chp 4 Health Screening and Promotion Flashcards
Mortality statistics: Leading causes of death in all ages/genders is 1 \_\_\_\_\_\_\_\_\_\_ 2 \_\_\_\_\_\_\_\_\_\_ 3 \_\_\_\_\_\_\_\_\_\_
- heart disease
- cancer
- Chronic lower resp diseases such as COPD
Cancer mortality:
Leading cause of cancer death:
_________ cancer
lung
Leading causes of cancer deaths in men:
- ________
- ________
- _______
- Lung
- prostate
- colorectal
Leading causes of cancer deaths in women:
- ________
- _______
- _______
- Lung
- Breast
- Colorectal
Leading causes of death in adolescents:
Death rate for teen _______ is higher than for _______
males; females
Leading causes of death in adolescents:
- ____________ —> _______ (39.5%)
- _________ (16.8%)
- _________ (14.3%)
- accidents —> MVCs
- Suicide
- Homicide
Leading causes of death in adolescents:
Suicide (2nd most common cause): Watch teens for signs of _______, excess ________, and suicidal behavior
depression
stress
Leading causes of death in adolescents:
Suicide:
_________ _______ between the adolescent and the parents/caregivers is extremely important in preventing teenage suicide
open communication
Leading causes of death in adolescents:
Homicide (3rd most common cause of death):
Nonfatal and fatal violence are much higher among _______ people compared to any other age group
young
Leading cause of mortality by age group:
Birth to 12 months:
_________ ___________
congenital malformations (20.3%)
Leading cause of mortality by age group:
Ages 1 to 44 years:
__________ __________
unintentional injuries
Leading cause of mortality by age group:
Ages 45 to 64 years:
_________
cancer
Leading cause of mortality by age group:
Ages 65 and older
_________ _________
heart disease
Life expectancy:
Average life expectancy is _____ years
78.6
Cancer statistics:
Prevalence:
Most common cancer: ________ cancer
skin
Cancer statistics:
Prevalence:
Most common TYPE of skin cancer:
basal cell carcinoma
Cancer statistics:
Prevalence:
Skin cancer: (the most common type of cancer)
___________ causes the majority of skin cancer deaths
melanoma
Cancer statistics:
Prevalence:
Most common cancer by gender (prevalence, not mortality):
Men: _______ cancer
prostate
Cancer statistics:
Prevalence:
In men, there are more cases of (the most common cancer) __________ cancer (this is PREVALENCE), but the cancer that causes the most deaths (MORTALITY) is _______ cancer
prostate
lung
Cancer statistics:
Prevalence:
Most common cancer by gender (prevalence, not mortality):
Women: _________ cancer
breast
Cancer statistics:
Prevalence:
In women, there are more cases of (the most common cancer) __________ cancer (this is PREVALENCE), but the cancer that causes the most deaths (MORTALITY) is _______ cancer
breast
lung
Cancer statistics:
Prevalence:
Most common cancer among all children:
_________
ALL (acute lymphoblastic leukemia) - 34% of all cancers in children
Screening tests:
Sensitivity:
A sensitive screening test is very good at identifying/detecting those people who ______ the disease (true ________)
have
positive
Screening tests:
Sensitivity:
An easy way to remember is to think of “sensitivity - rule ____”
in (“SIN”)
Screening tests:
Specificity:
An easy way to remember is to think of “specificity - rule _______”
out (SPOUT)
Screening tests:
Specificity:
A specific screening test is very good at identifying/detecting those people ______ the disease (true ________)
without
negative
Primary prevention:
Is _______ of a _____/_______
prevention; disease/injury
Primary prevention:
Individual actions such as ______ ______, ______, and helmets. Gun safety. Immunizations.
nutritious diet; seatbelts
Primary prevention:
Federal programs include immunizations, ______, and ______ laws
OSHA
EPA
Primary prevention:
______ prophylaxis for primary prevention of _____ and ____ cancer in adults aged 50 to 59 years who have a 10% risk or higher
ASA
CVD
colon
Secondary prevention:
Any _________ tests. Pap smears, mammos, CBCs to detect anemia, depression questionnaires, STIs, CAGE questionnaire, testing for Hep C, and having a person with a hx of MI, TIA, or CVA take an ASA or statin daily to prevent a ________ stroke or MI
screening
second
secondary prevention:
Is early ______ of a disease to ________ bodily damage
detection; minimize
Tertiary prevention: Prevention of disease _________, _________, _______ groups, education on _________.
progression
rehabilitation, support; equipment
Tertiary prevention:
Support groups such as ________, breast cancer support groups, ______ support groups
AA
HIV
Tertiary prevention:
_________ for patients with preexisting disease such as DM and HTN. This includes avoidance of ______ _______ and proper use of _______ or other medical equipment
Education
drug interactions; wheelchairs
Tertiary prevention:
Cardiac rehab, _____ and ______
PT; OT
Tertiary prevention:
Any treatment for ______ _______
active disease
USPSTF
ASA use to prevent CV disease and _____ _____ in age ___ to _____ with equal to ore more than 10% risk
colorectal cancer
50 to 59
USPSTF
ASA use to prevent CV disease - initiate lose-dose ASA therapy use for primary prevention of CV disease and colorectal cancer in patients with life expectancy of at least ___ years and who are willing to take low-dose aSA for at least ten years
10
USPSTF
Breast cancer:
Baseline mammo: Start at age _____ and repeat every ___ years until the age of _____ years
50
2; 74
USPSTF:
Mammograms:
Age ___ years or older:
Insufficient evidence for routine mammo
75
USPSTF: breast cancer -
the recommendation to start at age 50 and repeat every 2 years does not apply to women with known genetic mutations, familial breast cancer, hx of chest radiation at a young age or previously dx with breast lesion, who may benefit from screening mammos starting at age ____
40
USPSTF:
Colorectal cancer :
Baseline screening should start at age _____ until _____.
Age ____ to ___ years: Against routine screening but there may be cosiderations, individualize screenings as needed
Older than age ____: Do not screen
50; 75
76; 85
85
USPSTF:
Colorectal cancer:
Three screening methods are acceptable:
HSFOBT for ____ consecutive stool samples annually
Flex sigmoid or CT colonography every ___ years
Colonoscopy every _____ years
3
5
10
USPSTF: lipid disorders
Total lipid profile after a ___-hr minimum fast
9
USPSTF: lipid disorders
The USPSTF recommends the use of low-to moderate-dose statin when all of the following criteria are met:
Age ____ to ____ years
The patient has one or more risk factors for CVD (dyslipidemia, _____, ____, _______)
The patient has a calculated 10-year risk of CV event of ____% or greater
Age 76 or greater without hx of heart attack or stroke: insufficient evidence
40 to 74
DM, HTN, smoking
10
USPSTF:
Ling cancer:
Screening for persons who smoke (____ pack-years) or have quit in the past ____ years
30
15
USPSTF:
Lung cancer:
Age ___ to ____ years: Annual screening with low-dose CT
55 to 80
USPSTF:
Lung cancer:
Discontinue screening once person has not smoked for _____ years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
15
USPSTF:
Prostate ca:
Grade ___: ___ recommended
D; NOT
PSA screening not recommended
USPSTF:
Ovarian ca:
Grade ___: ___ recommended
D; NOT
USPSTF:
Ovarian ca:
Very high risk women with BRCA1 and BRCA2 mutations are ____ ____ ______.
If ovarian cancer screen is done, ______ ____ with _____ is ordered.
The screening starts at age 30.
referred to specialist
transvaginal ultrasound
CA-125
USPSTF:
Ovarian ca:
High-risk women: Refer to genetic counseling. Look for fam hx of having 2 or more first-to second-degree relatives with a hx of ovarian ca; Women of ______ ______ ethnicity with first-degree relative with breast or ovarian cancer.
Ashkenazi Jewish
USPSTF:
skin cancer counseling:
Recommended for children, adolescents, and young adults ages ___ to ____ with fair skin
Education includes avoidance of sunlight from ___ to ___, use of SPF ____ or higher
10 to 24
10 AM to 4 PM
15
USPSTF: Routine screening is not recommended for the following conditions: P O O T
Prostate ca
Ovarian Ca
Oral Ca
Testicular ca
USPSTF:
Breast cancer:
Breast self-exam has a grade ___ recommendation which recommends _____ teaching them.
D
against
USPSTF:
Blood pressure: Start at age ___ or older and recommends obtaining measurements ______ of _____ _______ for diagnostic confirmation before starting treatment
18
outside clinical setting
USPSTF:
Depression:
Start screening adolescents for major depressive disorder starting at age ____ to _____ years.
always screen the general adult population. For pregnant or postpartum women, use the _____ _____ ____-
12 to 18
Beck Depression Inventory
USPSTF:
Diabetes mellitus:
Age _____ to ____ years if ______ or _____
40 to 70 overweight or obese
USPSTF:
Obesity:
start at age ______ to _____ years and offer or refer to intensive _______ interventions
6; 18
behavioral
USPSTF:
STIs:
Start screening at the onset of _______ ______.
Offer high-intensity behavioral counseling.
sexual activity
USPSTF:
Skin cancer screening:
_______ evidence. Routine screening is ______
Insufficient; not recommended
USPSTF:
Osteoporosis:
Start screening at age _____ years or older.
May start earlier if a younger woman has a fracture risk equal or greater than that of a 65 year-old White woman (chronic steroids)
65
USPSTF:
Ovarian ca:
______ routine screening. Do not screen for except for high risk.
Against.
USPSTF:
Pancreatic cancer.
For or against routine screening?
Against.
Risk factors:
Breast cancer:
-OIder age: Age ____ years of older is most common risk factor
- Previous hx of breast ca
- ___ or more first-degree relatives with breast ca
- ___ menarche and _____ menopause, nulliparity (longer exposure to estrogen)
- Obesity
50
2
early; late
Risk factors: Cervical cancer: Multiple sex partners (greater than \_\_\_\_ lifetime) \_\_\_\_\_\_\_ age of onset immunosuppression and \_\_\_\_\_\_\_
4
younger
smoking
Risk factors: Colorectal cancer: -History of \_\_\_\_\_\_\_ polyposis -\_\_\_\_\_-degree relative with colon cancer -\_\_\_\_\_ disease
familial
first
Crohn’s
Risk factors: Prostate cancer: Age \_\_\_\_ or older \_\_\_\_\_\_\_ ancestry \_\_\_\_\_-degree relative with prostate ca
50
African
first
Risk factors: STIs: Multiple sex partners earlier age of onset of sexual activity new partners (defined as < \_\_ months) Hx of STD homelessness
3
Vaccines and immunizations:
Hep B vaccine
Total of ___ doses at age ___, ___, & ____ months.
Need a minimum interval of ____ weeks between doses one and two.
3
age 0, 1, 6 months
4
Vaccines and immunizations:
Hep B vaccine:
If series is not completed, do not restart the series. Catch up until _____-dose series is completed
3
Vaccines and immunizations:
influenza vaccine:
Start giving at the end of _______ of each year. It takes ____ weeks after the shot for a person to develop antibodies.
October
2
Vaccines and immunizations:
influenza vaccine:
As long as influenza viruses circulate, vaccination should continue to be offered, even into _______ or later.
January
Vaccines and immunizations:
influenza vaccine:
Health care personnel who work with patients older than _____ years should be vaccinated.
If a person with an egg allergy only experiences hives, an influenza vaccine can be administered.
50
Vaccines and immunizations:
influenza vaccine formulations:
Inactivated and recombinant influenza vaccines:
________ and __________ vaccines given by IM injection in the arm are preferred.
Trivalent; quadrivalent
Vaccines and immunizations:
influenza vaccine:
High-dose _______ influenza vaccine is for people age ____ or older
trivalent
65
Vaccines and immunizations:
influenza vaccine:
Recombinant ______ influenza vaccine that is egg-free is approved for persons age ____ years and older (Flublok)
trivalent
18
Vaccines and immunizations:
influenza vaccine:
Quadrivalent offers broader protection and is indicated for age ____ years and older
4
Vaccines and immunizations:
influenza vaccine:
LAIV (Live attenuated influenza vaccine)
Only for healthy persons aged ___ to ____ years.
Some antivirals should be avoided 48 hours before and ____ days after vaccination b/c they interfere with antibody production
2 to 49
14
Vaccines and immunizations: influenza vaccine: LAIV contraindications: Pregnancy chronic disease children on \_\_\_\_\_ therapy aged 2-17 years
Aspirin
Vaccines and immunizations:
influenza vaccine:
Age-appropriate _________ (RIV) or cell-cultured flu vaccines are an option for patients who refuse egg-based influenza vaccine.
recombinant
Most flu vaccines (including nasal spray) are manufactured using egg-based technology. What are the implications for patients?
Egg allergy affects ____% of children but only ___% of adults
1.3%; 0.2%
Tetanus vaccines (Tdap and Td): Give every \_\_\_\_ years for lifetime
10
Tetanus vaccines:
Boosters:
For “dirty”/contaminated wounds, give a booster if the last dose was more than ____ years prior
5
Vaccines and immunizations:
Tetanus vaccine:
Infancy and children younger than age 7 years: Use ___ form
DTaP
Vaccines and immunizations:
Tetanus vaccine:
Age 7 years and older:
Use only ____ or ____ forms of the vaccine; Give one _______ dose (lifetime) to replace one ____ dose
Td; Tdap
Tdap; Td
Vaccines and immunizations:
Tetanus vaccine:
The _____ can be substituted for a single dose of ___ once in a lifetime, starting at age ____ to ____ years
Tdap; Td
11 to 12
What is done if a patient has a tetanus-prone wound and vaccination status is unknown?
Administer immediate dose of ____ vaccine and the tetanus ___________ injection as soon as possible
Td/Tdap
immunoglobulin
Vaccines and immunizations: Tetanus vaccine: Which would are considered highest risk for tetanus infection? \_\_\_\_\_ wounds Wounds with \_\_\_\_\_\_\_\_\_\_ tissue \_\_\_\_-contaminated wounds \_\_\_\_\_ injuries
puncture
devitalized
soil
crush
Vaccines and immunizations:
Pneumococcal vaccine:
_____ (or _______): All adults age 65 years or older or if high risk for pneumococcal disease (age ___ to ___ years)
PPSV2e or Pneumovax
Vaccines and immunizations:
Pneumococcal vaccine:
____ (or _______): All children younger than ___ years of age or at high risk for pneumococcal disease. It is also recommended for all adults age ___ years or older.
PCV13 or Prevnar
65
Vaccines and immunizations:
Pneumococcal vaccine:
Age 65 years of older: CDC recommends giving ____ first (if never had PPSV23); then 12 months after, administer PPSV23 (better immunogenic response)
PCV13
Vaccines and immunizations: Pneumococcal vaccine: Highest risk of fatal pneumococcal infection: \_\_\_\_\_ diseases Anatomical or functional asplenia Any immunocompromise generalized malignancy or cancers of the blood (leukemia, lymphoma, multiple myeloma) Renal diseases hx of organ or bone marrow transplant
chronic (DM, alcoholism, CSF leaks, asthma, chronic hepatitis)
Vaccines and immunizations:
Pneumococcal vaccine:
If a person is vaccinated before the age of 65 with Pneumovax, what is recommended?
Give a booster dose of ________ ___ years after the initial dose
Pneumovax; 5
Vaccines and immunizations:
Shingles vaccine:
Zostavax is a ___ _____ virus vaccine
live attenuated
Vaccines and immunizations:
Shingles vaccine:
Age ___ years: Give one-time dose by ____ route.
A past hx of shingles is not a contraindication for receiving the shingles vaccine.
60; SQ
Vaccines and immunizations:
Shingles vaccine:
The shingles vaccine can be administered to persons if they have never had a ________ infection.
chickenpox
Vaccines and immunizations:
Shingles vaccine:
Certain antivirals can decrease immunological response if taken 24 hours before or ___ days after vaccination
14
Vaccines and immunizations:
Shingles vaccine:
May cause exacerbation of _________ and _______
asthma; polymyalgia rheumatica (PMR)
Vaccines and immunizations: Shingles vaccine: Risk factors for shingles: Older age (\_\_\_\_ years or older) immunocompromised (HIV, steroids, chemo) leukemia, lymphoma
60
Vaccines and immunizations: Shingles vaccine: Contraindications: pregnancy or breastfeeding \_\_\_\_\_\_, lymphomas, or other malignancies of bone marrow immunocompromise
leukemia
Vaccine facts:
What age group should receive the shingles vaccine?
Give a one-time dose at the age of ____ years or older (even if the patient has already had shingles).
The youngest age that Zostavax can be given is ___ years of age
60
50
Vaccines and immunizations:
Shingles vaccine:
Can any person who has never had chickenpox develop shingles?
No, they cannot.
Vaccines and immunizations:
Shingles vaccine:
How long are persons with shingles contagious?
Shingles is infections until all the skin lesions are ____ and _____. Follow _______ precautions.
About half of cases of shingles occur in persons age ___ years and older.
dry; crusted
contact
60
Which vaccine, the shingles or the varicella vaccine, contains more varicella zoster virus?
The shingles vaccine (about 14 times more compared to varicella vaccine)
Primary, secondary, or tertiary prevention:
After a heart attack patient gets prescribed a statin.
Secondary
Screening test for lung cancer is a :
low-dosed HELICAL CT
