Family Medicine Flashcards
When to do breast cancer screening?
- Women 50 - 74 yo mammography every 2 - 3 years
What are the lung cancer screening guidelines?
- Screen adulys 55 - 74 yo with more than 30 years of smoking history who currently still smoke or who quit within the past 15 years with annual low dose CT up to three consecutive times
- No need to screen if no smoking history
- Do not use chest x-ray to screen
What are the colorectal cancer screening guidelines?
- Screen adults 64 - 70 to with fecal occult blood test or fecal immunochemical test every 2 years OR flex sig every 10 years
- Can start at age 50 but less evidence regarding benefit
- Do not use colonoscopy as a screening test
What are the colorectal cancer screening guidelines in patient with history of HNPCC?
Colonscopy every 1-2 years starting at age 20 or 10 years younger than the earliest noted family case
What are the colorectal cancer screening guidelines in a patient wiht a history of familial adenomatous polyposis?
Flex sig annually starting at age 10-12
What are the colorectal cancer screening guidelines in a patient wiht a history of attenuated adenomatous polyposis?
Colonoscopy annually starting at 16-18 yo
What are the cervical cancer screening guidelines?
- Start paps at 30 until 69 every 3 years
- CAN start at age 25 or even 21 if sexually active
- If no date on screening and pt older than 70 then do every 3 year screening until 3 are normal
- If you have had 3 normal previous paps and are 70 then stop
What are adult and child vitamin D guidelines?
- 400 IU/d in exclusively breastfed babies
- 1000 IU/d in adults at higher risk of having low levels
- ALL adults should consider 1000 IU/d in fall/winter
- 800-2000 IU/d in adults over 50 yo or at risk for osteoporosis or multiple fractures
Calcium recommendations
- 1000 mg/d in adults age 19 - 50 and pregnant women
- 1200 mg/d in adults over 50
- Dietary intake is preferred over supplements
Name some adverse medical consequences of obesity
Diabetes, high cholesterol, HTN, coronary artery disease, osteoarthritis, stroke, OSA, cancer, gallbladder disease, lower back pain, increased mortality, pregnancy complications
What are the three medications approved in Canada for obesity?
Contrave (naltrexone + bupropion) = controls hunger and cravings
Saxenda (liraglutide) = decreases apetite and food intake
Xenical (orlistat) = reduces dietary fat absoption by 30% through inhibition of pancreatic and gastric lipases
Should be used alongside a reduced calorie diet & increased activity
When to screen for high cholesterol?
Every 1-3 years in adults over 40 yo or females who are menopausal or any age if there are increased dyslipidemia risks (South Asian, Indigenous, smoker, diabetic, HTN, ED, family history of dyslipidemia, CKD, inflammatory disease, HIV, COPD, obese, clinical evidence of atherosclerosis, etc)
What hyperlipidemia medications should you be cautious about combining?
Statin + fibrate because of increased risk of myalgia, CK elevation, myopathy or rhabdomyolysis
How would you counsel a pregnant patient who would like to quit smoking?
- Counselling is recommended as first line treatment
- NRT should be made available if they cannot quit using non pharmacologic methods
- Intermittent lozenges or gum is preferred over continuous patch dosing
- Unclear whether varenicline or bupropion is bad in gestation
How long does it take for withdrawal symptoms to set in in a patient trying to quit smoking?
2-3 hours after last cigarette
Peaks 2-3 days
Improves at 2-3 weeks
Resolve or relapse at 2-3 months
