general Flashcards
Harms of periodic screening
Overdiagnosis
False positive, anxiety, quality of life and consequences
Follow-up testing (infection, bleeding), medical intervention, hospitalization
cervical cancer screening age
25-69
≥ 70yo, stop if 3 successive negative Pap tests in last 10 years
Consider 21-69yo as per SOGC
Consider 21-65yo as per INSPQ
mammography screening age
Women 50-74yo q2-3y
recommends shared decision-making with women
colorectal cancer screening age and frequency in general population
50-74yo FOBT (or FIT) q2y or flexible sigmoidoscopy q10y (weak recommendation 50-59yo, strong recommendation 60-74yo)
risk factors of colon cancer and age of screening
1st degree relative ≤60yo CRC, high risk adenomas, or 2+ relatives
40yo or 10y prior to index case
lung cancer screening age and criteria
55-74yo with ≥30 py smoking history (current or quit <15y ago) low-dose CT q1y x 3 (weak recommendation; low quality evidence)
: USPSTF 2021 recommends annual screening with low-dose CT for 50-80yo with 20py smoking history, and to discontinue once a person has not smoked for 15 years or develops a health problem that limits life expency or ability/willingness to have curative lung surgery
age and criteria of screening for AAA
Men 65-80yo with one-time screening ultrasound for abdominal aortic aneurysm
age and frequency of db screening
≥40yo A1C or FPG q3y or earlier if high risk
age and frequency of DLP screening
≥40yo non-fasting lipids q5y (annually >20%) or earlier if risk
vit D and ca supplement doses
vitamin D 400-2000 IU daily, if age>50 years (or risk) 800-2000IU daily
Calcium 1200 mg/d from diet (increase to 1500-2000 mg/d if pregnant or lactating)
when to screen for osteoporosis and risk factors
All men and women ≥ 65yo
≥ 50yo if risk factor:
Fragility fracture after age 40 (low trauma fractures) and risk of future fractures
Vertebral compression fracture or osteopenia on X-ray
Parental hip fracture
Prolonged use of glucocorticoids (3mo of >7.5 mg prednisone daily in past year)
Rheumatoid arthritis, malabsorption syndrome
Current smoker
High alcohol intake (>3 units/day)
Major weight loss (10% below body weight at age 25)
<50 yo if disorder associated with rapid bone loss
Fragility fractures
High-risk medications
Malabsorption
Inflammatory
Primary hyperparathyroidism
tests for secondary causes of osteoporosis
Calcium, Albumin
CBC
Creatinine
Alk phos
TSH
SPEP (if vertebral fractures on X-ray)
25-OH Vitamin D checked once after 3 month of supplementation in impaired instesinal absorption, or osteoporosis requiring pharmacotherapy
ways to prevent osteoporosis
Smoking cessation, alcohol reduction <3 drinks/day
Vitamin D 1000-2000 IU PO daily
Calcium intake 1200mg/day from diet (three servings of low fat milk products)
Can consider Calcium supplement ≤500mg PO daily in those who cannot meet recommended dietary allowance at high risk of fractures
Sufficient protein intake (1g/kg/day)
Exercise Multicomponent program includes
Resistance training ≥ 2x/wk
Back extensor muscles daily
Balance training daily
Aerobic physical activity 150 mins/week of moderate intensity
Fall awareness and prevention
Assistive devices
Medication review (fall risk)
Environmental hazards
Hip protectors
Urinary incontinence
Name 6 classes of medication for osteoporosis treatment and an example
Oral bisphosphonate: Alendronate 70mg PO weekly or Risedronate 35mg PO weekly or 150mg PO monthly
Take 1 hour before breakfast with 250mL water, upright 30 mins, avoid any calcium for 2-3h
Adverse: Osteonecrosis of the jaw, atypical femur fractures, esophagitis, esophageal ulcers
Consider oral bisphosphonate holiday after 5y (10y in high risk, eg. previous fracture and T<-2.5)
IV bisphosphonate: Zoledronic acid 5mg IV once yearly if GI/esophageal disorders, or inability to tolerate (eg. sit upright for 30-60 mins)
Consider Drug Holiday after 3y (6y in high risk)
Monoclonal Ab (RANKL inhibitor): Denosumab (Prolia) 60mg sc twice yearly if impaired renal function
No drug holiday on Denosumab
Adverse: Joint/muscle pain, osteonecrosis of jaw, contraindicated in pregnancy
PTH Analog: Teriparatide (Forteo) 20mcg sc daily in severe osteoporosis who cannot tolerate bisphosphonate
Adverse: Hypercalciuria/emia, angioedema
SERM (Selective estrogen receptor modulators ): Raloxifene
Risk of thromboembolism
Other: Calcitonin intranasal, Hormone therapy (in menopausal symptoms)
when to refer osteoporosis to a specialist
Multiple fractures despite adherence to therapy
Secondary causes of osteoporosis/metabolic bone disease outside expertise
Extremely low BMD not explained by risk factors
CKD (eGFR<30mL/min)
age group in croup
6m-3yo
differential ddx of croup, name 6
bacterial tracheitis
retropharyngeal/ peritonsillar abscess
epiglottitis
aspiration of foreign body
allergic reaction
treatment of croup
Dexamethasone 0.6mg/kg po or IM x 1
mod severe: nebulized epi over 15 min
when can u d/c croup
after observing 2- 4h after meds
T or F:
No evidence for Heliox (or helium-oxygen mixture), antibiotics, short-acting beta-2-agonist bronchodilators in treatment of croup
True
3 categories of croup and their caracteristics
Mild: no stridoe or significant wob - dex + d/c
Mod: stridor and chest wall indrawing at rest but no agitation - dex + observe
severe: stridor and chest wall indrawing at rest with lethargy or agitation : dex + epi + observe
when to give antibiotics in acute bronchitis
consider antibiotics in ≥ 75 years, >3 weeks or suspect B. pertussis (Whooping cough, >3 weeks, vomiting (related to coughing), exposure to pertussis, not vaccinated)
name 6 symptomatic therapies for an URTI
Analgesics (Acetaminophen/NSAIDs)
Combination products (Antihistamine, decongestant, analgesics)
Consider Zinc lozenges 75mg PO daily, Pleragonium sidoides, Andrographis paniculata
Risk of irreversible anosmia in intranasal zinc preparations
Nasal symptoms
Nasal saline irrigation (poor evidence)
Intranasal cromolyn sodium 1 spray (5.2mg) in each nostril q2h PRN x 2 days then 4 times daily x 5 days
Intranasal ipratropium bromide 0.06% solution two sprays (42mcg/spray) in each nostril 3-4 times daily PRN x 4 days
Cough suppressant
Brompheniramine plus sustained-release pseudoephedrine
Ipratropium bromide inhaled
Dextromethorphan 30mg PO q6-8h PRN
two medication to help with flu
Zanamivir (Relenza) two inhalations (10mg) PO BID x 5d or oseltamivir (Tamiflu) 75mg PO BID x 5d