Updated: 12/11/2019

Pap Smear

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Snapshot
  • A 27-year-old women presents to her gynecologist for a routine visit. She denies any acute complaints and is currently sexually active with two men. She reports consistent use of condoms and denies any abnormal vaginal smell or discharge as well as dysuria. A pap test is performed, which shows atypical squamous cells of undetermined significance (ASC-US). Her last pap test was normal. A reflex human papillomavirus (HPV) test is performed.
Introduction
  • Papanicolaou (pap) test (cytology) is a method used to screen for cervical cancer
    • cervical cancer
      • can be divided into two main types
        • squamous cell carcinoma
          • more prevalent
        • adenocarcinoma
    • cervical cancer mortality and incidence has decreased with its use
      • pap test enables detection of precancerous lesions and disease in its early stages
    • other screening tests involves testing for high-risk strains of human papillomavirus (HPV)
  • Method
    • the test involves obtaining cells by scraping or brushing them from the cervical os and endocervix
    • these cells are then sent to the laboratory for cytologic analysis
      • identifies abnormal cells in the
        • transformation zone (T-zone)
Screening Recommendations
  • Pap test
    • women who are 21-65 years of age
      • perform every 3 years
      • regardless of initiation of sexual activity
  • Pap test and human papillomavirus (HPV)
    • women who are 30-65 years of age
      • perform every 5 years 
      • ideal for women who want to lengthen the screening interval
  • Discontinuing screening
    • women > 65 years of age with adequate prior screening
  • Special populations
    • hysterectomy with cervix removal and absent history of cervical intraepithelial neoplasia (CIN) grade 2 or 3 or cervical cancer
      • do not perform screening
Pap Test Results
  • Unsatisfactory cytology
  • Negative for intraepithelial lesion or malignancy (NILM)
  • Intraepithelial cell abnormalities
    • squamous cell abnormalities
      • atypical squamous cells of undetermined significance (ASC-US)
      • atypical squamous cells, can't exclude HSIL (ASC-H)
      • low-grade squamous intraepithelial lesion (LSIL)
      • high-grade squamous intraepithelial lesion (HSIL)
      • squamous cell carcinoma (SCC)
    • glandular cell abnormalities
      • atypical glandular cells (AGC)
Abnormal Pap Smear Management
 
Pap Smear Management
Pap Smear Test Result 21-24 Years Old 25-29 Years Old 30 Years Old & HPV Negative 30 Years Old & HPV Positive
Normal pap test result
  • Pap test ever 3 years
  • Pap test every 3 years
  • Co-testing (pap and HPV testing) every 5 years
    • preferred
  • Pap test every 3 years
    • acceptable
  • Co-testing in 1 year
    • acceptable
  • HPV testing
    • acceptable
ASC-US
  • Pap test in 1 year
    • preferred
  • Reflex HPV test
    • acceptable
  • Pap test in 1 year
    • acceptable
  • Reflex HPV test
    • preferred
  • Repeat co-testing in 3 years
  • Colposcopy
LSIL
  • Repeat pap test in 1 year
  • Colposcopy
  • Repeat pap test in 1 year
    • preferred
  • Colposcopy
    • acceptable
  • Colposcopy
ASC-H
  • Colposcopy
  • Colposcopy
  • Colposcopy
  • Colposcopy
HSIL
  • Colposcopy
  • Excisional treatment or colposcopy
  • Excisional treatment or colposcopy
  • Excisional treatment or colposcopy
  • Excisional treatments include
    • loop electrosurgical excision procedure (LEEP)
    • cold-knife conization
    • laser conization
 

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Questions (5)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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(M2.GN.15.30) A 27-year-old female presents to her OB/GYN for a check-up. During her visit, a pelvic exam and Pap smear are performed. The patient does not have any past medical issues and has had routine gynecologic care with normal pap smears every 3 years since age 21. The results of the Pap smear demonstrate atypical squamous cells of undetermined significance (ASCUS). Which of the following is the next best step in the management of this patient? Review Topic | Tested Concept

QID: 105667
1

Repeat Pap smear in 1 year

21%

(7/33)

2

Repeat Pap smear in 3 years

3%

(1/33)

3

Perform an HPV DNA test

52%

(17/33)

4

Perform colposcopy

18%

(6/33)

5

Perform a Loop Electrosurgical Excision Procedure (LEEP)

3%

(1/33)

L 2 E

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(M2.GN.15.6) A 36-year-old female presents to her gynecologist for a check-up. She has had normal Pap smears as recommended every 3 years since she turned 30 years old. The physician conducts a pelvic examination that is without abnormality and obtains a cervical Pap smear. The results of the patient's Pap smear from the visit return as high grade squamous intraepithelial lesion (HGSIL). Which of the following is the best next step in the management of this patient? Review Topic | Tested Concept

QID: 102947
1

Repeat Pap smear in 12 months

0%

(0/20)

2

Repeat Pap smear in 3 years

0%

(0/20)

3

Obtain HPV DNA test

20%

(4/20)

4

Perform colposcopy

75%

(15/20)

5

Radical hysterectomy

0%

(0/20)

L 3 E

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(M2.GN.15.5667) A 31-year-old female presents to her gynecologist for a routine Pap smear. Her last Pap smear was three years ago and was normal. On the current Pap smear, she is found to have atypical squamous cells of unknown significance (ASCUS). Reflex HPV testing is positive. What is the best next step? Review Topic | Tested Concept

QID: 106992
1

Repeat Pap smear and HPV testing in 5 years

0%

(0/24)

2

Repeat Pap smear in 3 years

0%

(0/24)

3

Repeat Pap smear in 1 year

0%

(0/24)

4

Colposcopy

92%

(22/24)

5

Loop electrosurgical excision procedure (LEEP)

4%

(1/24)

L 3 E

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