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PCM II Final > Approach to Health Maintenance and Counseling > Flashcards

Approach to Health Maintenance and Counseling Flashcards

1
Q

Components of taking a history for an adult wellness visit

A
  • Thorough history (medical & social) - Esp pay attention to FH and lifestyle history for risk factors
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2
Q

What are USPSTF recommendations?

A

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

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3
Q

For what group of people are USPSTF recommendations used?

A

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

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4
Q

What does USPSTF stand for?

A

U.S. Preventative Service Task Force

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5
Q

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

A

Patient preference, clinical expertise, research evidence

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6
Q

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
A
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7
Q

4 types of adult preventative services:

A
  • screening
  • immunizations
  • counseling to reduce risk
  • general health guidance
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8
Q

What is the goal of primary intervention?

Examples?

A

Goal: prevent disease

Examples: vaccines, counseling

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9
Q

What is the goal of secondary intervention?

Examples?

A

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

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

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10
Q

What is the goal of tertiary intervention?

Examples?

A

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

Examples: medications, chemotherapy, counseling

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11
Q

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

A

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.

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12
Q

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

A
  1. Age
  2. Gender
  3. Risk Factor
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13
Q

Under what circumstances would offering preventative services be discouraged?

A

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

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14
Q

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

A

Every 3 yrs

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15
Q

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

A

Every 1 year (annual)

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16
Q

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

A

Dependent on condition, i.e.

  • DM: A1C check every 3 mos
  • HTN: BP check every 3-6 mos
17
Q

General guidelines for 4 major female cancer screenings

A
  • 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)
18
Q

General guidelines for 2 major male cancer screenings

A
  • Colon: same as female (50-70 yo)
  • Lung: same as female (55-74 yo w/ 30 pack yr hx)
19
Q

Who should undergo a CVS risk assessment and how often?

A

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

20
Q

What should be screened for during a CVS risk assessment?

A
  • Diet
  • Smoking
  • Physical activity
  • HTN
  • Dyslipidemia
  • DM
  • Obesity
21
Q

How should one approach counseling during wellness visits?

A

Same as motivational interviewing: OARS

  • open-ended questions
  • affirmations
  • reflective listening
  • summaries
22
Q

Recommendations for influenza vaccine?

A

Everyone, annual

23
Q

Recommendations for Td/Tdap vaccine?

A

Everyone, every 10 yrs

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

24
Q

Recommendations for HPV vaccine?

A

Females up to 26 yo

(protect against cervical cancer)

25
Q

Recommendations for Zoster vaccine?

A

50+ yo

(protect against herpes & shingles)

26
Q

Recommendations for pneumococcal vaccine?

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

(protect against pneumonia)

27
Q

Recommendations for Hepatitis B vaccine?

A

65+ yo w/ DM or any other increased risk

PCM II Final (10 decks)

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