Approach to Health Maintenance and Counseling

Question 1

Components of taking a history for an adult wellness visit

Answer 1

• Thorough history (medical & social) - Esp pay attention to FH and lifestyle history for risk factors

Question 2

What are USPSTF recommendations?

Answer 2

EVIDENCE-BASED recommendations for clinical preventative services categorized into 5 letter grades: A, B, C, D or I.

Question 3

For what group of people are USPSTF recommendations used?

Answer 3

People who do not have signs or sx of the specific medical condition/disease

Question 4

What does USPSTF stand for?

Answer 4

U.S. Preventative Service Task Force

Question 5

Most effective care is provided when what 3 components are integrated together?

Answer 5

Patient preference, clinical expertise, research evidence

Question 6

Order the following from best to least favorable type of evidence:

• Case Series/Reports
• Cohort Studies
• Editorials/Expert opinions
• Systematic Reviews
• Case Control Studies
• RCT

Answer 6

Question 7

4 types of adult preventative services:

Answer 7

• screening
• immunizations
• counseling to reduce risk
• general health guidance

Question 8

What is the goal of primary intervention?

Examples?

Answer 8

Goal: prevent disease

Examples: vaccines, counseling

Question 9

What is the goal of secondary intervention?

Examples?

Answer 9

Goal: screening for disease while a patient may still be asymptomatic (before onset of disease)

Examples: routine blood pressure checks, labs, mammograms, counseling

Question 10

What is the goal of tertiary intervention?

Examples?

Answer 10

Goal: clinical intervention to prevent progression of disease or reduce its complications (involves tx)

Examples: medications, chemotherapy, counseling

Question 11

Define the USPSTF grading levels: A, B, C, D, I

Answer 11

A: USPSTF recommends service. Benefit is substantial. Offer service.

B: USPSTF recommends service. Benefit is moderate substantial. Offer service.

C: USPSTF selectively recommends service. Offer to selected patients pending clinical judgment.

D: USPSTF recommends against service. Discourage use of service.

I: Insufficent evidence at this time to encourage/discourage service.

Question 12

What factors do physicians use to determine what preventative services to prioritize recommending to their patients?

Answer 12

1. Age
2. Gender
3. Risk Factor

Question 13

Under what circumstances would offering preventative services be discouraged?

Answer 13

When screening may bring more harm than benefit, i.e. cost, anxiety, decreased benefit w/ age or comorbid conditions

Question 14

How often should adults <49 yo w/o chronic medical conditions get a check up?

Answer 14

Every 3 yrs

Question 15

How often should adults >50 yo w/o chronic medical conditions get a check up?

Answer 15

Every 1 year (annual)

Question 16

How often should patients w/ chronic medical conditions follow up?

Answer 16

Dependent on condition, i.e.

• DM: A1C check every 3 mos
• HTN: BP check every 3-6 mos

Question 17

General guidelines for 4 major female cancer screenings

Answer 17

• Colon: colonoscopy for 50-70 yo (every 10 yrs if nml result)
• Lung: low dose lung CT for 55-74 yo w/ minimum 30 pack year smoking hx (ppd x yrs smoker)
• Cervical: pap smear for 21-65 yo
• Breast: mammogram for 50-65 yo (though can start as early as 40 yo USPSTF-dependent)

Question 18

General guidelines for 2 major male cancer screenings

Answer 18

• Colon: same as female (50-70 yo)
• Lung: same as female (55-74 yo w/ 30 pack yr hx)

Question 19

Who should undergo a CVS risk assessment and how often?

Answer 19

20+ yo every 3-5 yrs (more frequently if increased risk factors)

Question 20

What should be screened for during a CVS risk assessment?

Answer 20

• Diet
• Smoking
• Physical activity
• HTN
• Dyslipidemia
• DM
• Obesity

Question 21

How should one approach counseling during wellness visits?

Answer 21

Same as motivational interviewing: OARS

• open-ended questions
• affirmations
• reflective listening
• summaries

Question 22

Recommendations for influenza vaccine?

Answer 22

Everyone, annual

Question 23

Recommendations for Td/Tdap vaccine?

Answer 23

Everyone, every 10 yrs

(both protect against tetanus, Tdap also against pertussis that otherwise leads to whooping cough)

Question 24

Recommendations for HPV vaccine?

Answer 24

Females up to 26 yo

(protect against cervical cancer)

Question 25

Recommendations for Zoster vaccine?

Answer 25

50+ yo

(protect against herpes & shingles)

Question 26

Recommendations for pneumococcal vaccine?

Answer 26

• 19-64 yo at increased risk AND
• all 65+ yo

(protect against pneumonia)

Question 27

Recommendations for Hepatitis B vaccine?

Answer 27

65+ yo w/ DM or any other increased risk