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Primary Care > Adult Health Maintenance Visits and Screening Guidelines > Flashcards

Adult Health Maintenance Visits and Screening Guidelines Flashcards

1
Q

Why learn USPSTF recommendations?

A

Most private insurance plans are required to cover preventive services that receive a grade of A or B from the Task Force without a copay

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2
Q

Screening for USPSTF grade A and B recommendations?

A

Yes

A: there is high certainty that the net benefit is substantial

B: there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial

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3
Q

Screening for USPSTF grade C recommendation?

A

Offer or provide this service for selected patients depending on individual circumstances

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4
Q

Screening for USPSTF grade D recommendation?

A

Discourage the use of this service

D: there is moderate or high certainty that the service has no net benefit or that the harms outweight the benefits

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5
Q

Screening for USPSTF grade I recommendation?

A

Read the clinical considerations section of the USPSTF

I = insufficient

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6
Q

What is an abdominal aortic aneurysm?

A

Aortic diameter exceeds 3.0 cm

Aneurysms that are considered for surgery are usually larger than 5.0 cm

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7
Q

Risk factors for AAA?

A

Most important RFs for AAA are increasing age, smoking status, male sex and family history

AAAs are 4-15x more common in men than women and tend to develop about 10 years earlier in men

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8
Q

USPSTF screening recommendations for AAA?

A

Screening (via ultrasound) for men 65-75 years old who have ever smoked (>100 cigarettes), selective screening for men ages 65-75 who have never smoked

No routine screening in women who have never smoked and have no family history of AAA

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9
Q

USPSTF grading/recommendation for AAA screening for men aged 65-75 years old who have ever smoked

A

Grade B

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10
Q

USPSTF grading/recommendation for AAA screening for men aged 65-75 years old who have never smoked

A

Grade C

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11
Q

USPSTF grading/recommendation for AAA screening for women who have never smoked

A

Grade D

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12
Q

USPSTF grading/recommendation for AAA screening for women aged 65-75 years old who have ever smoked

A

Grade I

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13
Q

AAA physical exam components?

A

Pulsatile mass in the epigastric region/periumbilical region

Exam can be limited, inaccurate with increased body habitus or smaller aneurysm size

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14
Q

AAA imaging?

A

Abdominal ultrasonography: sensitivity of 95-100% and specificity of nearly 100%, used for screening of asymptomatic individuals, used for monitoring of known AAAs

Abdominal CT and MRI: more expensive, involved for patient, exposure to excessive radiation; almost 2/3 of AAAs are diagnosed this way, but incidentally
CT used to diagnose symptomatic AAAs; also used for preoperative planning and postoperative follow-up of graft repairs

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15
Q

Breast cancer risks

A

Personal history of ovarian/peritoneal cancer, family history of breast/ovarian/peritoneal cancer, genetic predisposition with positive BRCA gene, radiotherapy to the chest between ages 10-30

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16
Q

Should we do screening mammography for breast cancer?

A

Yes - multiple studies have shown that screening mammography both reduces the odds of dying from breast cancer and promotes early treatment

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17
Q

What is the second most frequent cause of cancer death in women worldwide?

A

Breast cancer

Is also the most frequent type of non-skin cancer

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18
Q

Describe the screening recommendations for breast cancer

A

Age under 40: suggested to not screen unless first-degree family history indicates

Age 40-74: recommend screening (USPSTF recommendations are every other year)

Age 75+: offer screening only if life expectancy is at least 10 years

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19
Q

USPSTF grading/recommendation for breast cancer screening for women aged 40-74 years old?

A

Grade B

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20
Q

USPSTF grading/recommendation for breast cancer screening for women >75 years old and/or women with dense breasts?

A

Grade I

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21
Q

When to do a breast cancer physical exam?

A

Clinical exam should be performed for breast complaints or abnormalities

There is a lack of evidence showing benefit of screening clinical breast exam alone or with screening mammography

Suggest self breast exam in patients of above average risk

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22
Q

Describe approach to cardiovascular disease evaluation

A

Symptomatic patients should be tested (not screened) appropriately

Annual lipid screening with risk stratification based on ACC/AHA 10-year ASCVD numbers (if normal lipid panel can screen every 5 years)

Discussion of statin use vs lifestyle/diet modifications

Discussion of aspirin use with patients of below average, average, and above average risk

USPSTF recommends low-dose aspirin in adults 50-59 years who have ≥ 10% ten-year CVD risk, not at increased risk of bleeding, have life expectancy of at least 10 years, and willing to take for at least 10 years (low-dose aspirin can also be preventative for colorectal cancer)

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23
Q

Cardiovascular disease physical exam components?

A

Continue to auscultate for carotid bruits

Measurement of JVP?

Careful cardiac auscultation with appropriate maneuvers as directed (supine, Valsalva, etc…)

Abdominal palpation (AAA)

Lower extremity edema classification, stasis changes, absence of lower extremity hair, assess DP/PT pulses (remember: PAD is a CAD risk equivalent)

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24
Q

What does cervical cancer screening detect?

A

Precursors and early-stage disease of both cervical squamous cell carcinoma and adenocarcinoma

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25
Q

Who should have cervical cancer screening?

A

Women ages 21-29 should have screening every 3 years with cytology alone

Screening options for women ages 30-65: every 3 years with cytology alone; every 5 years with high-risk HPV testing alone; every 5 years with co-testing (Pap + HPV testing)

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26
Q

When to stop cervical cancer screening?

A

Stop screening at age 65 if no recent abnormal Paps/high-risk HPVs

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27
Q

USPSTS grading/recommendation for cervical cancer screening recommendation in women aged 21-65 years old?

A

Grade A

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28
Q

USPSTS grading/recommendation for cervical cancer screening recommendation in women <21 years old, women who have had a hysterectomy, or women >65 years old?

A

Grade D

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29
Q

When to do Chlamydia screening? Who to screen?

A

Annual screening in sexually active women ages 16-24 (GC/CT urine, self swab vs. provider-collected swab, mailer kits)

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30
Q

Who to screen for Chlamydia?

A

Sexually active women ages 16-24

Screen women aged 25+ who are at increased risk of infection

Screen during pregnancy

Consider screening men based on RFs, also test if symptomatic (pay special attention to MSM as risk for chlamydia is much greater)

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31
Q

USPSTF grading/recommendation for chlamydia/gonorrhea screening in sexually active women, including pregnant persons?

A

Grade B

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32
Q

USPSTF grading/recommendation for chlamydia/gonorrhea screening in sexually active men?

A

Grade I

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33
Q

How does colorectal cancer arise?

A

Most arise from adenomatous polyps that progress from small to large polyps, then to dysplasia, and eventually carcinoma

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34
Q

Colorectal cancer risk factors?

A

Personal history of adenomatous polyps
Family history (any first degree?) of colorectal cancer
Family history of adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome
Personal history of IBD or Crohn’s disease
Abdominal radiation history
HIV infection

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35
Q

Should colorectal cancer be screened?

A

Yes

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36
Q

What age should patients be screened for colorectal cancer?

A

Average risk adults should initiate screening at age 45

Consider screening 10 years prior to diagnosis date of first degree family member colorectal cancer

Continue to screen for colorectal cancer through age 75

Selectively offer screening for CRC in adults aged 76-85 (consider patient’s overall health, prior screening hx, preferences)

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37
Q

What modality is considered the gold standard for colorectal cancer screening?

A

Colonoscopy

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38
Q

Other testing modalities for colorectal cancer screening?

A

Fecal tests (FIT, FOBT), cologuard

Of note: if these are positive, patients MUST have a colonoscopy

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39
Q

USPSTF recommendation/grading for colorectal cancer screening in adults aged 50-75 years old?

A

Grade A

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40
Q

USPSTF recommendation/grading for colorectal cancer screening in adults aged 45-49 years old?

A

Grade B

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41
Q

USPSTF recommendation/grading for colorectal cancer screening in adults aged 76-85 years old?

A

Grade C

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42
Q

What are some screening tools for depression?

A

Casual PHQ-2 during historical interviewing or throughout exam (start with PHQ-2 and move to PHQ-9 questionnaire if needed)

Depression screening in patients aged 12 and older with PHQ-9 score of 9 or higher – follow-up PHQ-9 in 6 months with score ≤5 or improved symptoms

43
Q

USPSTF recommendation/grading for depression screening in adults, including pregnant and postpartum persons, and older adults (>65 years old)?

A

Grade B

44
Q

USPSTF recommendation/grading for depression screening in adolescents aged 12-18 years old?

A

Grade B

45
Q

USPSTF recommendation/grading for depression screening in children 11 years old or younger?

A

Grade I

46
Q

USPSTF recommendation/grading for anxiety screening in adults 64 years old or younger, including pregnant and postpartum persons?

A

Grade B

47
Q

USPSTF recommendation/grading for anxiety screening in children and adolescents aged 8-18?

A

Grade B

48
Q

Should we do yearly diabetes screening?

A

Consider yearly screening with fasting glucose, A1C or both

Consider a few things when choosing: frequency of primary care screening, overweight/obesity, concomitant illness, elevated fasting blood sugar readings in the past, family history of DM, history of gestational DM

49
Q

USPSTF recommendation/screening for diabetes in asymptomatic adults aged 35-70 years who have overweight or obesity?

A

Grade B

50
Q

Diabetes physical exam components?

A

Decreased visual acuity (“blurry vision”)
Abnormal weight gain, persistent obesity
Acanthosis nigricans
Impaired peripheral sensation with light touch or monofilament

(Remember, more involved foot/CV/peripheral vascular exam if known diabetes)

51
Q

Why is untreated hepatitis C concerning?

A

Untreated can progress to cirrhosis and end stage liver disease

52
Q

Risk factors for hepatitis C?

A

History of IV drug use, blood transfusions before 1992

53
Q

Hepatitis C screening?

A

Yes - anti-HCV antibody test

54
Q

Who to screen for hepatitis C?

A

Patients at high risk (periodically)

One-time screening in adults aged 18-79 years

55
Q

What to do if hepatitis C screening is positive?

A

Hepatitis C RNA PCR to confirm (viral load)

56
Q

Hepatitis C physical exam components?

A

Evaluate for stigmata of advanced liver disease: spider angiomas, palmar erythema, splenomegaly, jaundice, caput medusae

Of note: absence of these findings do not rule out the possibility of underlying disease

57
Q

When to screen for hepatitis B?

A

Screen during pregnancy

Screen adolescents/adults at increased risk

58
Q

How to screen for hepatitis B?

A

Hepatitis B surface antigen

59
Q

USPSTF grading/recommendation for hepatitis B screening in adolescents and adults at increased risk for infection?

A

Grade B

60
Q

USPSTF grading/recommendation for hepatitis B screening in pregnant women?

A

Grade A

61
Q

When to do HIV screening?

A

Per USPSTF: screening between ages 15 and 65 (frequency not defined) and periodically for at-risk individuals of any age; routine screen during pregnancy too

Per CDC: at least one time screening between ages 13 and 64; screen more frequently if risk factors (ex: MSM)

62
Q

How to screen for HIV?

A

HIV-1/HIV-2 antibody testing

63
Q

Should I screen or test a symptomatic patient concerning for HIV?

A

Perform testing (not screening)

64
Q

HIV physical exam components?

A

Possibility of constitutional symptoms (fever, fatigue, malaise, flattened affect)
Painless lymphadenopathy, most prominent in the axillary space
Pharyngeal edema and hyperemia without tonsillar enlargement or exudate
Mucocutaneous ulcerations
Candidiasis
Generalized rash
Persistent cough, dyspnea, hypoxia

65
Q

Significance of lung cancer mortality statistic?

A

Lung cancer is the leading cause of cancer-related death among men and women

66
Q

Who should be screened for lung cancer?

A
67
Q

How to screen for lung cancer?

A

Low-dose chest CT

68
Q

Are there potential harms of screening for lung cancer?

A

Yes

Consequences of evaluating abnormal findings (needle biopsy, surgery, invasive coronary studies)

Radiation exposure

Patient distress

Over-diagnosis

Certain cancers may not have affected morbidity and mortality

69
Q

USPSTF recommendation/grading for lung cancer screening for adults aged 50-80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years?

A

Grade B

70
Q

Risk factors for osteoporosis?

A

RFs should be assessed in all patients, but especially postmenopausal women and an individual who experiences a fragility or low-trauma fracture

RFs independent of bone mineral density:
Advanced age
Previous fracture
Long-term steroid therapy
Low body weight (less than 127 lbs)
Parental history of hip fracture
Cigarette smoking
Excess alcohol intake
Race (highest risk in white and Asian women)

71
Q

Who to screen for osteoporosis?

A

Bone mineral density testing is recommended for all women 65 and older as well as postmenopausal women younger than 65 who have clinical risk factors for fracture

72
Q

Osteoporosis screening in men?

A

USPSTF: grade I

73
Q

When to consider osteoporosis screening in men?

A

Radiographic osteopenia, history of low-trauma fractures and loss of more than 1.5” in height, as well as those with risk factors for fracture

74
Q

Modality for osteoporosis screening?

A

Dual energy x-ray absorptiometry (DEXA scan)

75
Q

When to repeat osteoporosis screening?

A

Depends on the results

76
Q

Risk factors for prostate cancer?

A

Older age, African American race, family history

77
Q

USPSTF recommendation/grading for prostate screening in men aged 55-69 years?

A

Grade C

Individual decision

Discuss benefits and harms

Screening: small potential benefit of reducing prostate cancer death

False positives, overdiagnosis, overtreatment, treatment complications

78
Q

USPSTF recommendation/grading for prostate screening in men aged >70 years?

A

Screening not recommended

Grade D

79
Q

When to start the discussion about prostate cancer screening?

A

For patients at an average risk: start at age 50

For patients at a higher risk (African American, family history): start at age 40-45

80
Q

Frequency of prostate cancer screening?

A

Every 1-2 years

81
Q

DRE sufficient for screening?

A

No

82
Q

Skin cancer risk factors?

A

Snowbirds wintering in Florida, Arizona, etc.
Retirees who are spending time playing golf
Avid outdoorspeople
Pool/lakegoers who want a good tan

83
Q

Skin cancer physical exam components?

A

Take time to perform a routine and complete skin exam

Patients should remove their shirt, pants - skin lesions in these areas are often missed or may not be seen by patient or their spouse

Biopsy as needed (or refer for biopsy)

Discuss referral for dangerous-appearing lesions, facial lesions, annual skin exams for patients with numerous nevi

84
Q

Significance of skin cancer prevalence?

A

Incidence of melanoma skin cancer is increasing faster than any other potentially preventable cancer in the US

85
Q

Skin cancer screening?

A

No specific recommendations from USPSTF regarding clinical exam, but skin exam is easy

USPSTF recommendations focus more on counseling

86
Q

Testicular cancer risk factors?

A

Cryptorchidism, history of contralateral testicular cancer, family history of testicular cancer, testicular atrophy, hypospadias

Vasectomy is NOT a RF for testicular cancer

87
Q

Important testicular cancer statistic?

A

Most common malignancy in males between 15 and 35 years old

88
Q

Screening for testicular cancer in asymptomatic male adolescent and adult?

A

Not recommended

89
Q

Modality of choice for evaluation of testicular/scrotal lump?

A

US with Doppler

90
Q

USPSTF recommendation/grading for screening for intimate partner violence in women of reproductive age?

A

Grade B

91
Q

USPSTF recommendation/grading for screening for unhealthy alcohol use in adults 18 years old or older, including pregnant women?

A

Grade B

92
Q

USPSTF recommendation/grading for screening for unhealthy alcohol use in adolescents aged 12-17 years old?

A

Grade I

93
Q

What are some quality measures for preventative health in primary care?

A

Breast cancer screening
Cervical cancer screening
Childhood immunization status
Chlamydia screening in women
Colorectal cancer screening
Immunizations for adolescents

94
Q

What are some quality measures for chronic conditions in primary care?

A

Controlling HBP
Diabetes Eye Exam
Optimal Asthma Control
Optimal Diabetes Care
Optimal Vascular Care
Spirometry for Assessment and Diagnosis of COPD

95
Q

Quality measures for mental health care in primary care?

A

PHQ-9 Utilization
Follow-up PHQ-9 at six months
Response at 6 months
Remission at 6 months
Follow-up PHQ-9 at 12 months
Response at 12 months
Remission at 12 months

Similar measures for adolescents and adults

96
Q

Other important quality measures in primary care?

A

Avoidance of antibiotic treatment in acute bronchitis/bronchiolitis
Follow-up care for children prescribed ADHD medication
Osteoporosis management in women who had a fracture

97
Q

Asthma screening?

A

Yes - Asthma Control Test (ACT)

Make sure to take note of any hospitalizations or emergency department visits that are due to asthma exacerbations

98
Q

What score is considered to be controlled asthma on ACT?

A

Controlled: ACT of 20 or higher. Combined total of 0 or 1 ED visit/hospitalization due to asthma within 1 year

Remember to educate on and update asthma action plans

99
Q

Diabetes screening goals in primary care?

A

A1C < 8.0%
BP < 140/90
Aspirin use in patients with vascular disease
NO tobacco use
Nightly statin use

Goals often referred to as the D-5

100
Q

Hypertension screening in primary care?

A

Blood pressure is obtained at every visit

101
Q

Vascular care screening and recommendations in primary care?

A

Screening metrics and recommendations are very similar to diabetes

BP < 140/90, aspirin use, statin use, and no tobacco use

Of note: vascular disease includes cerebral, carotid, aortic, and peripheral vascular diseases

102
Q

What to consider if a patient states “my energy levels are low” in primary care setting?

A

Diet and exercise changes
Recent viral/bacterial illness
Snoring

Consider:
Vitamin D screening
Thyroid screening
Iron deficiency anemia screening
Referral for sleep study
Long COVID?

103
Q

What to consider if a patient states “my neighbor had Lyme disease and we live by woods” in primary care setting?

A

Monitor for early signs of Lyme disease

Recognize EM rash and differentiate from that of a bite reaction or other common environmental rash

104
Q

Who gets prophylactic antibiotics for Lyme disease?

A

Attached tick is identified as a deer tick
Tick is estimated to have been attached for over 36 hours
Prophylaxis is begun within 72 hours of removal
Local rate of infection of ticks with B. burgdorferi is over 20%
Doxycycline is not contraindicated

Primary Care (11 decks)

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