Obstetrics & Gynaecology Flashcards
Outline the main changes made to the National Cervical Screening Program (NCSP) as of December 2017? What is the rationale for the Medical Services Advisory Council (MSAC) to recommend these changes?
How would you explain the new NCSP test to the patient?
When should she be offered screening under the current guidelines?
Given she is 24 years old and asymptomatic, under the new program she will be eligible for a HPV test at the age of 25. It is important to wait until patients meet the criteria, otherwise they will receive a bill for the test.
How does the HPV vaccination impact her need for cervical cancer screening and risk of developing cervical cancer?
How would you explain the different possible test result outcomes?
What follow up is required for the test result?
What other tests or advice would you offer?
**Follow up **- Depending on the follow up system of the general practice, and the test result, follow up can be done via a follow-up appointment, a telephone call, or a letter. A recall system should be in place at the GP practice to ensure the patient is contacted for the five yearly screening program. The NCSP includes a recall system.
**Other advice **- Given the history of unprotected sex with a new partner you would offer testing for other sexually transmitted infections (STIs) such as chlamydia, gonorrhoea, syphilis, hepatitis B and HIV, as well as discussing contraception options. Note that condoms do not offer full protection against HPV (as HPV is transmitted via skin-to-skin contact), but they do protect against most other STIs.
What advice would you provide to her boyfriend regarding the HPV vaccination? Justify your answer.
Given her prior history of HPV vaccination, why would the HPV test have been positive? And why would it now be negative?
What advice would you provide regarding self-collection, and would it be appropriate for this patient?
Under-screening of select population groups has been an ongoing issue with the NCSP. The introduction of HPV testing and the potential for self-collection may assist in addressing this issue. Identify 6 under-screened groups, and 12 interventions that have worked to improve the uptake in these groups.
What proportion of cervical cancers is caused by the strains that the current vaccine protects against?
List 6 potential difficulties associated with introduction of the HPV vaccination program.
What is the role of the Pharmaceutical Benefits Advisory Committee (PBAC) and the MSAC?
What have the outcomes been following evaluation of the HPV vaccination program?
Consider the outcomes attributed to vaccinating females only, and then consider the additional gains from including males in the schedule.
Australia already has the second-lowest incidence of cervical cancer and the lowest mortality rate from cervical cancer in the world, do you think the vaccine should have been funded?
There is no correct answer to this. You should consider resource allocation, opportunity costs and priorities in your answer, as well as the role of politics and advocacy (Jeanette Howard [wife of John Howard] had cervical cancer and the Gardasil vaccine was invented by 2006’s Australian of the Year, Professor Ian Frazer).
If a developing country was looking to implement an HPV vaccination program with limited resources, what could they consider doing to target high-risk groups?
What are the 9 stages of the audit cycle?
What are the 9 stages of the audit cycle?
What does PICO stand for?
What does ‘developmental origins of health and disease’ refer to? Give three examples of links between fetal growth and adult health that have been studied.
What is the ‘thrifty phenotype’ hypothesis?
What is the life course approach?
What are the implications of the different fetal health outcome theories for health resource allocation?
Discuss influenza and pertussis vaccination in pregnancy?
Define globalisation. What are the impacts of globalisation on health? Why is it important to consider health from a global perspective?
Describe the concept of medical migration. What are the impacts of medical migration on low- and middle- income countries that train the health care workers and on the high income countries to which they migrate?
Describe the importance of understanding a patient’s cultural background in relation to health care, acknowledging that not all patients belonging to a certain cultural or social group will behave in the same way. Describe an approach to cross-cultural medical assessment that could be incorporated into Sarina’s consultation.
Define: Globalisation.
2 Advantages and 5 Disadvantages of Globalisation?
