Columbus: well woman visit Flashcards
What are the American Cancer Society guidelines on diet and nutrition?
Choose most foods from plant sources
Limit intake of high fat foods particularly from animal sources
Be physically active and maintain healthy weight
Limit consumption of alcoholic beverages
When does ACOG recommend annual pelvic examinations?
Starting at age 21
What are the “five A’s” used for smoking intervention?
Ask about smoking history
Advise smokers to quit
Assess whether patient is willing to quit
Assist patient in quitting; consider nicotine replacement, bupropion, varenicline
Arrange follow-up care
When does ACOG recommend mammography?
USPSTF?
Starting at age 40 and then annually
Age 50-74 biennially
What are the major sequelae of smoking?
Cancer of the lung, oropharynx, esophagus, kidney, bladder, pancreas, cervix CAD/COPD Osteoporosis Thrombotic disease/stroke Persistent dysplasia Pregnancy complications
When does ACOG recommend clinical breast examination?
USPSTF?
Age 20-39 every one-three years
Age 40 and above annually
Insufficient evidence to justify exam
When does the CDC recommend HPV vaccination?
Girls and boys aged 11 or 12 years. Females up to age 26. Males up to age 21.
When does ACOG recommend breast self-examination?
USPSTF?
Recommends breast “self-awareness” and consider instruction of breast self-examination for high-risk patients
Recommends against instruction
How long should screening be continued with a history of CIN 2-3 or AIS?
Age-based screening for 20 years
When should Pap screening begin and at what frequency?
When can be stopped?
Age 21: Pap alone every 3 years
Age 30-65: HPV plus cytology every 5 years
No screening greater than age 65 or hysterectomy for benign disease
What special populations should have more frequent screening?
HIV positive
Immunosuppressed
DES exposed
Who should receive annual influenza vaccination?
Who should relieve receive live attenuated vaccine?
Recommended for all adults since 2010-11 flu season.
Healthy non-pregnant people age 2-49
When does ACOG recommend colorectal cancer screening?
What tests are suggested?
Age 50 and over.
Colonoscopy every 10 years
Flexible sigmoidoscopy every 5 years
Double contrast barium enema every 5 years
Virtual colonoscopy every 5 years
When is pneumococcus vaccination recommended?
Page 65 or older
Significant chronic disease
Immunocompromised individuals
Second dose given at age 65 unless immunized within the past five years
When is tetanus booster indicated?
Every 10 years or if more than 5 years since last booster at the time of wound management
When is varicella zoster vaccination indicated?
All people 60 or more years. Previous varicella infection is not a contraindication.
When is Tdap vaccination indicated?
Adults age 19-64 should receive Tdap once
Pregnant women during each pregnancy between 27-36 weeks
Anyone not previously vaccinated who anticipates close contact with infant
When is meningococcus vaccination recommended?
All adolescents age 11-18
College students or military personnel not previously vaccinated
When is routine chlamydia screening recommended?
sexually active women age 25 and younger
Hepatitis B vaccination is a routine childhood series. What high-risk adults should be screened for immunity or revaccinated?
Sexual contact with known carrier Multiple sexual partners Recent treatment for STD IV drug user Blood product recipient Healthcare worker
When is hepatitis C screening indicated?
One-time screening for all the adults born between 1945 and 1965
When is HIV screening recommended?
Women and girls age 13-64
Patients presenting for TB treatment
Patients presenting for STD treatment
Pre-conceptual evaluation or routine prenatal care
Repeat screening annually for high risk patients
USPSTF recommends screening everyone age 15-65
What are the three leading causes of death for women aged 19-39?
- Accidents
- Cancer
- HIV
When should women be screened for domestic violence?
What medical conditions are associated with domestic violence?
All women of reproductive age
Chronic pain, depression, alcohol and substance abuse
What is the TACE screening tool for alcohol abuse?
What quantity suggests at-risk drinking?
Tolerance, annoyed, cutdown, eye-opener
More than 7 drinks per week or more than three drinks on one occasion in the past 90 days
What are suggested depression screening questions?
Over the past two weeks, have you felt down, depressed, or hopeless?
Or
Over the past two weeks, have you felt little interest or pleasure in doing things?
What therapies are helpful for preventing heart disease?
Consuming fish twice a week, Omega-three fatty acids may be considered in women with CHD
Low-dose aspirin in women 65 or older
When is pharmacotherapy indicated for elevated blood pressure?
Greater than or equal to 140/90
Or greater than or equal to 130/80 if diabetic or renal disease
When does UW Health recommend lipid screening?
What frequency is recommended?
Age 20 and above
Every 5 years
When does USPSTF recommend cholesterol screening for women?
What women are thought to be at higher risk?
Page 45 and older every five years. Starting at age 35 for high-risk women.
Family history of lipid disorder
Family history of premature coronary artery disease
Personal history of coronary artery disease
Diabetes
Smoker
What cholesterol screening is recommended by the USPSTF?
Does this require fasting?
Total cholesterol and HDL cholesterol
No
When is diabetes screening recommended?
Age 45 or older and every three years.
Screen earlier for obesity, strong family history, history of fetal macrosomia or gestational diabetes, hypertension, hypertriglyceridemia, PCOS
Are the criteria for diagnosis of diabetes?
Fasting plasma glucose greater than equal to 126
2-hour plasma glucose greater than or equal to 200
Symptoms of diabetes and random plasma glucose greater than or equal to 200
When is osteoporosis screening recommended?
Age 65 and older
Under age 65 if history of fracture, alcoholism, smoker, frail stature, medications causing bone loss, FRAX 10 year risk of 9.3% or greater
What medications are approved for prevention of osteoporosis?
Hormone replacement therapy
Bisphosphonates
Raloxifene
What doses does ACOG recommend by age for calcium and vitamin D supplementation?
19-50: 1000 milligrams per day calcium, 600 IU per day vitamin D
51-70:1200 mg per day, 600 IU per day
Greater than 70:1200 mg per day, 800 IU per day
What reference does ACOG recommend for complete recommendations for well woman examinations?
www.acog.org/wellwoman
What T-score indicates osteoporosis?
How often should women be screened for osteoporosis based on T-score results?
Greater than or equal to 2.5
Less than or equal to 1.5: 15 years
1.5 to 1.99: 5 years
2 to 2.49: 1 year
According to ACC/AHA cardiovascular risk screening guidelines, when should statin therapy be given?
Clinical atherosclerotic CVD
LDL greater than or equal 290 mg/dL
Age 40-75 with diabetes and LDL 70-189 mg/dL
Age 40-75 with no diabetes and LDL 70-189 mg/dL AND 10-year atherosclerotic CVD risk greater than or equal to 7.5
When do the new ACA/AHA guidelines recommend starting cardiovascular risk screening?
Age 21
