALM COEIN
>> what are some uterine causes of abnormal uterine bleeding?
* endometrial polyp
* pregnancy (normal, ectopic, spontaneous abortion)
* cancer
* trauma
* fibroids
* endometriosis
Answer: UTERUS:
>> what are some cervical causes of abnormal uterine bleeding?
* cervical cancer (SCC, adenocarcinoma)
* cervicitis
* trauma
SET 2026 QUESTIONS WITH SOLUTIONS
GRADED A+
>> what is the 2nd leading cause of death in women ages 20-39 worldwide?
Answer: invasive cervical carcinoma
>> what is the purpose of the pap smear?
* used for screening and diagnosis (complementary to biopsy)
Answer: * to detect treatable precancerous lesions in the cervix
>> what is the gross appearance of the cervical transformation zone on
colposcopy?
Answer: application of acetic acid reveals transition zone as white
>> what are the layers of cervical squamous epithelium?
* basal
* parabasal
* intermediate
* superficial
Answer: basal to apical:
>> what are the normal histological appearances of the various layers of cervical
squamous epithelium?
* parabasal: beginning to flatten out, more visible cytoplasm, still blue
* intermediate: flattened, squamous, shrunken nucleus, lighter blue
* superficial: very flat, nucleus disappearing, pink
Answer: * basal: more cuboidal, dark blue, large nucleus
,>> what is a koilocyte? what does one look like/
* Nuclear enlargement
* Irregularity of the nuclear membrane contour
* A darker than normal nucleus (Hyperchromasia)
* A clear area around the nucleus (perinuclear halo)
Answer: A Koilocyte is a squamous epithelial cell that has undergone a
number of structural changes, which occur as a result of infection of the cell
by HPV:
>> in describing cervical cells, what terms are used in pap smear cytology?
biopsy/histology?
* biopsy/histology: CIN 1 (mild dysplasia), CIN 2 (moderate dysplasia), CIN 3
(severe dysplasia to carcinoma in situ)
Answer: * pap smear cytology: LSIL, HSIL
>> what does LSIL look like on pap smear cytology?
Answer: * koilocytes
>> what does HSIL look like on pap smear cytology?
Answer: * more undifferentiated koilocytes
>> what does squamous cell carcinoma look like on pap smear cytology?
* fibroblasts
* old blood
Answer: * lymphocytes
>> what test should be done for a woman whose pap smear indicates LSIL?
Answer: * colposcopy
>> how should a patient with a pap smear indicating HSIL be treated?
a) immediate loop electrosurgical excision, or
b) colposcopy
,Answer: either
>> what is the treatment for a woman with a biopsy indicating CIN 3?
Answer: excision!
>> what proportion of CIN1 regress? what proportion of CIN 3 progress to
cancer?
CIN 3: >12% progress to cancer
Answer: CIN 1: 57% regress spontaneously
>> what is ASC-US? what test should automatically follow a pap smear
indicating ASC-US?
* follow up: HPV test
Answer: ASC-US: atypical squamous cells of undetermined significance
(Borderline or atypical abnormalities on Pap smear that do not fit into
normal, LSIL, HSIL, or cancer categories)
>> for women >30 years old, what test should always be administered along with
a pap smear? why?
* why? because the prevalence of HPV (the main risk factor for cervical cancer)
is lower in women > 30 and is therefore a more meaningful surrogate marker for
cancer risk
* a normal pap combined with a negative HPV test allows a woman to increase
the interval between future screenings
Answer: HPV test!
>> do we do routine screening for HPV in all women? why or why not?
* why? because HPV a) is so common in young people and b) most often is
self-resolving, that it is a much less meaningful test for younger women than for
older women
Answer: * HPV screening is only done as a primary screen for women over
30
, >> important points about the HPV vaccine
* does not replace other prevention strategies (condoms, etc.)
* contains VLPs (virus-like particles)
* Gardasil protects against strains of HPV that can cause genital/anal warts
* NOT used as therapy for existing HPV infection
* DOES NOT change screening (pap smear) recommendations
Answer: * goal: prevent HPV infection (6, 11, 16, 18) in unexposed
girls/women & boys/men via induction of antibodies (cervical cancer
prophylaxis)
>> what are the most common causes of abnormal uterine bleeding? (mnemonic)
* Polyp (endometrial)
* Adenomyosis
* Leiomyosis (fibroids)
* Malignancy (cancer)
* Coagulopathy
* Ovulatory dysfunction
* Endometrial
* Iatrogenic
* Not yet classified
Answer: mnemonic: PALM COEIN
>> what are some uterine causes of abnormal uterine bleeding?
* endometrial polyp
* pregnancy (normal, ectopic, spontaneous abortion)
* cancer
* trauma
* fibroids
* endometriosis
Answer: UTERUS:
>> what are some cervical causes of abnormal uterine bleeding?
* cervical cancer (SCC, adenocarcinoma)
* cervicitis
* trauma
