screening (additional cards to Sian's)

Question 1

how do you treat CIN 1 if found at colposcopy examination

Answer 1

no treatment required just extra monitoring.

follow up in 12 months with a smear

Smear - HrHPV negative then recall in 3 years (36 months) regardless of age category

Hr-HPV +ve –> cytology abnormal –> back to colp

cytology normal - then repeat smear again in 12 months

Question 2

what is the usual treatment offered for CIN 2 or 3

Answer 2

LLETZ - large loop excision

Question 3

following a LLETZ what is the usual time frame to do a repeat smear/follow up

Answer 3

6 months

Question 4

if Hr-HPV positive on follow up 6 month smear post LLETZ what should happen if cytology negative or positive

Answer 4

referral back to colposcopy regardless of cytology result

Question 5

if Hr-HPV negative on follow up 6 month smear post LLETZ what recall does the patient then have for next smear

Answer 5

36 month recall smear

Question 6

if someone is pregnant and due their routine smear when should you tell them to book in

Answer 6

12 weeks postnatal

Question 7

if abnormal smear in pregnancy/ just before pregnancy and patient is due to see colposcopy what would colp do

Answer 7

examine cervix, aim is to rule out invasive disease and defer biopsy and treatment to post partum.

Question 8

what hpv vaccine is now used? is it live vaccine

Answer 8

gardasil 9 (protects against 9 strains of hpv; hpv is dsDNA), no not live vaccine

protects against 6,11 (GW), 16 and 18 (cancer strains), 31, 35, 45,52 and 58

Question 9

who is eligible for gardasil 9 vaccine to protect against hpv

Answer 9

girls and boys up till age of 25 (usually get a SINGLE dose now) age 12-13 years in year 8

GBMSM < 25 only need one dose

GBMSM eligible until age of 45 years, give two doses usually (if over age 23 - <45 years) 0 and 4-6 months second dose

HIV positive MSM need three doses - 0,1, 4-6 months

Question 10

what is the recommended vaccine schedule for HIV positive MSM

Answer 10

0,1,4-6 months (three doses in total) eligible <45 years.

Question 11

what is the routine HPV vaccine schedule that girls and boys receive. What age are they eligible to have the vaccine until on the NHS

Answer 11

single dose of gardasil 9.
usually have it in year 8 (age 12-13 years)

can have it up until 25 th birthday if missed it.

Question 12

what is most appropriate advice to give a patient currently pregnant and smoking (SBA)

a) advice them to try and stop smoking
b) offer to prescribe them bupropion or varenciline to help support them in stopping smoking
c) offer them a referral to smoking cessation group and advice on cutting down and stopping
d) advice on cutting down and offer to prescribe NRT immediately

Answer 12

c) offer them a referral to smoking cessation group and advice on cutting down and stopping smoking

a) not best answer
b) CI in pregnancy also varenciline not available currently
c) true
d) ideally try and cut down without NRT only use this first if pt already tried to cut down and failed.