 Welcome back to our USMLE Question of the Week. As always, we begin reading this question on the last sentence so that we understand what the question is asking. What would most likely be present in the specimens that account for these findings? A 30-year-old female visits her physician with complaints of vaginal bleeding after sexual intercourse. She started menses at age 13 and has 34-day cycles. She has had unprotected sex with multiple partners after becoming sexually active at age 19. She also states that she did not receive normal childhood vaccinations as her parents didn't believe in them. Cytologic specimens taken from the cervix and vagina. On microscopy, cervical cells have large nuclei with open chromatin and several cells have mitotic figures. What would most likely be present in the specimens that account for these findings? So we're talking about cervical cells showing large nuclei, open chromatin and mitotic figures. This tells me that there's active cell division occurring and this likely is a malignant cell division due to the increase in the large nuclei and the open chromatin. Furthermore, seeing that this patient did not receive normal childhood vaccinations likely indicates they may have an HPV infection which can lead to cervical cancer. Therefore, I'm looking for an answer that has something to do with HPV. I do know HPV is a double-stranded DNA virus. It's not a gram-positive diplococci, not a gram-positive cocci. Is it RNA or DNA? We can leave those two and determine the difference. And then squamous cells covering bacteria, for sure not. I do remember that HPV is a double-stranded DNA virus. Therefore, my answer would be A. A is the correct answer as this is a malignant transformation of normal cells. We're seeing increased nuclear to cytoplasm ratios having open chromatin and mitotic figures that tell us that these cells are actively dividing. Since she has a history of multiple sexual partners, post-coital bleeding and did not ever receive the HPV vaccination, then we assume that this is most likely a HPV infection that has in turn led us to cervical cancer. And HPV, once again, is a double-stranded DNA virus.