Stats / Culture / Ethics Flashcards
What is the most common cancer in NZ women?
- Breast cancer
- Melanoma
- Colorectal
- Lung
- Uterine
What is the most common cancer in NZ men?
- Prostate
- Colorectal
- Melanoma
- Lung
- Lymphoma
What is required for abortion?
- Counselling NOT mandatory but must be made aware of it
- People can self-refer
- Can be home, primary care, TE
- <20/40 no restriction
> 20/40:
- qualified practitioner
- clinically appropriate
- MUST consult another HP
if object:
- disclose, and tell them how
What is the most common cause of concussion?
Falls
Refugee health
Refugee: granted status as ‘quota refugee’
Asylum seeker: whilst waiting
3 arrivals:
1. quota system: 1,500 per year. In 2024/25 - 100 syrian, 100 rohingya
2. Family of (RFSC): 600 places. IF not by other category.
3. Spontaneous: asylum seeker, or when temp visa expires.
Where from: vietnam, laos, camdobia, burma, iran, iraq, afghanistan
If quota:
- granted permanent residency on arival
- first 2 weeks in manged isolation, then 5 week reception in Mangere
- health assessments completed prior to arrival, FU at reception
- Accommodation is found prior to end of above: HNZ or private rentals
- GP then transferred out to new area from Mangere
- supported up to 12 months
- five years free visits to GP if CSC, free interpreting
if spontaneous
- No routine screening. BUT if application lodged with letter to confirm, eligible for public funding
Trans health
Do you have any language you prefer to use for your body or your genitals so that I can help you feel more comfortable?
do you have sex with people with a penis, people with a vagina, or both?
People can get chlamydia and gonorrhoea in their urine, throat, bottom and cervix. You can do your own swabs of these sites if needed. Have you had sexual contact at any of these sites?
Risks:
- 3x more likely than cis-women to experience sexual assault, 10x men
- contraception: hormones do not guarantee contraception
Any trans person who has UPSI anal with people with a penis -> PREP
Offer screening:
- BASED on anatomy, sexual practices and patient preference
- lower threshold for self-collection OR urine (but explain less sensitive)
Who is eligible for CSC?
Age >16
NZ citizen, PR, have/applied for refugee status
Salary(person+/-partner) : 33,181 if single, 64,000 if 1 parent + child, 80,000 ig parent and 2 kids
Get, reduced cost with:
- Subsidised prescriptions - free
- fares for public transport including trains, buses and some ferries
- fees for after-hours health practitioner visits
- glasses for children under 16
- emergency dental care provided by hospitals, and approved contractors
Will auto have sent if on benefits, OR fill in with WINZ
NZ super is 25k per year >65
Eligibility for gender-affirming surgery
> 18, non-smoker AND non-vaper 12w (nicotine reduces graft viability ANY amount)
mentally/physically fit for procedure - need letter from psychologist via Hauora Tahine (1yr)
BMI <35, <30 for surg
12m hormones
Good support
Currently working through referrals from 2021. Once meet surgeon and called up from waitlist happens quickly. Need updated health from from GP.
Funded:
Masculinising top surgery
Vaginoplasty / Minimal Depth Vaginoplasty
Metoidioplasty with or without urethral lengthening (using genital tissue only - less fx)
Phalloplasty with or without urethral lengthening (more complex using tissues from body)
Hysterectomy also possible via gynae
https://www.tewhatuora.govt.nz/health-services-and-programmes/providing-health-services-for-transgender-people/the-gender-affirming-genital-surgery-service
Transgender health
W: 1% secondary children identify
Meds
- Blockers: GnRH analogues
- Transmasculine young adults should try others first
- COCP, double if breakthrough, DEPO, Cerazette, Mirena, Can still be fertile if amen on T!
- SE: long-term bone
- Fertility preservation funded only for trans-feminine and if oophrectomy. Expensive
Initial Ix:
- e’s, FBC, HbA1c, lipid, LFT, LH/OE/PRL(M2F), testosterone
Monitoring (3m w GP, 6m w clinic, yr with clinic then yrly with GP)
- mGAHT: usual + testosterone level, aim normal m range. Reduce test if >HCT!. Can increase each month up to .5, patient can increase by drawing up. Reason Reandron given by medical person is deep and risk of oil embolism (self-limiting)
- fGAHT: usual + oes aim normal range, test <2, PRL 2yrly. Oestrogen patch, increase up to 200 (2x 100 patches). Can add progesterone when effects plateaued but not conclusive benefit. Increase dose every couple of months by 25-50mcg. Testosterone main issue for effect rather than oestogen level to some extent. Testosterone will be low with cyproterone but normal in spironalactone as just blocks. Patient choice: cypro has more mood SEs and in theory a risk of meningioma although rare on such low does (12.5 / quarter tablet - and definitely not with dose in Ginet). Spiro dizziness and diuretic effect.
- SE: VTE, CVD, insulin res, liver, stones, mood, osteoporosis
mGAHT (testosterone)
- Reversible: periods, acne, body fat, muscle, sexual desire
- Not: >clit, atrophy, voice change, hair growth, scalp loss
e.g. depo, sustanon, reandron (nurses)
- SE: polycyth, lipid, mood, OSA, liver
fGAHT (oes + antiandrogen)
- Reversible: <libido, <erection, skin, <muscle, body fat
- Not: breasts, thinning hair
- Unclear: testes, libido, sexual function
CI: migraine aura, hormone ca, clotting, obesity. Test in preg
General
- HEEADSSS, safe plan
- Safe chest binding
- Fertility funded, only in transmen if having oophrectomy
- SLT/voice therapy public or private, wait 1year if testosterone
Refer:
- persistent age >9
What is the visual acuity standard for private car licence?
When is legally blind?
6/12 (6/9 for higher class)
6/60 or 20 degs of field (normal 180)
Vision that improves with pinhole = refractory
Needlestick injury
- Rinse with warm water soap 3 mins. NO evidence for milking or antiseptic
- same if mucous - Cover with dressing
- ?Tetanus
Either can refuse testing
Avoid preg, donating blood and using condoms until all follow-up results
Report any viral illness
HIV: 2000p, 0.3% risk
Hep B: 90,000, 6-30%
Hep C: 50,000, 1.8%
