On day 13 of her cycle, a 26-year-old woman's hormonal smear shows parabasal cells 0%, intermediate 35% and superficial 65%, with a karyopyknotic index of 60%. This pattern shows:

A high oestrogen effect, as near ovulation

Atrophy from oestrogen deficiency

A progesterone effect of the luteal phase

An androgen effect with parabasal cells

By The Bethesda System, a liquid-based cervical preparation is satisfactory for squamous cellularity if it contains at least about:

5,000 well-preserved squamous cells

8,000-12,000 well-preserved squamous cells

The transformation zone of the cervix, where most cervical cancers arise, lies at the junction of:

Squamous and columnar epithelium

Vaginal and ectocervical epithelium

A vaginal smear contains many boat-shaped intermediate cells with folded edges and yellow glycogen. These navicular cells indicate:

A progesterone effect, as in pregnancy

The oestrogen peak at ovulation

Gynaecological cytology and the Pap stain

77 Kerala MSc MLT Entrance practice questions on Gynaecological cytology and the Pap stain, part of Pathology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
On day 13 of her cycle, a 26-year-old woman's hormonal smear shows parabasal cells 0%, intermediate 35% and superficial 65%, with a karyopyknotic index of 60%. This pattern shows:
1. AAtrophy from oestrogen deficiency
2. BA high oestrogen effect, as near ovulation
3. CA progesterone effect of the luteal phase
4. DAn androgen effect with parabasal cells
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Answer: B · A high oestrogen effect, as near ovulation
The maturation index lists parabasal, intermediate and superficial cells in that order. Here 65% of cells are superficial and the KPI is high, a shift to the right that shows strong oestrogen stimulation, as expected just before ovulation. Progesterone shifts the index to intermediate cells. Atrophy shifts it to parabasal cells.
- A: Atrophy shows many parabasal cells, and here there are none.
- C: Progesterone gives a predominance of intermediate cells.
- D: There are no parabasal cells, so this is not an androgen or atrophic pattern.
Question 2 · Medium
By The Bethesda System, a liquid-based cervical preparation is satisfactory for squamous cellularity if it contains at least about:
1. A5,000 well-preserved squamous cells
2. B8,000-12,000 well-preserved squamous cells
3. C50,000 squamous cells
4. D2,000 squamous cells
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Answer: A · 5,000 well-preserved squamous cells
The Bethesda System sets a minimum of about 5,000 well-visualised, well-preserved squamous cells for a liquid-based preparation. For a conventional smear the estimated minimum is 8,000-12,000, because cells are spread unevenly and partly hidden. Fewer cells make the specimen unsatisfactory, and the reason is stated. Cellularity is estimated by counting reference fields.
- B: 8,000-12,000 is the conventional smear minimum.
- C: 50,000 cells is far above the minimum.
- D: 2,000 cells is below the satisfactory threshold.
Question 3 · Easy
The transformation zone of the cervix, where most cervical cancers arise, lies at the junction of:
1. AEndocervical glands and stroma
2. BEndometrium and endocervix
3. CSquamous and columnar epithelium
4. DVaginal and ectocervical epithelium
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Answer: C · Squamous and columnar epithelium
The transformation zone is the area between the original and the current squamocolumnar junction, where columnar epithelium is replaced by squamous metaplasia. Immature metaplastic cells there are most susceptible to HPV, so most precancers and cancers start there. A good smear must sample this zone. Its position moves with age and hormones.
- A: Glands and stroma are not two surface epithelia meeting.
- B: The endometrium-endocervix junction is not where cervical neoplasia starts.
- D: Vaginal and ectocervical epithelia are both squamous.
Question 4 · Medium
A vaginal smear contains many boat-shaped intermediate cells with folded edges and yellow glycogen. These navicular cells indicate:
1. AInfection with Candida species
2. BAtrophy after the menopause
3. CThe oestrogen peak at ovulation
4. DA progesterone effect, as in pregnancy
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Answer: D · A progesterone effect, as in pregnancy
Navicular cells are glycogen-rich intermediate cells with thick, folded edges. They form under progesterone, so they dominate in pregnancy and the luteal phase. Oestrogen alone gives flat superficial cells with pyknotic nuclei. Atrophy shows parabasal cells.
- A: Candida causes yeasts and inflammation, not navicular cells.
- B: Atrophy gives parabasal cells.
- C: The oestrogen peak gives superficial cells with pyknotic nuclei.
Question 5 · Easy
The Cytobrush is used in cervical sampling mainly to collect cells from the:
1. APosterior vaginal fornix
2. BEndocervical canal
3. CEctocervix
4. DLateral vaginal wall
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Answer: B · Endocervical canal
The Cytobrush is inserted into the endocervical canal and rotated to collect endocervical cells. It is used with a spatula, which samples the ectocervix. The posterior fornix pool was once sampled for vaginal pool cells, and the lateral vaginal wall is sampled for hormonal studies. Broom devices sample both areas at once.
- A: The posterior fornix pool is not the Cytobrush target.
- C: The ectocervix is sampled with a spatula.
- D: The lateral vaginal wall is scraped for hormonal cytology.
Question 6 · Medium
A heavily bloody cervical smear can be fixed in which fixative, which also lyses the red cells?
1. ACarnoy's fixative
2. B10% neutral buffered formalin
3. CBouin's fluid
4. DAbsolute methanol
Answer and explanation in LearnFree account
Question 7 · Medium
In The Bethesda System, a transformation zone component is reported as present when the smear contains at least:
1. A50 endocervical or metaplastic cells
2. B5 endocervical or metaplastic cells
3. C10 endocervical or metaplastic cells
4. DOne group of endometrial cells
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Question 8 · Medium
A cervical smear shows multinucleated squamous cells with nuclear moulding, margination of chromatin and glassy nuclei. Which infection do these changes typify?
1. AHuman papillomavirus
2. BHerpes simplex virus
3. CChlamydia trachomatis
4. DCytomegalovirus
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Question 9 · Easy
What do koilocytes in a cervical smear indicate?
1. AHuman papillomavirus infection
2. BCandida infection
3. CHerpes simplex virus infection
4. DTrichomonas infection
Answer and explanation in LearnFree account
Question 10 · Easy
In The Bethesda System, ASC-H stands for:
1. AAtypical squamous cells, hyperkeratotic type
2. BAtypical squamous cells of undetermined significance
3. CAtypical squamous cells with HPV changes
4. DAtypical squamous cells, cannot exclude HSIL
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Question 11 · Hard
A cervical smear from a 52-year-old woman shows a few benign-appearing endometrial cells. She is not menstruating. How should they be handled by The Bethesda System (2014)?
1. AIgnore them, as they look benign
2. BReport them, as she is 45 years or older
3. CCall the specimen unsatisfactory
4. DReport atypical glandular cells (AGC)
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Question 12 · Hard
After the laboratory switches to a new tap water supply, Pap-stained nuclei appear reddish-purple and lack crisp detail, while the cytoplasm stains normally. The most likely cause and remedy are:
1. AWater in the xylene; change the clearing bath
2. BIncomplete bluing; use Scott's tap water substitute
3. CUnder-fixation; fix in 95% ethanol for longer
4. DExhausted EA; replace the counterstain
Answer and explanation in LearnFree account
Question 13 · Medium
In hormonal cytology, the karyopyknotic index (KPI) is the percentage of:
1. AIntermediate cells with folded edges
2. BParabasal cells among all squamous cells
3. CSquamous cells with eosinophilic cytoplasm
4. DSuperficial cells with pyknotic nuclei
Answer and explanation in LearnFree account
Question 14 · Hard
A woman whose smear was reported negative is found on biopsy to have CIN 3. On review, a few unmarked HSIL cells are found near one edge of the same smear. How is this error best classed?
1. AA fixation artefact
2. BAn interpretive error
3. CA sampling error
4. DA screening (detection) error
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Question 15 · Hard
Mature superficial and intermediate cells show nuclei over three times the normal intermediate nucleus, with hyperchromasia, binucleation and sharp perinuclear cavities. The Bethesda category is:
1. ALSIL
2. BASC-US
3. CHSIL
4. DASC-H
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Question 16 · Medium
In a regressive Pap stain with Harris haematoxylin, the excess dye is removed from the cytoplasm with:
1. ADilute hydrochloric acid
2. BXylene
3. CScott's tap water substitute
4. DDilute ammonia water
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Question 17 · Hard
Two years after pelvic radiotherapy for cervical cancer, a 55-year-old woman's vault smear shows greatly enlarged cells with bizarre shapes, vacuolated two-toned cytoplasm and multinucleation. The nuclei are enlarged in proportion to the cytoplasm, with fine chromatin. The best interpretation is:
1. ARecurrent invasive squamous carcinoma
2. BHSIL in the vaginal vault
3. CHerpes simplex cytopathic effect
4. DRadiation change, reported as NILM
Answer and explanation in LearnFree account
Question 18 · Hard
A 28-year-old woman has a thin grey discharge with a fishy odour. Results: vaginal pH 5.2 (normal 3.8-4.5); KOH whiff test positive; Pap smear shows many clue cells, few lactobacilli and scanty neutrophils. How should the cytology be reported?
1. ANILM, shift in flora suggestive of bacterial vaginosis
2. BASC-US, reactive change with infection
3. CNILM, Trichomonas vaginalis present
4. DNILM, fungal organisms consistent with Candida
Answer and explanation in LearnFree account
Question 19 · Medium
For the general population of women, the 2021 WHO guideline recommends cervical screening by:
1. AColposcopy every three years from age 25
2. BPap cytology every year from first intercourse
3. CVIA alone every year from the age of 18
4. DHPV DNA testing from age 30, every 5-10 years
Answer and explanation in LearnFree account
Question 20 · Medium
Round cells with dense blue-green cytoplasm and short spiky cytoplasmic processes, lying between squamous and columnar cells, show that the smear has sampled the:
1. AUpper lateral wall of the vagina
2. BSurface of the vulval skin
3. CEndometrium in its secretory phase
4. DTransformation zone with squamous metaplasia
Answer and explanation in LearnFree account
Question 21 · Easy
Squamous cells whose borders are blurred by a carpet of small coccobacilli, with few lactobacilli in the background, suggest:
1. AGonococcal cervicitis
2. BBacterial vaginosis
3. CTrichomoniasis
4. DCandidiasis
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Question 22 · Hard
A new trainee runs the Pap stain with Harris haematoxylin. Nuclei are pale grey-blue with washed-out chromatin, while cytoplasm stains normally. The haematoxylin was fresh, bluing was correct and the timer showed 2 minutes in 0.5% acid alcohol instead of a few dips. What is the cause?
1. AThe EA counterstain was too acidic
2. BBluing water was too alkaline
3. COver-differentiation removed the dye from the nuclei
4. DThe haematoxylin was under-ripened
Answer and explanation in LearnFree account
Question 23 · Easy
Döderlein bacilli, the normal dominant flora of the healthy adult vagina, are:
1. ACorynebacteria
2. BGardnerella
3. CLactobacilli
4. DMobiluncus
Answer and explanation in LearnFree account
Question 24 · Medium
A laboratory compares each abnormal cervical cytology report with the colposcopic biopsy result from the same woman. This activity is called:
1. ARapid rescreening of negatives
2. BCytohistological correlation
3. CInterlaboratory comparison
4. DLiquid-based cell transfer
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Question 25 · Easy
The ectocervix and vagina are normally lined by:
1. AKeratinised stratified squamous epithelium
2. BTransitional (urothelial) epithelium
3. CSimple mucin-secreting columnar epithelium
4. DNon-keratinised stratified squamous epithelium
Answer and explanation in LearnFree account

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Gynaecological cytology and the Pap stain

On day 13 of her cycle, a 26-year-old woman's hormonal smear shows parabasal cells 0%, intermediate 35% and superficial 65%, with a karyopyknotic index of 60%. This pattern shows:

By The Bethesda System, a liquid-based cervical preparation is satisfactory for squamous cellularity if it contains at least about:

The transformation zone of the cervix, where most cervical cancers arise, lies at the junction of:

A vaginal smear contains many boat-shaped intermediate cells with folded edges and yellow glycogen. These navicular cells indicate:

The Cytobrush is used in cervical sampling mainly to collect cells from the:

A heavily bloody cervical smear can be fixed in which fixative, which also lyses the red cells?

In The Bethesda System, a transformation zone component is reported as present when the smear contains at least:

A cervical smear shows multinucleated squamous cells with nuclear moulding, margination of chromatin and glassy nuclei. Which infection do these changes typify?

What do koilocytes in a cervical smear indicate?

In The Bethesda System, ASC-H stands for:

A cervical smear from a 52-year-old woman shows a few benign-appearing endometrial cells. She is not menstruating. How should they be handled by The Bethesda System (2014)?

After the laboratory switches to a new tap water supply, Pap-stained nuclei appear reddish-purple and lack crisp detail, while the cytoplasm stains normally. The most likely cause and remedy are:

In hormonal cytology, the karyopyknotic index (KPI) is the percentage of:

A woman whose smear was reported negative is found on biopsy to have CIN 3. On review, a few unmarked HSIL cells are found near one edge of the same smear. How is this error best classed?

Mature superficial and intermediate cells show nuclei over three times the normal intermediate nucleus, with hyperchromasia, binucleation and sharp perinuclear cavities. The Bethesda category is:

In a regressive Pap stain with Harris haematoxylin, the excess dye is removed from the cytoplasm with:

Two years after pelvic radiotherapy for cervical cancer, a 55-year-old woman's vault smear shows greatly enlarged cells with bizarre shapes, vacuolated two-toned cytoplasm and multinucleation. The nuclei are enlarged in proportion to the cytoplasm, with fine chromatin. The best interpretation is:

A 28-year-old woman has a thin grey discharge with a fishy odour. Results: vaginal pH 5.2 (normal 3.8-4.5); KOH whiff test positive; Pap smear shows many clue cells, few lactobacilli and scanty neutrophils. How should the cytology be reported?

For the general population of women, the 2021 WHO guideline recommends cervical screening by:

Round cells with dense blue-green cytoplasm and short spiky cytoplasmic processes, lying between squamous and columnar cells, show that the smear has sampled the:

Squamous cells whose borders are blurred by a carpet of small coccobacilli, with few lactobacilli in the background, suggest:

A new trainee runs the Pap stain with Harris haematoxylin. Nuclei are pale grey-blue with washed-out chromatin, while cytoplasm stains normally. The haematoxylin was fresh, bluing was correct and the timer showed 2 minutes in 0.5% acid alcohol instead of a few dips. What is the cause?

Döderlein bacilli, the normal dominant flora of the healthy adult vagina, are:

A laboratory compares each abnormal cervical cytology report with the colposcopic biopsy result from the same woman. This activity is called:

The ectocervix and vagina are normally lined by: