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Pathology · USMLE Step 1

USMLE Pathology: Cytopathology and Screening

Pap smear, fine-needle aspiration cytology, and the Bethesda cervical screening system, a lab-method deck distinct from the biopsy-morphology focus of the organ-specific pathology decks.

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What type of cells does a conventional Pap smear sample from the cervix?
Exfoliated cells from the cervical transformation zone.
What is the primary purpose of a Pap smear?
To screen for precancerous and cancerous cervical lesions.
Who developed the Pap smear technique?
George Papanicolaou.
What is the cervical transformation zone?
The junction between squamous epithelium of the ectocervix and columnar epithelium of the endocervix.
At what age does average-risk cervical cancer screening typically begin?
Age 21.
How often should average-risk women aged 21 to 29 be screened with cytology alone?
Every 3 years.
What is the preferred screening strategy for average-risk women aged 30 to 65?
Cytology plus HPV co-testing every 5 years.
Which two HPV genotypes are most strongly linked to cervical cancer?
HPV 16 and 18.
What cytologic feature is characteristic of HPV-infected squamous cells?
Koilocytes: cells with a perinuclear halo, nuclear enlargement, and hyperchromasia.
What does the Bethesda system standardize?
Reporting terminology for cervical cytology results.
What does the Bethesda category ASC-US stand for?
Atypical squamous cells of undetermined significance.
What does the Bethesda category ASC-H mean?
Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion.
Which histologic lesion does LSIL correspond to?
Cervical intraepithelial neoplasia grade 1 (mild dysplasia).
Which histologic lesions does HSIL correspond to?
CIN 2 and CIN 3 (moderate to severe dysplasia or carcinoma in situ).
What does the Bethesda category AGC stand for?
Atypical glandular cells.

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