Aquifer Flashcards
What is the USPSTF and ACS stance on the practice of breast self-exams
The USPSTF and the ACS do NOT recommend that providers teach patients to do breast self-exams. In a Cochrane review, breast self-exams were associated with an almost 2x increase in breast biopsy with no reduction of mortality.
Limitations of the clinical breast exam performed by providers for ASYMPTOMATIC patients
In 2015, the ACS made a recommendation against clinical breast exams for screening purposes, citing the extremely low sensitivity rate and high false-positive rate of physician-performed CBEs in asymptomatic patients. The USPSTF cites inconclusive evidence to weigh the benefits with risk
What are the 2018 USPSTF Guidelines for cervical cancer screening timelines?
In 2018, the USPSTF updated their guidelines to recommend that:
At age 21: cervical cancer screening should begin.
Between ages 21 and 29: screening should be performed every three years with cytology alone.
Between ages 30 and 65: screening can be done every five years with high risk HPV (hrHPV) testing alone, every five years with cotesting (hrHPV and cytology), or every three years with cytology alone.
What is DES exposure?
diethylstilbestrol (DES) exposure in utero. DES is a nonsteroidal estrogen that was given to pregnant females to prevent miscarriages. However, it was linked to clear cell adenocarcinoma of the vagina and its use was discontinued in 1971
Which high risk groups are recommended to have more frequent cervical cancer screenings?
Patients who have compromised immunity, are HIV positive, have a history of cervical intraepithelial neoplasia grade 2, 3, or cancer, or have been exposed to diethylstilbestrol (DES) in utero.
When do guidelines recommend cervical cancer screening be discontinued?
Patients older than 65 years who have had adequate screening within the last 10 years may choose to stop cervical cancer screening. Adequate screening is three consecutive normal Pap tests with cytology alone or two normal Pap tests if combined with HPV testing.
What are the guidelines regarding cervical cancer screening for patients with h/o hysterectomy?
Patients who have undergone a total hysterectomy for benign reasons do not require cervical cancer screening.
Virtually all cervical cancers are caused by infection with ….
high-risk types of human papillomavirus (HPV 16, 18)
What is the relationship between smoking tobacco and cervical cancer?
Cigarette smoking, which is strongly correlated with cervical dysplasia and cancer, independently increases the risk by up to fourfold.
Sensitivity vs. Specificity
Sensitivity measures proportion of actual positives that are correctly identified as such (e.g., percentage of sick people identified as having the condition). The more sensitive the test, the fewer false negative results.
Specificity measures the proportion of negatives that are correctly identified as such (e.g., percentage of well people identified as not having the condition). The more specific the test, the fewer false positives.
Sensitivity and specificity of the pap test in screening for cervical cancer
Pap test has a sensitivity of only between 30% and 80% and a specificity of 86% to 100%
What are the USPSTF, ACOG, and ACP consensus guideline for ovarian cancer screening in asymptomatic patients?
The USPSTF, the American College of Obstetricians and Gynecologists, and the American College of Physicians all recommend against routine screening for ovarian cancer in asymptomatic patients.
DDx for nipple discharge
Pregnancy Excessive breast stimulation Prolactinoma Breast cancer Intraductal papilloma Mammary duct ectasia Paget disease of the breast Ductal carcinoma in situ Hormone imbalance Injury or trauma to breast Breast abscess Use of medications (e.g., antidepressants, antipsychotics, some antihypertensives and opiates)
Sensitivity of screening mammograms for breast cancer
The sensitivity of mammography is between 60% and 90%. False-negative results are more common in younger females, as denser breast tissue makes it harder to find abnormalities on x-rays.
Expected timing of menopause
On average, patients with ovaries reach menopause at age 51, but menopause can start earlier or later. A few patients start menopause as young as 40, and a very few as late as 60.
Relationship of smoking cigarettes to menopause
Those who smoke tend to go through menopause a few years earlier than nonsmokers.
2 questions of the PHQ-2
“Over the past two weeks, have you often been bothered by either of the following problems?”
- Little interest or pleasure in doing things.
- Feeling down, depressed, or hopeless.
Sensitivity and specificity of the MINI-COG for cognitive impairment
99% sensitive, 93% specific
(4) common side effects of SSRI drug class
Headaches Sleep disturbances (drowsiness and, less frequently, insomnia) Gastrointestinal problems such as nausea and diarrhea Sexual dysfunction
Timeline of SSRI therapy for depression
In a first episode of depression, it’s usually recommended that the patient take the medication for nine to 12 months, as stopping any sooner runs a high risk for recurrence. Recurrent episodes of depression are treated for two to three years. With multiple recurrences and - in the elderly, who experience increased rates of recurrence - continuous therapy should be considered.
How long do criteria-meeting mood symptoms have to be present to make the diagnosis of MDD?
2 weeks
SIG-E-CAPS mnemonic for remembering MDD criteria
- SLEEP changes (insomnia or hypersomnia nearly every day)
- Loss of INTEREST (anhedonia) or enjoyment in usual activities
- GUILT or worthlessness
- Loss of ENERGY or fatigue nearly every day
- Decreased CONCENTRATION or indecisiveness nearly every day
- APPETITE changes (increase or decrease)
- PSYCHOMOTOR agitation or restlessness observed by others nearly every day
- SUICIDAL ideation
Most common method of suicide in the elderly
Drug overdose
Most reliable sign/symptom for compartment syndrome
loss of normal neurologic sensation (paresthesia) is the most reliable sign
Type of ankle sprain: Generally involves the interosseous membrane and the anterior inferior tibiofibular ligament. Pain and disability are often out of proportion to the injury. One would expect a positive ankle squeeze test
Syndesmotic “high” ankle sprain
Type of ankle injury: Typically due to an inversion injury and may occur in conjunction with a lateral ankle sprain. Patient may complain of persistent pain posterior to the lateral malleolus. Swelling may or may not be present. May also occur with repetitive trauma
Peroneal tendon tear
A common sports injury classically associated with an audible “pop.” Incidence increases with age. Patients are unable to plantarflex.
achilles tendon rupture
How to use the anterior drawer test in work-up of an ankle injury
The patient is supine, the ankle joint is in 20° of flexion, the heel is resting on the palm of the examiner’s hand that is resting on the table. thereby stabilizing the calcaneus. The examiner then stabilises the tibia and fibula whilst drawing the calcaneus anteriorly observing the amount of anterior translation at the lateral aspect of the ankle and the change in end feel. The amount of anterior translation and the eventual weakening of the end feel, changing from hard ligamentous to weak elastic, is observed. An anterior translation greater than 1 cm compared to the healthy contralateral ankle and an evident weakening of the end feel are most indicative of a partial rupture or complete rupture of the anterior talofibular ligament. The test is graded on a 4-point scale. 0 represents no laxity and 3 represents gross laxity.
Evidence
Anterior drawer has sensitivity of 86 percent and specificity of 74 percent for a diagnostic test of 160 patients with an inversion ankle sprain when compared to an arthrogram.[2]
Which ligament is the most commonly injured with an inversion injury of the ankle resulting in lateral ankle sprain?
anterior talofibular ligament (ATFL)
How to use the inversion stress (talar tilt) test in work-up of an ankle injury
Short answer: Invert the patient’s ankle. Laxity indicates injury of the calcaneofibular ligament.
Long answer: The patient is positioned in sitting or supine lying with the knee in full extension. The examiner stabilizes the distal leg with one hand while the other hand holds the heel with the ankle in neutral position. The heel is inverted with respect to the tibia. It is important to hold the talus and calcaneus as one unit to prevent excessive subtalar movement. Pain in the area of the ligament or a sensation of clunk would indicate a positive test. An outward translation in excess of 5 degrees on the injured side compared to the uninjured side, or a spongy or indefinite end feel indicate a complete tear of CFL.
Grading Ankle Sprains
Grade I sprain involves stretching and/or a small tear of a ligament. There is mild tenderness and swelling, slight to no functional loss, and no mechanical instability. No excessive stretching or opening of the joint with stress.
Grade II sprain is characterized as an incomplete tear and moderate functional impairment. Symptoms include tenderness over the involved structures, with mild to moderate pain, swelling, and ecchymosis. In this grade, there is some loss of motor function and mild to moderate instability. Stretching of the joint with stress, but with a definite stopping point.
Grade III sprain is characterized as a complete tear and loss of integrity of the ligament. Severe swelling (greater than 4 cm about the fibula) and ecchymosis may be present, along with inability to bear weight and mechanical instability. Significant stretching of the joint with stress, without a definite stopping endpoint.
What are the Ottowa Ankle Rules for imaging of ankle injuries?
The Ottawa ankle rules are a clinical decision tool designed to help in evaluation of adults (age 18 and up) with acute ankle and midfoot injuries. These have been reported to have a sensitivity of 97% to 100%.
The rules suggest that radiographs of the ANKLE are needed if:
There is pain in the malleolar zone AND either bony tenderness along the distal 6 cm of the posterior edge of either malleolus OR inability to bear weight 4 steps both immediately after the injury and in the emergency department.
Radiographs of the FOOT are needed if:
There is pain in the midfoot region AND one of the following: (a) bony tenderness at either the navicular bone or base of the fifth metatarsal OR (b) inability to bear weight four steps immediately after the injury and in the emergency department.
