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ADV DIAG > EXAM 1- SCREENING > Flashcards

EXAM 1- SCREENING Flashcards

1
Q

Most effective form of health care

A

primary prevention

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2
Q

primary prevention

A

health screening for risk factors

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3
Q

types of primary prevention

A
  1. immunizations
  2. health risk assessment
  3. education
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4
Q

secondary prevention

A

ID and treat pts that are asymptomatic who have risk factors for disease

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5
Q

types of secondary prevention

A
  1. CA- mammogram, PAP, PSA, Cscope

2. HTN- BP checks

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6
Q

tertiary prevention

A

part of management of a given established disease aimed at decreasing complications

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7
Q

tertiary prevention types

A
  1. lifestyle modifications
  2. education about disease
  3. meds
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8
Q

what to consider for if screening is worthwhile

A
  1. prevelance rates
  2. disease associated with disability and death
  3. high risk populations
  4. individual risk factors
  5. economics
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9
Q

sensitivity- true positive

A

% of pts that test positive who have the disease

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10
Q

specificity- true negative

A

% of pts that test negative who do not have the disease

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11
Q

USPSTF

A

US Preventive Services Task Force

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12
Q

breast CA

A

most freq dx CA in women

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13
Q

overall lifetime risk of breast CA for all women

A

12%

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14
Q

breast ca risk

A

family hx of breast ca

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15
Q

other high risk factors for breast ca

A
  1. BRCA1/BRCA2 mutation

2. Ashkenazi Jew

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16
Q

CBE

A

USPSTF recommended that there is not enough evidence to suggest adding CBE to mammogram for early detection of breast CA

clinician has to use their judgement

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17
Q

mammogram digital vs film

A

Sensitivity/digital: 70%
Sensitivity/ Film: 66%
Specificity Both: 92%

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18
Q

mammogram

A

x ray examination of breast

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19
Q

mammogram CI

A

pregnanct women

woman younger than 25 (bc radiation)

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20
Q

USPSTF - breast CA

A

Recommends against routine screening 40-49 years: Grade C
Screen women age 50-74 every 2 years: Grade B
Recommends against teaching SBE
Insufficient evidence grade D with grade I statement

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21
Q

American CA Society- breast CA

A

Annual mammography age 40 years
Clinical breast exam every 3 years age 20-39
Annually after age 40years

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22
Q

American college of obstetrics

A

Mammography every 1-2 years beginning age 40

Clinical breast exam annually beginning age 20 years

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23
Q

cervical ca burden of disease

A

12,200 new cases and 4210 deaths annually (2010)
Incidence varies by ethnicity/race
Worldwide: second most common cancer in women
Most common cause of mortality from GYN cancer

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24
Q

cervical CA risk factors

A

early onset intercourse < 17 y/o, # of sex partners, smoking, DES exposure in-utero, HPV

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25
Q

Papanicolaou Smear aka Pap test Uses

A

Screening for cancer of the cervix

Detects neoplastic cells in cervical secretions

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26
Q

pap test

A

Can be done by GYN or PCP, done by swabbing cervix and using under screen to check for active bacteria or infections and sent and read to see if there are neoplastic cells that indicate risk or CA

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27
Q

USPSTF Recommendations of cervical CA

A

Age 21-65 years
PAP every 3 years
Age 30-65 years
Combination of cytology and HPV testing Grade A recommendation
Over age 65: no screening Grade D
Total Hysterectomy
No screening grade D when no h/o prior abnormality

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28
Q

USPSTF cervical CA age 21-29

A

pap with cervical cytology q 3 yr

no HPV testing

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29
Q

USPSTF cervical CA age 30-65

A

Screen with cervical cytology every 3 yearsorin women who want to lengthen screening interval, screen with cervical cytology and HPV testing every 5 years.

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30
Q

USPSTF cervical CA > 65 y/o

A

Recommend against screening if adequate prior screening and not at high risk for cervical cancer.

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31
Q

USPSTF recommendations against screening for cervical ca with HPV screening alone or in combination with cytology

A

women < 30 y/o

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32
Q

Recommendations by The American Cancer Society (ACS), The American Society for Colposcopy and Cervical Pathology (ASCCP), and The American Society for Clinical Pathology (ASCP) for cervical CA

A

Begin Pap smears at age 21, regardless of when sexual activity began.
Age 21-29: Screen with cervical cytology alone every 3 years.
Age 30-65: Screen with cervical cytology and HPV testing (co-testing) every 5 years (preferred)orscreen with cervical cytology alone every 3 years (acceptable).
Women >65 years of age with a history of CIN 2, 3, or adenocarcinoma in situ: Continue routine screening for at least 20 years after treatment or regression. In some women, this may mean screening past age 65.
HPV testing alone should not be used as cervical cancer screening.

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33
Q

ACS- cervical CA begin

A

age 21, regardless of sexual activity beginning

34
Q

ACS- cervical CA age 21-29

A

screen with cervical cytology alone q 3 yr

35
Q

acs- cervical CA age 30-65

A

Screen with cervical cytology and HPV testing (co-testing) every 5 years (preferred)orscreen with cervical cytology alone every 3 years (acceptable).

36
Q

ACS - cervical ca, > 65 yr with hx of CIN 2,3, or adenocarcinoma in situ

A

Continue routine screening for at least 20 years after treatment or regression. In some women, this may mean screening past age 65.

37
Q

HPV testing alone

A

should not be done as cervical CA screening

38
Q

Adequate negative prior screening for cervical CA definition

A

three consecutive negative cytology results or two consecutive negative co-tests within the last 10 years before stopping with the most recent test within the last 5 years.

39
Q

discontinuation of PAP- USPTF

A

Discontinue after age 65 with adequate prior screening*and not at high risk of cervical cancer (ie, history of high-grade precancerous lesion or cervical cancer, in utero DES exposure, or immunocompromised).

40
Q

ACS/ASCCP/ASCP discontinuation of PAP

A

Discontinue after age 65 with adequate negative prior screening*and no history of CIN 2 or higher within the last 20 years.

41
Q

Women with HIV screening for cervical CA

A

continue for HIV

42
Q

D/C PAP post total hysterectomy (uterus and cervix) ACS/ASCCP/ASCP

A

Discontinue after hysterectomy in women with no prior history of CIN 2 or higher in the past 20 years, or cervical cancer ever.

evidence of adequate negative screening not required.

43
Q

D/C PAP after total hysterectomy

A

Recommends against screening in women who do not have a history of a high-grade precancerous lesion (CIN 2-3) or cervical cancer

44
Q

clinical information needed for pap

A
  1. age
  2. date of last menstrual period
  3. pregnancy status
  4. postpartum or postmenopausal
  5. hx of abnormal pap smears
  6. surgery
  7. hx of carcinoma
  8. any forms of treatment
45
Q

pap smear liquid based cervical cytology (LBCC) vs conventional pap

A

LBCC more satisfacotry

46
Q

CI for PAP

A
  1. menstruating
  2. vaginal infection

specimen should not be allowed to dry on slide

other altering factors- lubricating jelly on speculum, douching, tub bathing, drugs like digoxin and tetracycline

47
Q

pap - CA result

A

Patients with suspicious pap must have colposcopy cone biopsy, and/or dilation and curettage

diagnosis made only with biopsy of tumor

48
Q

pap- STI result

A

Fungal, parasite, and herpes infections can cause cellular changes on pap- must culture for these specifically

49
Q

PSA

A

Prostate specific antigen

Screening for early detection of prostatic cancer

50
Q

Burden of disease- prostate CA

A 
2nd leading cause of CA death in men
lifetime risk 15.9%
risk of death 2.8%
70% men > 70 yrs have occult prostate CA that does not effect health status, more likely to die from something else
22-23% mortality <70 yrs
51
Q

prostate CA risks

A

AA (increased incidence)

family hx- relative risk of 2 with 1st degree relative, 5 when 2 affected

52
Q

DRE

A

Sensitivity 59%
Specificity is unknown but suggested to be as high as 94%
Poor reproducibility

May add to CA detection when combined with PSA

53
Q

PSA >/= 4.0

A

68-80% sensitivity

60-70% specificity

54
Q

USPSTF 2012 conclusion for PSA screening

A

Recommend against PSA screening for prostate cancer

Grade D recommendation = little clinical benefit

55
Q

colon CA screening

A

Third most common cancer in the US
Second leading cause of cancer death in US
5% life time risk for developing colon cancer
20%of colon cancer diagnoses are in individuals with specific risk factors

56
Q

Colon CA risks

A

personal or family h/o colorectal cancer/adenomatous polyps in 1st degree relative
UC
Familial polyposis or hereditary nonpolyposis colorectal cancer

57
Q

guaiac based FOBT

A

2 samples of 3 different stools to six test card panels
Positive Hgb or blood: turns blue
False negative with Vitamin C
False positive with ASA, NSAIDS, red meat (within past week)
DRE single panel test sensitivity 9% should not be used

58
Q

hemoccult II

A

Sensitivity 25-38% & specificity 98%

59
Q

hemoccult SENSA

A

Sensitivity 64-80% & specificity 87-90%

60
Q

tier 1 colon ca screening

A

Colonoscopy every 10 years

Annual FIT

61
Q

tier 2 colon ca screening

A

CT colonography every 5 years
FIT–fecal DNA every 3 years
Flexible sigmoidoscopy every 5–10 years

62
Q

tier 3 colon ca screening

A

capsule colonoscopy every 5 years

Septin 9 testing is not recommended.

63
Q

USPSTF 2008 colon ca screening recommendations

A

start average risk patients at age 50 years and continue until age 75 years
FOBT, sigmoidoscopy or colonoscopy
aged 76 to 85 years and less than 10 yrs of life expectancy
Recommend against routine screening Grade C recommendation

USPSTF does not recommend colorectal cancer screening for adults older than 85 years

64
Q

USPSTF stool based screening tests and intervals

A

Guaiac-based fecal occult blood test (FOBT), every year
Fecal immunochemical test (FIT), every year
FIT-DNA, every 1 or 3 years

65
Q

USPSTF direct visualization screening tests and intervals

A 
Colonoscopy, every 10 years
Computed tomographic (CT) colonography, every 5 years
Flexible sigmoidoscopy, every 5 years
Flexible sigmoidoscopy with FIT; sigmoidoscopy every 10 years, with FIT every year
66
Q

average risk for colon CA recommendations

A

testing with a tier 1 test should begin at age 45 years for African Americans and at age 50 for patients of all other races

67
Q

family history of colorectal cancer or advanced adenoma diagnosed

A

colonoscopy at age10 years younger than the youngest age at diagnosis of a first-degree relative, or age 40, to be repeated every 5 years.

68
Q

one first-degree relative with colorectal cancer, advanced adenoma, or an advanced serrated lesion diagnosed at age 60 or older,

A

tier 1 test age 40, continue same intervals as average-risk patients.

69
Q

colonoscopy

A

a fiber optic tube to directly inspect the entire colon

approximately 5 feet long

has two fiber optic bundles: one provides a light source inside the colon and the other transmits the image from the colon to a high definition monitor and recording device

third channel can be connected to a suction apparatus to remove debris blocking the view

fourth channel can be used to insert a biopsy device

70
Q

colonoscopy

A

must cleanse their bowel prior to a colonoscopy
usually given conscious sedation for the procedure
done by a gastroenterologist
can biopsy suspicious lesions and remove polyps at the time of the procedure without the need for another preparation and a separate sedation and procedure

71
Q

flexible sigmoid

A

about two feet long: examines first 60 CM of colon
If h/o polyps need full colonoscopy
If polyps are seen cscope is needed
Detects 66% of men if a polyp is found and triggers full colonoscopy
55% of lesions in women as cancers are more proximal
can be done with the patient awake and on an examining table in the primary care provider’s office
Discomfort often limits the examination to the first foot of the colon (sigmoid colon)

72
Q

lung ca burden of disease

A

Leading cause of death men and women (combined)
2012 > 160,000 deaths
This is more than breast, prostate and colon cancer combined

73
Q

high risk population for lung CA

A

85% lung cancers caused by smoking
65 y/o 1ppd 50yr smoker: 10% risk of developing lung cancer over next 10 years
75 y/o 2ppd/50 yr smoker: 15% risk

74
Q

USPSTF recommendations for screening for lung CA

A

annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years (2013 update) for at risk pts

75
Q

CT scan for lung ca

A

sensitivity 94% specificity 73%

76
Q

indications for lung CA screening

A

have a 30 pack-year smoking history and currently smoke

or have quit within the past 15 years

Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

77
Q

ACS recommendations for lung CA screening

A

clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about lung cancer screening with patients aged 55 to 74 years who have at least a 30-pack-year smoking history, currently smoke or have quit within the past 15 years, and who are in relatively good health

78
Q

30 pack yr hx

A

1 pack/day for 30 years = 30 pack yr hx
2 packs/day for 15 years = 30 pack yr hx

ACS

79
Q

CAD burden of disease

A

CAD/CHD leading cause of death in the US
1/3 CHD events are related to a TC> 200mg/dL
Age 40years: 49% lifetime risk Men & 32% women

80
Q

quality of screening tests for cholesterol

A 
TC and HDL not affected by eating
TG: affected by eating 
May be 20-30% higher must be fasting
TC can vary by 6% a day
HDL can vary by 7.5% a day
Recommend two measurements prior to initiating therapy
81
Q

USPSTF screening for cholesterol

A

Grade A
Screen all men age 35
Screen all women age 45

82
Q

uspstf grade b recommendations for cholestserol

A

Screen men age 20-35 and women age 20-45

WITH
Family history of CAD prior to age 50
Diabetes
HTN
Smoking

ADV DIAG (23 decks)

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