CNM Board Exam Review – Certified Nurse Midwife Study Guide &
Practice Questions
what is the 2nd leading cause of death in women ages 20-39 worldwide? - correct answer
✔✔invasive cervical carcinoma
what is the purpose of the pap smear? - correct answer ✔✔* to detect treatable precancerous
lesions in the cervix
* used for screening and diagnosis (complementary to biopsy)
what is the gross appearance of the cervical transformation zone on colposcopy? - correct
answer ✔✔application of acetic acid reveals transition zone as white
what are the layers of cervical squamous epithelium? - correct answer ✔✔basal to apical:
* basal
* parabasal
* intermediate
* superficial
what are the normal histological appearances of the various layers of cervical squamous
epithelium? - correct answer ✔✔* basal: more cuboidal, dark blue, large nucleus
* parabasal: beginning to flatten out, more visible cytoplasm, still blue
* intermediate: flattened, squamous, shrunken nucleus, lighter blue
* superficial: very flat, nucleus disappearing, pink
what is a koilocyte? what does one look like/ - correct 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:
,* Nuclear enlargement
* Irregularity of the nuclear membrane contour
* A darker than normal nucleus (Hyperchromasia)
* A clear area around the nucleus (perinuclear halo)
in describing cervical cells, what terms are used in pap smear cytology? biopsy/histology? -
correct answer ✔✔* pap smear cytology: LSIL, HSIL
* biopsy/histology: CIN 1 (mild dysplasia), CIN 2 (moderate dysplasia), CIN 3 (severe dysplasia to
carcinoma in situ)
what does LSIL look like on pap smear cytology? - correct answer ✔✔* koilocytes
what does HSIL look like on pap smear cytology? - correct answer ✔✔* more undifferentiated
koilocytes
what does squamous cell carcinoma look like on pap smear cytology? - correct answer ✔✔*
lymphocytes
* fibroblasts
* old blood
what test should be done for a woman whose pap smear indicates LSIL? - correct answer ✔✔*
colposcopy
how should a patient with a pap smear indicating HSIL be treated? - correct answer ✔✔either
a) immediate loop electrosurgical excision, or
b) colposcopy
how do LSIL and HSIL appear on colposcopy and biopsy? - correct answer ✔✔
,what is the treatment for a woman with a biopsy indicating CIN 3? - correct answer
✔✔excision!
what proportion of CIN1 regress? what proportion of CIN 3 progress to cancer? - correct answer
✔✔CIN 1: 57% regress spontaneously
CIN 3: >12% progress to cancer
what is ASC-US? what test should automatically follow a pap smear indicating ASC-US? - correct
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)
* follow up: HPV test
for women >30 years old, what test should always be administered along with a pap smear?
why? - correct answer ✔✔HPV test!
* 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
what is the flow of management for abnormal pap smears? - correct answer ✔✔
do we do routine screening for HPV in all women? why or why not? - correct answer ✔✔* HPV
screening is only done as a primary screen for women over 30
* 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
important points about the HPV vaccine - correct answer ✔✔* goal: prevent HPV infection (6,
11, 16, 18) in unexposed girls/women & boys/men via induction of antibodies (cervical cancer
prophylaxis)
, * 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
what are the most common causes of abnormal uterine bleeding? (mnemonic) - correct answer
✔✔mnemonic: PALM COEIN
* Polyp (endometrial)
* Adenomyosis
* Leiomyosis (fibroids)
* Malignancy (cancer)
* Coagulopathy
* Ovulatory dysfunction
* Endometrial
* Iatrogenic
* Not yet classified
what are some uterine causes of abnormal uterine bleeding? - correct answer ✔✔UTERUS:
* endometrial polyp
* pregnancy (normal, ectopic, spontaneous abortion)
* cancer
* trauma
* fibroids
* endometriosis
Practice Questions
what is the 2nd leading cause of death in women ages 20-39 worldwide? - correct answer
✔✔invasive cervical carcinoma
what is the purpose of the pap smear? - correct answer ✔✔* to detect treatable precancerous
lesions in the cervix
* used for screening and diagnosis (complementary to biopsy)
what is the gross appearance of the cervical transformation zone on colposcopy? - correct
answer ✔✔application of acetic acid reveals transition zone as white
what are the layers of cervical squamous epithelium? - correct answer ✔✔basal to apical:
* basal
* parabasal
* intermediate
* superficial
what are the normal histological appearances of the various layers of cervical squamous
epithelium? - correct answer ✔✔* basal: more cuboidal, dark blue, large nucleus
* parabasal: beginning to flatten out, more visible cytoplasm, still blue
* intermediate: flattened, squamous, shrunken nucleus, lighter blue
* superficial: very flat, nucleus disappearing, pink
what is a koilocyte? what does one look like/ - correct 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:
,* Nuclear enlargement
* Irregularity of the nuclear membrane contour
* A darker than normal nucleus (Hyperchromasia)
* A clear area around the nucleus (perinuclear halo)
in describing cervical cells, what terms are used in pap smear cytology? biopsy/histology? -
correct answer ✔✔* pap smear cytology: LSIL, HSIL
* biopsy/histology: CIN 1 (mild dysplasia), CIN 2 (moderate dysplasia), CIN 3 (severe dysplasia to
carcinoma in situ)
what does LSIL look like on pap smear cytology? - correct answer ✔✔* koilocytes
what does HSIL look like on pap smear cytology? - correct answer ✔✔* more undifferentiated
koilocytes
what does squamous cell carcinoma look like on pap smear cytology? - correct answer ✔✔*
lymphocytes
* fibroblasts
* old blood
what test should be done for a woman whose pap smear indicates LSIL? - correct answer ✔✔*
colposcopy
how should a patient with a pap smear indicating HSIL be treated? - correct answer ✔✔either
a) immediate loop electrosurgical excision, or
b) colposcopy
how do LSIL and HSIL appear on colposcopy and biopsy? - correct answer ✔✔
,what is the treatment for a woman with a biopsy indicating CIN 3? - correct answer
✔✔excision!
what proportion of CIN1 regress? what proportion of CIN 3 progress to cancer? - correct answer
✔✔CIN 1: 57% regress spontaneously
CIN 3: >12% progress to cancer
what is ASC-US? what test should automatically follow a pap smear indicating ASC-US? - correct
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)
* follow up: HPV test
for women >30 years old, what test should always be administered along with a pap smear?
why? - correct answer ✔✔HPV test!
* 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
what is the flow of management for abnormal pap smears? - correct answer ✔✔
do we do routine screening for HPV in all women? why or why not? - correct answer ✔✔* HPV
screening is only done as a primary screen for women over 30
* 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
important points about the HPV vaccine - correct answer ✔✔* goal: prevent HPV infection (6,
11, 16, 18) in unexposed girls/women & boys/men via induction of antibodies (cervical cancer
prophylaxis)
, * 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
what are the most common causes of abnormal uterine bleeding? (mnemonic) - correct answer
✔✔mnemonic: PALM COEIN
* Polyp (endometrial)
* Adenomyosis
* Leiomyosis (fibroids)
* Malignancy (cancer)
* Coagulopathy
* Ovulatory dysfunction
* Endometrial
* Iatrogenic
* Not yet classified
what are some uterine causes of abnormal uterine bleeding? - correct answer ✔✔UTERUS:
* endometrial polyp
* pregnancy (normal, ectopic, spontaneous abortion)
* cancer
* trauma
* fibroids
* endometriosis
