bps oncology pharmacy practice exam

18
BPS Oncology Pharmacy Practice Exam After reading each question, use the radio buttons provided to select your answer. When finished, click the Score Test button to submit your answers. Your results will be tabulated and questions that you missed will be displayed with your answer and, if necessary, the correct answer. 1. On day 14 after allogeneic stem cell transplant, the patient complains of right-upper-quadrant pain. He has gained 10 kg over the past 3 days. The preparative regimen for his AML was cyclophosphamide and busulfan. What is the most likely cause of the pain? A. Cytomegalovirus hepatitis B. Graft-versus-host disease C. Veno-occlusive liver disease D. Acute cholecystitis 2. A 50-year-old male presents to the emergency department with a temperature of 39.4°C, severe hypotension, and chills. The patient has a history of hypertension, diabetes, and coronary artery disease. He received paclitaxel and carboplatin 9 days ago for non-small-cell lung cancer. His absolute neutrophil count is 56 cells/mm³. Which of the following interventions would be most appropriate for this patient? A. Cefepime B. Imipenem and filgrastim C. Ceftriaxone and filgrastim D. Ciprofloxacin and aztreonam 3. Which of the following chemotherapy agents has been associated with severe extravasation injury? A. Bleomycin B. Cyclophosphamide C. Methotrexate D. Vincristine

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Page 1: BPS Oncology Pharmacy Practice Exam

BPS Oncology Pharmacy Practice Exam

After reading each question, use the radio buttons provided to select your answer. When finished, click the Score Test button to submit your answers. Your results will be tabulated

and questions that you missed will be displayed with your answer and, if necessary, the correct answer.

1.On day 14 after allogeneic stem cell transplant, the patient complains of right-upper-quadrant pain. He has gained 10 kg over the past 3 days. The preparative regimen for his AML was cyclophosphamide and busulfan. What is the most likely cause of the pain?

 

A. Cytomegalovirus hepatitis

B. Graft-versus-host disease

C. Veno-occlusive liver disease

D. Acute cholecystitis

2.A 50-year-old male presents to the emergency department with a temperature of 39.4°C, severe hypotension, and chills. The patient has a history of hypertension, diabetes, and coronary artery disease. He received paclitaxel and carboplatin 9 days ago for non-small-cell lung cancer. His absolute neutrophil count is 56 cells/mm³. Which of the following interventions would be most appropriate for this patient?

 

A. Cefepime

B. Imipenem and filgrastim

C. Ceftriaxone and filgrastim

D. Ciprofloxacin and aztreonam

3.Which of the following chemotherapy agents has been associated with severe extravasation injury?

 

A. Bleomycin

B. Cyclophosphamide

C. Methotrexate

D. Vincristine

4.A 68-year-old female has been recently diagnosed with stage IV breast cancer. Her tumor is found to be estrogen-and progesterone-receptor positive. Which of the following is recommended for initial hormonal management?

 

A. Anastrozole 1 mg PO q.d.

B. Aminoglutethimide 250 mg PO q.i.d.

C. Tamoxifen 40 mg PO b.i.d.

D. Exemestane 25 mg PO q.d.

Page 2: BPS Oncology Pharmacy Practice Exam

5.Which of the following is the most appropriate treatment for Helicobacter pylori - associated low- grade lymphoma of mucosa-associated lymphoid tissue (MALT)?

 

A. Omeprazole, amoxicillin, DICE

B. ProMACE cytaBOM

C. Omeprazole, amoxicillin, clarithromycin

D. CHOP, rituximab

6.Which of the following combination chemotherapy regimens is considered first-line treatment for adults with acute nonlymphocytic leukemia?

 

A. Mitoxantrone and cytarabine

B. Cytarabine and doxorubicin

C. Mitoxantrone and daunorubicin

D. Cytarabine and daunorubicin

7.Questions 7 and 8 refer to the same patient. S.I. is a 65-year-old female with metatstic colon cancer. Her treatment plan includes irinotecan,leucovorin, and flourouracil (IFL). You have been asked to discuss potential side efects and management of them with her. Which of the following describes the proper management plan for diarrhea that occurs greater than 24 hours after treatment?

 

A. Take two atropine tablets at the onset of diarrhea and then repeat after each loose bowel movement. Continue taking atropine tablets on this schedule until you are diarrhea free for 12 hours.

B. Drink at least eight 8-oz. glasses of water a day to prevent dehydration. If symptoms persist for more than 48 hours, call your physician.

C. Take two loperamide capsules at the onset of diarrhea and then take one capsule every two hours. Continue taking loperamide on this schedule until you are diarrhea free for 12 hours.

D. Take two diphenoxylate/atropine tablets at the onset of diarrhea and then take two tablets after each loose bowel movement. Continue taking diphenoxylate/atropine tablets every 4 hours until you are diarrhea free for 12 hours.

8.On day 18 of her treatment course she calls complaining of severe mouth pain and dizziness. When she arrives at the clinic, she reports that she has been unable to eat or drink for the past 2 days and for two days prior to that her intake was minimal. Lab values are as follows: Na 136, K 4.3, CO2 27, C1 102, BUN 34, SCr 1.8, WBC 1800/mm³, Hgb 10.5, Hct 37, Plt 90/mm³, neutrophils (%) 42, lymphocytes (%) 45, monocytes(%) 12, eosinophils (%) 0.7, basophils (%) 0.3. The fellow asks you if you think it is going to be necessary to adjust the patient’s next cycle of chemotherapy. Which of the following represents the most appropriate dosing recommendation to make at this time?

  A. This patient is not going to be able to tolerate further treatment with

Page 3: BPS Oncology Pharmacy Practice Exam

chemotherapy. She should be enrolled into an investigational protocol or receive symptomatic and supportive care.

B. Treatment will need to be delayed. When the patient fully recovers from the treatment- related toxicities, reduced doses of flourouracil, and irinotecan will be necessary.

C. Treatment will need to be delayed. When the patient fully recovers from the treatment-related toxicities, reduced doses of irinotecan will be necessary. Flourouracil and leucovorin can be resumed at the original dose.

D. This patient is not going to be able to tolerate further treatment with this regimen. She should be treated with only flourouracil and leucovorin when she fully recovers from these treatment-related toxicities.

9.Which of the following most accurately characterizes the neurotoxicity profile of oxaliplatin?

 

A. Acute neurotoxicity can be triggered by exposure to cold

B. Acute neurotoxicity usually does not recur with further dosing.

C. Chronic neurotoxicity can be triggered by exposure to cold

D. Chronic neurotoxicity does not limit further treatment

10.With regard to treatment trials, the primary purpose of the informed consent process is to provide:

 

A. information regarding the treatment and the financial costs associated with trial participation.

B. liability coverage for the institution and the participating investigators.

C. a contract between the investigator and a person participating in the trial.

D. sufficient information for a potential subject to make a decision about participating in a trial.

11.When an investigational drug is being studied in a phase II clinical trial which of the following choices best characterizes the appropriate endpoints of the study?

 

A. Efficacy and dose limiting toxicity (DLT)

B. Pharmacokinetic and pharmacodynamic parameters

C. Response rate and safety

D. Overall survival or clinical benefit response

12.You have been asked to write a departmental policy to ensure that all thalidomide capsules are dispensed consistent with the revised S.T.E.P.S. Program. Which of the following accurately characterizes compliance with this program?

  A. Subsequent prescriptions can only be filled if fewer than 7 days of

Page 4: BPS Oncology Pharmacy Practice Exam

therapy remain from the previous prescription. B. A prescription for thalidomide is valid and can be filled up to 14

days after it is written. C. Up to a 2 month supply of thalidomide can be dispensed at one time

with no refills. D. Capsules can be removed from the blister packs prior to dispensing

if the patient requests this.

13.A new physician joins the Oncology Division at your hospital. He has several research protocols that involve the use of gene transfer products and he has submitted these to the IRB for approval. You sit on the IRB and have concerns about the safety and proper handling of these agents. Which of the following publications would provide the best information about the dangers involved in handling these gene transfer agents and precautions that should be taken to ensure the safety of those preparing them?

 

A. CDC/NIH publication - Biosafety in Microbiological and Biomedical Laboratories

B. ASHP Technical Assistance Bulletin on Handling Cytotoxic and Hazardous Drugs

C. OSHA Technical Manual - Controlling Occupational Exposure to Hazardous Drugs

D. JCAHO publication - Comprehensive Accreditation Manual for Hospitals

14. It is recommended that patients who have had basal cell carcinoma of the skin or those who are at high risk for skin cancer use a minimum sunblock of SPF:

 

A. 5.

B. 15.

C. 30.

D. 45.

15.You are participating in an annual patient education program sponsored by your employer. You have been asked to help staff the booth focusing on current cancer screening guidelines. A woman asks you about the latest recommendations for the screening of gynecologic cancers. Which of the following statements accurately represents the American Cancer Society (ACS) cervical cancer screening guidelines.

 

A. At age 30 or after, women who have a single normal or negative cytology result can receive subsequent screening every three years.

B. All women of screening age should receive human papillomavirus (HPV) DNA testing in conjunction with cytology smears.

C. Women should begin cervical cancer screening no later than age 21 or within 3 years of becoming sexually active, whichever occurs first.

D. All women who are 70 years of age or older with an intact uterus no longer require cervical cancer screening.

Page 5: BPS Oncology Pharmacy Practice Exam

BPS Oncology Pharmacy Practice Exam Results

You answered 5 of 14 correctly, leaving 1 unanswered.In the key below, correct answers are marked in green and incorrect answers are marked in

red.If you did not answer a question, no answer is marked.

Continue ExamExit Exam

1.On day 14 after allogeneic stem cell transplant, the patient complains of right-upper-quadrant pain. He has gained 10 kg over the past 3 days. The preparative regimen for his AML was cyclophosphamide and busulfan. What is the most likely cause of the pain?

 

A.   Cytomegalovirus hepatitis B.   Graft-versus-host disease C.   Veno-occlusive liver disease D.   Acute cholecystitis

2.A 50-year-old male presents to the emergency department with a temperature of 39.4°C, severe hypotension, and chills. The patient has a history of hypertension, diabetes, and coronary artery disease. He received paclitaxel and carboplatin 9 days ago for non-small-cell lung cancer. His absolute neutrophil count is 56 cells/mm³. Which of the following interventions would be most appropriate for this patient?

 

A.   Cefepime B.   Imipenem and filgrastim C.   Ceftriaxone and filgrastim D.   Ciprofloxacin and aztreonam

3.Which of the following chemotherapy agents has been associated with severe extravasation injury?

 

A.   Bleomycin B.   Cyclophosphamide C.   Methotrexate D.   Vincristine

4.A 68-year-old female has been recently diagnosed with stage IV breast cancer. Her tumor is found to be estrogen-and progesterone-receptor positive. Which of the following is recommended for initial hormonal management?

 

A.   Anastrozole 1 mg PO q.d. B.   Aminoglutethimide 250 mg PO q.i.d. C.   Tamoxifen 40 mg PO b.i.d. D.   Exemestane 25 mg PO q.d.

Page 6: BPS Oncology Pharmacy Practice Exam

5.Which of the following is the most appropriate treatment for Helicobacter pylori - associated low- grade lymphoma of mucosa-associated lymphoid tissue (MALT)?

 

A.   Omeprazole, amoxicillin, DICE B.   ProMACE cytaBOM C.   Omeprazole, amoxicillin, clarithromycin D.   CHOP, rituximab

6.Which of the following combination chemotherapy regimens is considered first-line treatment for adults with acute nonlymphocytic leukemia?

 

A.   Mitoxantrone and cytarabine B.   Cytarabine and doxorubicin C.   Mitoxantrone and daunorubicin D.   Cytarabine and daunorubicin

7.Questions 7 and 8 refer to the same patient. S.I. is a 65-year-old female with metatstic colon cancer. Her treatment plan includes irinotecan,leucovorin, and flourouracil (IFL). You have been asked to discuss potential side efects and management of them with her. Which of the following describes the proper management plan for diarrhea that occurs greater than 24 hours after treatment?

 

A.   Take two atropine tablets at the onset of diarrhea and then repeat after each loose bowel movement. Continue taking atropine tablets on this schedule until you are diarrhea free for 12 hours.

B.   Drink at least eight 8-oz. glasses of water a day to prevent dehydration. If symptoms persist for more than 48 hours, call your physician.

C.   Take two loperamide capsules at the onset of diarrhea and then take one capsule every two hours. Continue taking loperamide on this schedule until you are diarrhea free for 12 hours.

D.   Take two diphenoxylate/atropine tablets at the onset of diarrhea and then take two tablets after each loose bowel movement. Continue taking diphenoxylate/atropine tablets every 4 hours until you are diarrhea free for 12 hours.

8.On day 18 of her treatment course she calls complaining of severe mouth pain and dizziness. When she arrives at the clinic, she reports that she has been unable to eat or drink for the past 2 days and for two days prior to that her intake was minimal. Lab values are as follows: Na 136, K 4.3, CO2 27, C1 102, BUN 34, SCr 1.8, WBC 1800/mm³, Hgb 10.5, Hct 37, Plt 90/mm³, neutrophils (%) 42, lymphocytes (%) 45, monocytes(%) 12, eosinophils (%) 0.7, basophils (%) 0.3. The fellow asks you if you think it is going to be necessary to adjust the patient’s next cycle of chemotherapy. Which of the following represents the most appropriate dosing recommendation to make at this time?

  A.   This patient is not going to be able to tolerate further treatment with chemotherapy. She should be enrolled into an investigational protocol or receive symptomatic and supportive care.

Page 7: BPS Oncology Pharmacy Practice Exam

B.   Treatment will need to be delayed. When the patient fully recovers from the treatment- related toxicities, reduced doses of flourouracil, and irinotecan will be necessary.

C.   Treatment will need to be delayed. When the patient fully recovers from the treatment-related toxicities, reduced doses of irinotecan will be necessary. Flourouracil and leucovorin can be resumed at the original dose.

D.   This patient is not going to be able to tolerate further treatment with this regimen. She should be treated with only flourouracil and leucovorin when she fully recovers from these treatment-related toxicities.

9.Which of the following most accurately characterizes the neurotoxicity profile of oxaliplatin?

 

A.   Acute neurotoxicity can be triggered by exposure to cold B.   Acute neurotoxicity usually does not recur with further dosing. C.   Chronic neurotoxicity can be triggered by exposure to cold D.   Chronic neurotoxicity does not limit further treatment

10.With regard to treatment trials, the primary purpose of the informed consent process is to provide:

 

A.   information regarding the treatment and the financial costs associated with trial participation.

B.   liability coverage for the institution and the participating investigators.

C.   a contract between the investigator and a person participating in the trial.

D.   sufficient information for a potential subject to make a decision about participating in a trial.

11.When an investigational drug is being studied in a phase II clinical trial which of the following choices best characterizes the appropriate endpoints of the study?

 

A.   Efficacy and dose limiting toxicity (DLT) B.   Pharmacokinetic and pharmacodynamic parameters C.   Response rate and safety D.   Overall survival or clinical benefit response

12.You have been asked to write a departmental policy to ensure that all thalidomide capsules are dispensed consistent with the revised S.T.E.P.S. Program. Which of the following accurately characterizes compliance with this program?

  A.   Subsequent prescriptions can only be filled if fewer than 7 days of therapy remain from the previous prescription.

B.   A prescription for thalidomide is valid and can be filled up to 14 days after it is written.

C.   Up to a 2 month supply of thalidomide can be dispensed at one time

Page 8: BPS Oncology Pharmacy Practice Exam

with no refills. D.   Capsules can be removed from the blister packs prior to

dispensing if the patient requests this.

13.A new physician joins the Oncology Division at your hospital. He has several research protocols that involve the use of gene transfer products and he has submitted these to the IRB for approval. You sit on the IRB and have concerns about the safety and proper handling of these agents. Which of the following publications would provide the best information about the dangers involved in handling these gene transfer agents and precautions that should be taken to ensure the safety of those preparing them?

 

A.   CDC/NIH publication - Biosafety in Microbiological and Biomedical Laboratories

B.   ASHP Technical Assistance Bulletin on Handling Cytotoxic and Hazardous Drugs

C.   OSHA Technical Manual - Controlling Occupational Exposure to Hazardous Drugs

D.   JCAHO publication - Comprehensive Accreditation Manual for Hospitals

14. It is recommended that patients who have had basal cell carcinoma of the skin or those who are at high risk for skin cancer use a minimum sunblock of SPF:

 

A.   5. B.   15. C.   30. D.   45.

15.You are participating in an annual patient education program sponsored by your employer. You have been asked to help staff the booth focusing on current cancer screening guidelines. A woman asks you about the latest recommendations for the screening of gynecologic cancers. Which of the following statements accurately represents the American Cancer Society (ACS) cervical cancer screening guidelines.

 

A.   At age 30 or after, women who have a single normal or negative cytology result can receive subsequent screening every three years.

B.   All women of screening age should receive human papillomavirus (HPV) DNA testing in conjunction with cytology smears.

C.   Women should begin cervical cancer screening no later than age 21 or within 3 years of becoming sexually active, whichever occurs first.

D.   All women who are 70 years of age or older with an intact uterus no longer require cervical cancer screening.

BPS Oncology Pharmacy Practice Exam Results

You answered 5 of 14 correctly, leaving 1 unanswered.

Page 9: BPS Oncology Pharmacy Practice Exam

In the key below, correct answers are marked in green and incorrect answers are marked in red.

If you did not answer a question, no answer is marked.Continue Exam

Exit Exam

1.On day 14 after allogeneic stem cell transplant, the patient complains of right-upper-quadrant pain. He has gained 10 kg over the past 3 days. The preparative regimen for his AML was cyclophosphamide and busulfan. What is the most likely cause of the pain?

 

A.   Cytomegalovirus hepatitis B.   Graft-versus-host disease C.   Veno-occlusive liver disease D.   Acute cholecystitis

2.A 50-year-old male presents to the emergency department with a temperature of 39.4°C, severe hypotension, and chills. The patient has a history of hypertension, diabetes, and coronary artery disease. He received paclitaxel and carboplatin 9 days ago for non-small-cell lung cancer. His absolute neutrophil count is 56 cells/mm³. Which of the following interventions would be most appropriate for this patient?

 

A.   Cefepime B.   Imipenem and filgrastim C.   Ceftriaxone and filgrastim D.   Ciprofloxacin and aztreonam

3.Which of the following chemotherapy agents has been associated with severe extravasation injury?

 

A.   Bleomycin B.   Cyclophosphamide C.   Methotrexate D.   Vincristine

4.A 68-year-old female has been recently diagnosed with stage IV breast cancer. Her tumor is found to be estrogen-and progesterone-receptor positive. Which of the following is recommended for initial hormonal management?

 

A.   Anastrozole 1 mg PO q.d. B.   Aminoglutethimide 250 mg PO q.i.d. C.   Tamoxifen 40 mg PO b.i.d. D.   Exemestane 25 mg PO q.d.

5.Which of the following is the most appropriate treatment for Helicobacter pylori - associated low- grade lymphoma of mucosa-associated lymphoid tissue (MALT)?

  A.   Omeprazole, amoxicillin, DICE B.   ProMACE cytaBOM C.   Omeprazole, amoxicillin, clarithromycin

Page 10: BPS Oncology Pharmacy Practice Exam

D.   CHOP, rituximab

6.Which of the following combination chemotherapy regimens is considered first-line treatment for adults with acute nonlymphocytic leukemia?

 

A.   Mitoxantrone and cytarabine B.   Cytarabine and doxorubicin C.   Mitoxantrone and daunorubicin D.   Cytarabine and daunorubicin

7.Questions 7 and 8 refer to the same patient. S.I. is a 65-year-old female with metatstic colon cancer. Her treatment plan includes irinotecan,leucovorin, and flourouracil (IFL). You have been asked to discuss potential side efects and management of them with her. Which of the following describes the proper management plan for diarrhea that occurs greater than 24 hours after treatment?

 

A.   Take two atropine tablets at the onset of diarrhea and then repeat after each loose bowel movement. Continue taking atropine tablets on this schedule until you are diarrhea free for 12 hours.

B.   Drink at least eight 8-oz. glasses of water a day to prevent dehydration. If symptoms persist for more than 48 hours, call your physician.

C.   Take two loperamide capsules at the onset of diarrhea and then take one capsule every two hours. Continue taking loperamide on this schedule until you are diarrhea free for 12 hours.

D.   Take two diphenoxylate/atropine tablets at the onset of diarrhea and then take two tablets after each loose bowel movement. Continue taking diphenoxylate/atropine tablets every 4 hours until you are diarrhea free for 12 hours.

8.On day 18 of her treatment course she calls complaining of severe mouth pain and dizziness. When she arrives at the clinic, she reports that she has been unable to eat or drink for the past 2 days and for two days prior to that her intake was minimal. Lab values are as follows: Na 136, K 4.3, CO2 27, C1 102, BUN 34, SCr 1.8, WBC 1800/mm³, Hgb 10.5, Hct 37, Plt 90/mm³, neutrophils (%) 42, lymphocytes (%) 45, monocytes(%) 12, eosinophils (%) 0.7, basophils (%) 0.3. The fellow asks you if you think it is going to be necessary to adjust the patient’s next cycle of chemotherapy. Which of the following represents the most appropriate dosing recommendation to make at this time?

  A.   This patient is not going to be able to tolerate further treatment with chemotherapy. She should be enrolled into an investigational protocol or receive symptomatic and supportive care.

B.   Treatment will need to be delayed. When the patient fully recovers from the treatment- related toxicities, reduced doses of flourouracil, and irinotecan will be necessary.

C.   Treatment will need to be delayed. When the patient fully recovers from the treatment-related toxicities, reduced doses of irinotecan will be necessary. Flourouracil and leucovorin can be resumed at the original dose.

Page 11: BPS Oncology Pharmacy Practice Exam

D.   This patient is not going to be able to tolerate further treatment with this regimen. She should be treated with only flourouracil and leucovorin when she fully recovers from these treatment-related toxicities.

9.Which of the following most accurately characterizes the neurotoxicity profile of oxaliplatin?

 

A.   Acute neurotoxicity can be triggered by exposure to cold B.   Acute neurotoxicity usually does not recur with further dosing. C.   Chronic neurotoxicity can be triggered by exposure to cold D.   Chronic neurotoxicity does not limit further treatment

10.With regard to treatment trials, the primary purpose of the informed consent process is to provide:

 

A.   information regarding the treatment and the financial costs associated with trial participation.

B.   liability coverage for the institution and the participating investigators.

C.   a contract between the investigator and a person participating in the trial.

D.   sufficient information for a potential subject to make a decision about participating in a trial.

11.When an investigational drug is being studied in a phase II clinical trial which of the following choices best characterizes the appropriate endpoints of the study?

 

A.   Efficacy and dose limiting toxicity (DLT) B.   Pharmacokinetic and pharmacodynamic parameters C.   Response rate and safety D.   Overall survival or clinical benefit response

12.You have been asked to write a departmental policy to ensure that all thalidomide capsules are dispensed consistent with the revised S.T.E.P.S. Program. Which of the following accurately characterizes compliance with this program?

 

A.   Subsequent prescriptions can only be filled if fewer than 7 days of therapy remain from the previous prescription.

B.   A prescription for thalidomide is valid and can be filled up to 14 days after it is written.

C.   Up to a 2 month supply of thalidomide can be dispensed at one time with no refills.

D.   Capsules can be removed from the blister packs prior to dispensing if the patient requests this.

13.A new physician joins the Oncology Division at your hospital. He has several research protocols that involve the use of gene transfer products and he has submitted these to the IRB for approval. You sit on the IRB and have concerns about the safety

Page 12: BPS Oncology Pharmacy Practice Exam

and proper handling of these agents. Which of the following publications would provide the best information about the dangers involved in handling these gene transfer agents and precautions that should be taken to ensure the safety of those preparing them?

 

A.   CDC/NIH publication - Biosafety in Microbiological and Biomedical Laboratories

B.   ASHP Technical Assistance Bulletin on Handling Cytotoxic and Hazardous Drugs

C.   OSHA Technical Manual - Controlling Occupational Exposure to Hazardous Drugs

D.   JCAHO publication - Comprehensive Accreditation Manual for Hospitals

14. It is recommended that patients who have had basal cell carcinoma of the skin or those who are at high risk for skin cancer use a minimum sunblock of SPF:

 

A.   5. B.   15. C.   30. D.   45.

15.You are participating in an annual patient education program sponsored by your employer. You have been asked to help staff the booth focusing on current cancer screening guidelines. A woman asks you about the latest recommendations for the screening of gynecologic cancers. Which of the following statements accurately represents the American Cancer Society (ACS) cervical cancer screening guidelines.

 

A.   At age 30 or after, women who have a single normal or negative cytology result can receive subsequent screening every three years.

B.   All women of screening age should receive human papillomavirus (HPV) DNA testing in conjunction with cytology smears.

C.   Women should begin cervical cancer screening no later than age 21 or within 3 years of becoming sexually active, whichever occurs first.

D.   All women who are 70 years of age or older with an intact uterus no longer require cervical cancer screening.