Aquifer Flashcards
Ottawa ankle rules
only get ankle XR if pain in malleolar zone and
- bony tenderness along distal posterior edge of either malleolus OR
- unable to bear weight (4 steps unassisted) right after injury and while in ED
Cervical cancer screening guidelines by age group
21-29: screening every 3 years
30-65: can screen every 5 years if co-tested for HPV (preferred) OR every 3 years with cytology alone (acceptable)
Risk groups that need more freq cervical cancer screening
- immunocompromised
- HIV+
- history of CIN 2, 3, or cancer
- exposure to DES in utero
*note cigarette smoking is strongly correlated with cervical dysplasia and cancer
criteria for stopping cervical cancer screening in women >65
adequate screening within the last 10 years, ie 3 consecutive normal pap with cytology OR 2 consecutive normal pap with HPV testing
Screening mammography criteria
Every 2 years for women age 50-74
Screening mammography criteria
Biennially for women age 50-74
What tool can you use to individualize recommendations for mammogram?
Gail criteria
When should Tdap be given in adults?
Tdap should replace a single dose of Td for adults age 19-64 who have not previously received Tdap
Perimenopausal symptoms due to estrogen deficiency
Vaginal dryness; decreased libido
Hot flashes - dress in light layers, use fan, regular exercise, avoid spicy foods and heat, manage stress
Mood swings - esp depression
Osteoporosis screening guidelines
DEXA for >65
for <65 use WHO fx assessment tool to risk stratify. screen if risk of fx >9.3 percent over 10 years.
Osteoporosis risk factors
low estrogen states (early menopause, prolonged premenopausal amenorrhea, low weight)
low physical activity
inadeq calcium intake (eg poor nutrition, alcoholism)
family history osteoporotic fx
personal h/o previous fx as an adult
smoking
white
Adult physical activity guidelines
each week:
150 minutes moderate-intensity exercise OR
75 minutes vigrous exercise OR
combination of both
incorporate strengthening exercises at least twice a week
smoking cessation strategies
set quit date
use nicotine replacement
taking meds
choose a substitute activity (eg walk, chew gum when urge to smoke occurs)
make a list of reasons why imp to quit and keep it handy
keep track of where, when, and why you smoke to help identify triggers to avoid
throw away all smoking things- ashtrays, lighters, etc
join support group
Pap smear adequacy
> 5000 squamous cells
sufficient endocervical cells
Pap smear results
Negative for intraepithelial lesion or malignancy
Evidence of epithelial abnormalities:
- ASC- atypical squamous cells. some abnormal cells, may be infection, irritation, or precancerous
- LSIL- low grade squamous intraepith lesion. may prgress to high grade, but most regress
- HSIL- considered a significant precancerous lesion
- squamous cell carcinoma
Indications for exercise stress testing
asymptomatic males >45 with one or more risk factors )hypercholest, HTN, smoking, FHx premature CAD) may get useful prognostic info from exercise testing
frequency of fasting lipid screen
adults >21 every 4-6 years lipid screening and reassess ASCVD risk
fasting- at least 8 hours after last food intake
Side effects of SSRIs/SNRIs
headache GI- nausea, diarrhea sleep disturbances- drowsiness, insomnia (infrequently) SIADH sexual dysfunction serotonin syndrome
common causes of insomnia in the elderly
envirmonment
drugs/etoh/caffeine
parasomnias-like restless leg
disturbances in sleep wake cycle- jet lag, shift work
psych- depression, anxiety
cardiorespiratory disease (asthma, copd, HF)
pain or pruritis
GERD
hyperthyroidism- elderly often don’t present with the typical sxs
diagnostic criteria for major depressive disorder
depressed mood or anhedonia PLUS at least five of SIGECAPS, present for at least 2 weeks
most common means of suicide in the elderly
drug overdose
labs or studies that can be done to rule out medical causes of insomnia, fatigue, and depression
CBC- anemia and vitamin deficiencies
CMP- electrolyte, renal, hepatic problems
TSH- hypo or hyperthyroidism
ESR- rheumatologic disease
ECG if pt using drugs that might alter cardiac conductivity such as TCAs
SAFE-T (Suicide Assessment Five Step Evaluation and Triage) components
- Risk factors
- Protective Factors
- Suicide inquiry- thoughts, plans, behaviors, intent
- Risk level/intervention
- Document- risk level and rational, trreatment plan to address/reduce current risk, firearms instructions if relevant, followup.
adult depression screening
PHQ-2:
over the past 2 weeks, have you often been bothered by
- Little interest or pleasure in doing things, or
- Feeling down, depressed, hopeless
For each question the patient can answer:
Not at all (0 points) Several days (1 point) More than half the days (2 points), Nearly every day (3 points).
(if positive, follow with PHQ-9)