MLT GlobeHisto & Cyto Techniques: Cytology – page 4
80 Histo & Cyto Techniques MCQs on Cytology with answers and explanations.
What is the purpose of the two-step smearing technique for aspirates diluted with blood or fluid?
Excess fluid is drained off, leaving tissue fragments that are then spread, giving a concentrated, thin, evenly cellular smear.
Cells from a specimen fixed before smearing tend to wash off during staining. Which slide should be used?
Prefixed cells lose their natural stickiness, so an adhesive coating keeps them on the slide; oil prevents adhesion.
Before cytocentrifugation, a very viscous synovial fluid is best treated with:
Hyaluronidase digests hyaluronic acid, lowering viscosity so cells spread evenly; the other treatments would distort or destroy cells.
In a Pap-stained cervical smear, mature superficial squamous cells typically have:
Superficial cells have pink (eosinophilic) cytoplasm and small, dense pyknotic nuclei. Intermediate cells have blue-green cytoplasm and larger vesicular nuclei.
A smear fixed with a spray fixative containing polyethylene glycol arrives in the lab. Before Pap staining, the slide should be:
The waxy polyethylene glycol coating must be dissolved (e.g., soaking in 95% alcohol) before staining, otherwise stain uptake is poor.
A cervical Pap shows squamous cells with sharply defined perinuclear cavities and enlarged, hyperchromatic, wrinkled nuclei (koilocytes). Using the Bethesda System, this is reported as:
Koilocytes represent HPV cytopathic effect and are classified as LSIL, which includes CIN 1. ASC-US is used when changes are only suggestive.
A cervical sample shows a few squamous cells with abnormalities that suggest, but are insufficient for, a high-grade lesion. The appropriate Bethesda category is:
ASC-H means atypical squamous cells, cannot exclude HSIL. ASC-US is used when the atypia suggests a low-grade change or its nature is unclear.
A Pap smear shows squamous cells whose borders are obscured by a coating of small coccobacilli, with few lactobacilli in the background. This suggests:
Clue cells with a coccobacillary background indicate a shift in vaginal flora suggestive of bacterial vaginosis. Trichomonas appears as pear-shaped organisms with eosinophilic granules.
During rapid on-site evaluation of a fine-needle aspiration, one set of smears is air-dried. Which stain is appropriate for these slides?
Air-dried smears are stained with Romanowsky-type stains, which are quick and show cytoplasm and background well. Pap stain requires wet alcohol fixation.
Fine-needle aspiration of a palpable thyroid nodule is usually performed with a needle of what gauge?
Fine needles of about 23–27 gauge give adequate cells with little blood and discomfort. Larger 14–18 gauge needles are used for core biopsies.
A urine cytology sample from a kidney transplant recipient shows enlarged cells with a single, homogeneous, glassy dark nuclear inclusion. These 'decoy cells' indicate:
Decoy cells carry polyomavirus inclusions that can mimic malignant cells but are benign; in transplant patients they suggest BK virus reactivation. Herpes shows multinucleation and nuclear molding.
A Pap smear shows pear-shaped, grey-green organisms about 15–30 µm long with a faint, eccentric nucleus and red cytoplasmic granules. They are:
These are the typical Pap-stain features of Trichomonas; flagella are often not seen. Candida appears as budding yeasts and pseudohyphae.
Tangled clumps of thin filamentous bacteria, forming 'cotton ball' masses on a Pap smear, are most often seen in women:
Actinomyces-like organisms are strongly associated with intrauterine device use. The finding is reported under organisms in the Bethesda System.
A 35-year-old's cervical cytology is reported as ASC-US. In current practice, the preferred next laboratory step is:
HPV testing (often reflex from the same liquid-based sample) triages ASC-US: a positive result leads to colposcopy according to risk-based guidelines. CA-125 is not a cervical screening test.
Under the 2014 Bethesda System, benign-appearing endometrial cells in a cervical sample are reported when the woman is aged:
Bethesda 2014 raised the reporting age to 45, because endometrial cells in women 45 or older may, rarely, signal endometrial disease. In younger women they are usually normal.
For a blind trans-costal liver aspiration, the needle is usually inserted at:
The lower intercostal spaces in the midaxillary line overlie the right lobe below the lung; higher spaces risk puncturing lung.
For a liquid-based cervical cytology preparation to be satisfactory, the Bethesda System requires at least how many well-preserved, well-visualized squamous cells?
Liquid-based preparations need an estimated minimum of 5,000 squamous cells. Conventional smears require about 8,000–12,000.
The Bethesda System notes the presence of a transformation zone component when at least how many well-preserved endocervical or squamous metaplastic cells are seen?
At least 10 well-preserved endocervical or metaplastic cells, singly or in groups, indicate sampling of the transformation zone. Its absence is reported as a quality indicator.
Peritoneal fluid from a 58-year-old woman shows papillary clusters of malignant cells with concentrically laminated calcified bodies. The most likely primary is:
Psammoma bodies with papillary malignant clusters in peritoneal fluid strongly suggest serous carcinoma of the ovary or peritoneum. Hepatocellular carcinoma rarely forms psammoma bodies.
In a pleural effusion, which immunostain on a cell block best supports reactive mesothelial cells rather than metastatic adenocarcinoma?
Calretinin (with WT1 and D2-40) is a mesothelial marker. Claudin-4, MOC-31 and BerEP4 are epithelial markers that favor adenocarcinoma.