Adult Health Maintenance

Question 1

Examples of primary prevention

Answer 1

preventing disease before it occurs

(vaccines, education about stress management, healthy diet, exercising) removal of colon polyps to prevent colon cancer

Question 2

Examples of secondary prevention

Answer 2

promote early DETECTION of disease

mammogram, eye exam to check for glaucoma

Question 3

Examples of tertiary prevention

Answer 3

therapy/rehab after a disease has been diagnosed

medications for CHF, rehab programs for stroke patients, chronic pain management

Question 4

Criteria for effective screening

Answer 4

1. Disease should have high enough prevalence
2. Time frame when person is asymptomatic and risk factors identified
3. There must be an intervention that can be given during asymptomatic period that will prevent development of disease or reduce morbidity
4. Screening test with decent specificity/sensitivity, that is cost effective and acceptable to patients

Question 5

USPSTF recommendation levels

Answer 5

A - high certainty of benefit -> OFFER/PROVIDE service
B - high certainty of moderate benefit -> offer/provide
C - considerations for benefit to certain patients; no clear benefit or harm -> offer on individual case basis
D - not net benefit; may have significant harm -> discourage service
I - insufficient evidence for benefit -> if patient wants, make sure patient understands uncertainty about benefits vs harm

Question 6

Leading cause of death in adult men

Answer 6

cardiovascular disease

Question 7

What age to screen for hypertension?

Answer 7

EVERYONE 18 OR OLDER (A)

Question 8

When to start screening for lipid disorders (men and women)

Answer 8

Men 35 and over
Women 45 and over
20 years old for people with risk for CV disease
Level A

Question 9

What labs can you order for lipid screening?

Answer 9

• nonfasting total cholesterol with HDL levels

- fasting lipid panels that include LDL

Question 10

When to take aspirin to reduce risk of MI

Answer 10

Men aged 45-79 as long as benefit outweigh risk of GI hemorrhage (Level A)

Question 11

When to ultrasound for abdominal aortic aneurysm (AAA)?

Answer 11

Men 65-75 who have smoked (Level B),

not really recommended for men who haven’t smoked, recommended against in women who haven’t smoked

Question 12

In adults with low risk for coronary events, when to use ECG/stresstesting/CT for coronary calcium

Answer 12

not recommended in low risk adults

Question 13

When to start screening for colon cancer?

Answer 13

50 and older (men and women, Level A)

Question 14

Options for colon cancer screening (and how often)

Answer 14

fecal occult blood testing (FOBT) (guiac cards for 3 BMs collected at home), - annually
flexible sigmoidoscopy, - every 3-5 years
colonoscopy - every 10 years

any abnormal FOBT or flexible = colonoscopy

Question 15

When to start routinely screening for prostate cancer using digital exam and/or PSA

Answer 15

Currently recommends against routine screening (Level D)

Question 16

Who should get screened for lung cancer and with what modality?

Answer 16

Men and women aged 50-80 with 30 year pack history who continue to smoke or have quit less than 15 years ago should be screened with low dose CT of chest (NOT CHEST XRAY!)

Question 17

Who should get screened for T2DM?

Answer 17

adults with HTN or hyperlipidemia

Question 18

When to give Tdap booster

Answer 18

Any adults aged 19-65 who haven’t had a Td booster in 10 years or haven’t had Tdap as an adult

Question 19

Who should get the influenza vaccine?

Answer 19

6 months and older! ANNUALLY!!!

Question 20

Who should get pneumococcal polysaccharide (PPSV-23) and pneumococcal conjugate (PCV-13)?

Answer 20

All adults aged 65 or older or any unvaccinated adults younger than 65 who are immunocompromised or have certain chronic conditions

Question 21

Who should get HepB vaccine?

Answer 21

those with high risk of exposure (like health care workers)

Question 22

Who should get Hep A vaccine?

Answer 22

patients with chornic liver disease, who use clotting factors, or have occupational exposure, msm

Question 23

Who should get Varicella vaccine?

Answer 23

no reliable history of vaccine or disease, who are seronegative on testing, who are at risk for exposure

Question 24

Who should get meningococcal vaccine?

Answer 24

high risk groups (college dorm students, military recruits, complement deficiencies/asplenia)

Question 25

What other lifestyle modifications can be made?

Answer 25

diet, exercise, safe sex, seat bealts