1: Screening and Health Maintenance Flashcards
Name the 3 prongs of the USPST mission.
- Evaluate benefits and harms of preventive services in healthy populations based on age, gender, and risk factors for disease.
- Make recommendations about which preventive services should be incorporated routinely into primary care practice.
- Assess quality of evidence and magnitude of net benefit.
Why screen those born between 1945-1965 for hep c?
Predates universal screening of blood donations, which began in 1992.
What are the risk factors for hep c?
- Born between 1945-1965.
- IV or intranasal drug use.
- Long-term hemodialysis.
- Incarceration.
- Being born to an infected mother.
- Getting a tattoo at an unregulated establishment.
- Other exposure through percutaneous means.
What is the MOST significant risk factor for chlamydia/gonorrhea?
Age (through 24 yo)
An attribute or exposure that is causally associated with an increased probability of a disease or injury.
Risk factor
What is an additional screening recommendation for overweight or obese adults age 40-70?
DMT2
How long do you test at risk patients for lung cancer?
Yearly until 15 years after smoking cessation, then discontinue.
Name the 10 Grade A/B recommended screenings.
- Alcohol misuse
- Cervical cx
- Chalmydia/gonorrhea
- Depression
- Height/Weight
- HTN
- HIV
- Intimate partner violence
- Rubella immunity
- Tobacco use
What quantity puts women at risk for alcohol misuse
Alcohol consumption greater than 7 drinks/week or greater than 3 drinks/day.
What screening tests are used for BRCA-related cx?
Genetic counseling and testing for BRCA mutations.
What test is used for cervical cx and how frequently?
- Papanicolaou (PAP) q 3 years OR
- PAP + HPV DNA test q 5 years for those 30-65 yo.
What test is used for chlamydia/gonorrhea?
Nucleic Acid Amplification Tests (NAATs)
What are recommendations to prevent/treat DMT2?
Promote physical activity and a healthy diet.
What items are included in the essential health benefits package?
Essential Health Benefits Package includes coverage of all preventive health services that receive an A or B rating from the USPSTF at no cost to the individual. It is up to providers to be aware of which items are covered.
What screening test is used for osteoporosis?
Fracture Risk Assessment (FRAX)
What are rubella recommendations?
They are inactive, but in-line with CDC. Test all women of childbearing age.
What is the optimal screening interval for lipid disorders?
Not determined. Every 5 years for general population. More frequently for those with high levels and less frequently for those with repeatedly low levels.
What are the 5 risk factors for osteoporosis?
- Low body weight
- Cigarette smoking
- Family hx
- Increased alcohol intake
- White race
When was the USPST created?
Created by the U.S. Public Health Service in 1984.
What is the best predictor of hip fracture?
Bone density using dual-energy x-ray absorptiometry (DXA) of hip and lumbar spine.
What is the risk factor for lung cancer?
Smoking
What is the most effective approach to screening?
Combine evidence with individual needs of the patient.
What is the test for BP?
Recommended screening is blood pressure measurement in provider’s office using sphygmomanometer.
T/F When no risk factors are found for a dx a woman can still be at risk for the dx.
False. When no risk factors are found for a disease, a woman is not at risk for that disease. However, a woman’s risk factors can change.
What is an obese BMI?
30+
When does cervical cx screening begin?
21 yo OR within 3 years of onset of sexual activity.
What are the risk factors for colorectal cx?
- First-degree relative at a younger age
- Multiple first-degree relatives
- Rare genetic disorders (familial adenomatous polyposis or hereditary nonpolyposis colorectal cx)
- Inflammatory bowel dx (NOT IBS but IBD).
T/F Comprehensive patient hx is one of the most valuable tools available to clinicians.
True
What 3 tests are used for colorectal cx screening?
- Yearly high-sensitivity fecal occult testing (FOBT)
- Flexible sigmoidoscopy q 5 years in combination with FOBT q 3 years.
- Colonoscopy q 10 years.
What 3 tests are used to screen for intimate partner violence (IPV)?
All are 3-4 questions and can be self-administered:
- Hurt, Insult, Threaten, Scream (HITS).
- Humiliation, Afraid, Rape, Kick (HARK).
- Slapped, Threatened, and Throw (StaT).
What is the test for lung cancer?
Low-dose computed tomography (CT)
What is the screening test for hepatitis c?
Anti-HCV antibody testing and confirmation with polymerase chain reation (PCR).
What is goal BP for adults?
- < 150/90: Adults 60+ without kidney disease or DM.
- <140/90: All other adults, regardless of age or disease.
How do you deal with IPV?
Document and treat injuries, give counseling referral, and inform about community resources.
What is the optimal screening for depression?
Optimal frequency not determined. Screen all who have never been screened and rescreen based on clinical judgment and existence of risk factors.
What is an additional screening recommendation for women who smoke?
Lung cx
Why is it so important to screen women for depression?
Women are 70% more likely than men to develop clinical depression.
What are 4 risk factors for syphilis?
- Commercial sex worker
- Exchanging sex for drugs
- Correctional facility inmate
- High-risk sex behaviors
What can excess weight lead to?
Increased morbidity and mortality.
What is the intent of the USPST?
To provide clinicians with a framework for decision making about the provision of preventive health services that is based on extensive reviews on existing evidence.
Why is alcohol misuse in women so important?
Smaller quantities cause more severe damage in women.
What is the initial step in secondary prevention?
Assessment: hx, physical exam, lab tests.
What is an issue with changes in bone density?
It may take up to 2 years to identify changes in bone density and longer to improve fracture risk prediction.
What are the risk factors for lipid disorders?
- DM
- Personal hx of CHD or noncoronary atherosclerosis
- Family hx of cardiovascular dx
- Tobacco use
- HTN
- Obesity
How do you calculate BMI?
Divide weight (kg) by height (meters squared).
What is an additional screening recommendation for women with familial risk factors for breast cx?
BRCA-related cx
T/F Breast self-examination is a recommended tool for patients.
False. Task Force recommends against teaching it (Grade D). Some evidence actually suggests that clinical breast exams and breast self-exams may increase the likelihood of further testing and biopsy without improving outcomes.
What are the 7 risk factors for Hep B?
- Birth in a country with high HBV rates
- Lack of HBV vaccine
- HIV-positive
- Household contacts or sex partner infected with HBV
- IV drug user
- Hemodialysis
- Cytotoxic/immunosuppressive therapy
When were initial findings of USPST published and what was the name?
1989 Guide to Clinical Preventive Services
What is done for a woman who is not immune to rubella?
Vaccinate all nonpregnant women. Vaccinate pregnant women immediately postpartum.
What is the screening test for Hepatitis B?
Hep B surface antigen (HBsAg) with confirmation of initially reactive tests.
What test is used for breast cx?
Mammography q 2 years.
What is the optimal interval for nonpregnant women and Hep B screening?
Insufficient evidence. Use clinical judgment.
What is the screening test for lipid disorders?
Serum measurement of total cholesterol, LDL, and HDL.
How do you limit healthcare costs in secondary prevention?
Use only tests and treatments with proven benefits.
What are 2 STI screening recommendations for pregnant women?
- Hep B
- Syphilis
What are 7 risk factors for chlamydia/gonorrhea?
- Age
- African American/Hispanic
- Hx of STIs
- New or multiple sex partners
- Exchanging sex for money/drugs
- Nonmonogamous relationships who do not use condoms consistently
- Specific communities
What is the test for syphilis?
Venereal Disease Research Laboratory (VDRL) or Rapid Plasma Regain (RPR) test.
How do you screen for alcohol misuse?
- AUDIT
- Abbreviated AUDIT-C
- Simply ask: “How many times in the past year have you had 4 or more drinks/day?”
What population is mainly targeted by the USPST with their recommendations?
Intended for the general population who have no signs/symptoms of dx or risk factors for specific dx entities (unless otherwise noted).
What are the subclasses of Alcohol Use Disorder (AUD)?
- Mild
- Moderate
- Severe
What are the 7 risk factors for BRCA-related cx?
- Family hx of breast cx before age 50
- Bilateral breast cx
- Breast and ovarian cx
- Breast cx in a male
- Multiple cases of breast cx
- 2 types of BRCA-related cx
- Ashkenazi Jewish ethnicity
List the 5 Grade A/B screening recommendations for older women.
- Breast cx
- Colorectal cx
- Hep C infx
- Lipid disorders
- Osteoporosis
How many times should someone be screened for hep c?
Screening with date of birth as the only risk factor requires 1 screening. Those with additional risk factors should be screened periodically.
How many women are affected by IPV?
More than 1 in 4.
What were the 4 primary changes the ACA enacted in healthcare?
- All must carry health insurance.
- Expand Medicaid to incomes at 138% of poverty level.
- Make lower-cost insurance available on the exchanges.
- Require all insurance to cover essential health benefits package at no cost to consumer.
What tests are used for depression screening?
Self-administered tests that have been previously validated:
- PHQ
- PHQ-2
- Geriatric Depression Scale for older adults
- Edinburgh Postnatal Depression Scale for postpartum and pregnant women.
T/F Brief interventions are effective at increasing quit rates.
True
What is the test for tobacco use?
Implement the 5 As:
- Ask about tobacco use.
- Advise to quit.
- Assess willingness.
- Assist to quit.
- Arrange follow-up and support.
What is the initial screening for BP?
Mean of 2 BP measurements, with patient in seated position, at least 5 minutes apart.
What is an overweight BMI?
25-29.9
When is a management plan developed and what is the focus?
Once risk factors are identified. The plan should include measures that focus on reducing short/long-term consequences.
What is the optimal screening interval for DMT2?
Unclear, but reasonable to rescreen every 3 years if normal levels.
ACA utilizes older breast cx recommendations. What are they?
- Mammography q 1-2 years with or without clinical breast exam.
- Begins at age 40.
What is the test for rubella?
Serologic confirmation of rubella immunity.
What are the tests for DMT2?
- Fasting plasma glucose
- 2-hour postload plasma glucose
- Hemoglobin A1c
Define secondary prevention.
Services that enable early identification of risk factors or diagnosis of disease conditions in asymptomatic patients.
