Return to Scenario ListShow Learning Points most relevant to Phase 1:

Abnormal cervical smear result

Clinical Discipline(s)/Organ System(s)
Anatomical Pathology, General Practice, Obstetrics & Gynaecology, Reproduction & Development
Progress Test Topic(s)
Women's health
A 31 year old Māori woman has recently had a routine cervical smear and the result shows a low grade squamous intraepithelial lesion (LSIL). She has come to her GP to discuss the result.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Anatomy of the cervix and vulva
   - Pathophysiology including histology of the normal process of cervical metaplasia, the progression of precursor cervical abnormalities to carcinoma, influence of smoking on this process
   - Role of human papilloma virus (HPV) in the aetiology of cervical and vulvar pathology
   - The role of HPV test in screening for cervical pathology
   - Understand the differences between screening and diagnostic tests for cervical pathology
Clinical and Communication Skills 
   - History from someone with an abnormal smear result; focus on sexual, gynaecological and reproductive history
   - Risk factors for cervical abnormality
   - Gynaecological examination including pelvic examination, speculum
   - Correct technique for taking a smear, including completing form
   - Understand terminology used in reporting cervical smears
   - Indications for follow-up of abnormal smears and appropriate referral to colposcopy services as per National Screening Unit guidelines
   - Explain procedure of colposcopy and cervical biopsy
   - Management options for high grade cervical abnormalities; complications of treatment
   - Symptoms and signs of cervical cancer and importance of timely referral to gynaecological oncology
   - Clinical staging classification of cervical cancer
   - Outline management of cervical cancer, including indications for surgery
   - Late presentations of cervical cancer including symptom control and palliative care
Personal and Professional Skills 
   - Intimate examination and use of a chaperone
   - Consultation skills in discussing pre-cancerous lesions
   - Breaking bad news in cases of cervical cancer
   - Discussing a sexual history
Hauora Māori 
   - Inequalities in incidence, stage at diagnosis, and survival of cervical cancer between Māori and non-Māori
   - Appreciating the factors contributing to a higher incidence of cervical cancer in Māori women
   - Appreciating the barriers to cervical screening and improving access to the New Zealand screening programme for Māori women
   - Provider perceptions on factors contributing to cervical cancer disparities between Māori and non-Māori
   - Whānau role in ‘breaking bad news’ including impact on fertility
Population Health 
   - Screening for cancer of the cervix: rationale, requirements for success, performance of the New Zealand programme
   - Smoking cessation programs
   - Role of routine condom use to reduce transmission of sexually transmitted infections
   - Role of the HPV vaccination and potential impact on the epidemiology of cervical cancer
   - Epidemiology of cervical cancer
Conditions to be considered relating to this scenario
low grade squamous intraepithelial lesion, high grade squamous intraepithelial lesion, atypical squamous cells, atypical glandular cells, human papilloma virus
Less common but 'important not to miss'
squamous cell carcinoma, adenocarcinoma, adenocarcinoma in situ
HIV, immunodeficiency, vulval intraepithelial neoplasia, vulvar cancer

National Screening Unit: www.nsu.govt nz

New Zealand Immunisation Schedule