Adult Preventive Medicine

Question 1

USPSTF, ACOG, ACS recommendations for breast self exam

Answer 1

USPSTF: not recommended

ACOG: consider for high-risk patients

ACS: optional for age 20 yo and older

Question 2

USPSTF, ACOG, ACS recommendations for Clinical breast exam

Answer 2

USPSTF: insufficient evidence

ACOG: 25-39 yo q1-3 yr, 40+ q1yr

ACS: does to recommend

Question 3

USPSTF, ACOG, ACS recommendations for Mammography

Answer 3

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

Question 4

Cervical cancer screening guidelines

Answer 4

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

Question 5

Colon cancer screening guidelines

Answer 5

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

Question 6

Lung cancer screening guidelines

Answer 6

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

Question 7

Prostate screening ACS recommendations

Answer 7

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

Question 8

When to start screening for HTN

Answer 8

18+

Question 9

When to start screening for T2DM (FBG)

Answer 9

all patients with sustained BP >135/80

Question 10

When to start screening for HLD

Answer 10

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)

Question 11

When to start screening for AAA

Answer 11

one time abd u/s in men 65-75 y who have ever smoked

if positive get serial u/s q6mo

Question 12

When to start screening for osteoporosis

Answer 12

DEXA q2yr all women over 65

Scren postmenopausal women under 65 with fracture risk greater than risk of a 65 yo woman

Question 13

When to start screening for HIV

Answer 13

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

Question 14

When to start screening for GC, chlamydia

Answer 14

high risk men, no recs for high risk men

Question 15

When to start screening for syphilis

Answer 15

MSM who engage in high-risk sexual behavior, commercial sex workers, people in correctional facilities

Question 16

Treatment of alcohol abuse

Answer 16

2+ CAGE positive

counsel patient about health risks
CBT
inpatient rehab
12 step program
Meds: 
-Naltrexone
-Acamprosate
-Disulfiram

Question 17

Smoking cessation

Answer 17

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

Question 18

Age indicated for flu vaccine

Answer 18

annually over 6mo

Question 19

Age indicated for pneumococcal

Answer 19

once after 65

younger if DM, liver/heart/or lung dz

Question 20

Age indicated for Zoster

Answer 20

over 60

Question 21

Age indicated for Td/Tdap

Answer 21

q10 yr, one time Tdap dose

Question 22

Adult indication for meningococcal vaccine

Answer 22

splenic pt

Question 23

Adult indication for hepatitis A vaccine

Answer 23

chronic liver disease - like Hep C

Question 24

Adult indication for hepatitis B vaccine

Answer 24

chronic liver disease
receiving tx for STI or HIV
multiple sexual partners
IV drug users