Adult Preventive Medicine Flashcards
USPSTF, ACOG, ACS recommendations for breast self exam
USPSTF: not recommended
ACOG: consider for high-risk patients
ACS: optional for age 20 yo and older
USPSTF, ACOG, ACS recommendations for Clinical breast exam
USPSTF: insufficient evidence
ACOG: 25-39 yo q1-3 yr, 40+ q1yr
ACS: does to recommend
USPSTF, ACOG, ACS recommendations for Mammography
USPSTF: Recommended biennially 50-74 yo
ACOG: initiate annual or biennial starting 40-50 yo until 75yo
ACS: age 40-45 offer annually, 45-54 recommend annually, 55+ biennially recommended - stop when life expectance less than 10 y
Cervical cancer screening guidelines
start at 21 yo
21-29 - q3 yr without co-testing
30-65 y - perform pap + HPV cotesting q5 hrs
stop at 65 yo
If total hysterectomy for benign condition (prolapse, fibroids) - no cervix = no pap
Colon cancer screening guidelines
Colonoscopy q10y from 50-75 yo
-significant family hx of colon cancer screen starting at 40 yo or 10 yr prior to age of family member diagnosed
If contraindication, refusing colonscopy, or colonoscopy is not available in an acceptable time frame - can use alternate screening:
- flex sig q5 yr with FOBT q3ys
- Double contrast barium enema q5 yr
- FOBT annually
CT colonography not recommended
Lung cancer screening guidelines
Not recommended in asa non-smokers
Annual CT Chest 55-80 yo with 30 py hx and either still smoking or quit within last 15 yr
if quit more than 15 yo ago, no screening
Prostate screening ACS recommendations
discuss screening using PSA with or without DRE starting at age 50
40-45 yo for high risk
15% of prostate cancers not palpable on DRE, USPSTF recommends against DRE
When to start screening for HTN
18+
When to start screening for T2DM (FBG)
all patients with sustained BP >135/80
When to start screening for HLD
all men over 35 (or 20 w/increased CHD risk - DM, Fox CAD, smoker, HTN, obesity)
all women over 45 (or 20 w/ increased CHD risk)
When to start screening for AAA
one time abd u/s in men 65-75 y who have ever smoked
if positive get serial u/s q6mo
When to start screening for osteoporosis
DEXA q2yr all women over 65
Scren postmenopausal women under 65 with fracture risk greater than risk of a 65 yo woman
When to start screening for HIV
all patients 15-65 - q3-5 y with average risk, q1y high risk
screen older/younger pt at high risk: MSM, IV drug users, multiple unprotected sex partners, exchange sex for drugs or money
When to start screening for GC, chlamydia
high risk men, no recs for high risk men
When to start screening for syphilis
MSM who engage in high-risk sexual behavior, commercial sex workers, people in correctional facilities
Treatment of alcohol abuse
2+ CAGE positive
counsel patient about health risks CBT inpatient rehab 12 step program Meds: -Naltrexone -Acamprosate -Disulfiram
Smoking cessation
ask about tobacco use and encourage patients to quit
Refer to behavioral counseling
Meds:
-Nicotine replacement (gum, lozenges, patches, inhalers)
-Bupropion - Wellbutrin, Zyban
-Varenicline - Chantix (more effective)
Meds plus counseling more effective than either alone
Age indicated for flu vaccine
annually over 6mo
Age indicated for pneumococcal
once after 65
younger if DM, liver/heart/or lung dz
Age indicated for Zoster
over 60
Age indicated for Td/Tdap
q10 yr, one time Tdap dose
Adult indication for meningococcal vaccine
splenic pt
Adult indication for hepatitis A vaccine
chronic liver disease - like Hep C
Adult indication for hepatitis B vaccine
chronic liver disease
receiving tx for STI or HIV
multiple sexual partners
IV drug users
