Guidelines Flashcards
Which of the following is/are correct regarding self breast examination?
Effectiveness is controversial. Self-breast exam actually increases the number of biopsies performed.
Patients who choose to perform self-examination should be trained in appropriate technique and follow-up. BSE allows motivated women to be in control of this aspect of their health care and allows for patient autonomy and education.
What are the cervical cancer screening guidelines?
The guidelines recommend that:
At 21 years of age – cervical cancer screening should begin.
Between the ages of 21-29 years – screening should be performed every three years (PAP with reflex HPV).
Between the ages of 30-65 years – screening can be done every three years with cytology alone, or every five years if co-tested for HPV
Sooner in high risk (HIV, DES exposure, immunocompromised, history of dysplasia)
Can stop after 65
What are risk cancers for cervical cancer?
Early onset sexual activity, multiple sex partners, cigarette smoking, immunosuppression, DES exposure.
Lung cancer screening?
Only in high risk patients 55-65yo with a 30 pack-year history of smoking.
Pathologic reasons for breast discharge?
- Prolactinoma (milky)
- Breast cancer
- Intraductal papilloma
- Mammary duct ectasia
- Paget’s disease of the breast
- Ductal carcinoma in situ - Hormone imbalance
- Injury or trauma to breast
- Breast abscess
- Use of medications use (e.g., antidepressants, antipsychotics, some antihypertensives and opiates)
Sensitivity?
True positive rate. A negative result in a test with high sensitivity is useful for ruling out disease. A high sensitivity test is reliable when its result is negative, since it rarely misdiagnoses those who have the disease. A test with 100% sensitivity will recognize all patients with the disease by testing positive. A negative test result would definitively rule out presence of the disease in a patient.
Specificity?
True negative rate. Positive result in a test with high specificity is useful for ruling in disease. The test rarely gives positive results in healthy patients. A test with 100% specificity will read negative, and accurately exclude disease from all healthy patients. A positive result will highlight a high probability of the presence of disease.
Osteoporosis vs. Osteopenia
Osteoporosis is spinal or hip bone mineral density (BMD) of 2.5 standard deviations or more below the mean for healthy, young women (T-score of −2.5 or below) as measured by dual energy x-ray absorptiometry (DEXA).
Osteopenia is defined as a spinal or hip BMD between 1 and 2.5 standard deviations below the mean (T-score between -1 and -2.5).
Definition of menopause
12 straight months without menses.
Menopause and osteoporosis
Before menopause, estrogen offers some protection against heart disease and osteoporosis. For bone health, it is recommended that premenopausal women need approximately 1000 mg of calcium daily while postmenopausal women need 1500 mg of calcium daily
Start screen with DEXA scans for women at 65.
What are risk factors for osteoporosis?
Early menopause, lack of physical activity, history of previous fractures, white race. Obesity is protective (higher estrogen).
Diseases associated with high BMI.
High blood pressure Coronary artery disease Stroke Osteoarthritis Some cancers, and Type 2 diabetes
Stages of Change model
Pre-contemplative, Contemplation, Preparation, Action, Maintenance, Relapse.
Diabetes risk factors
Age ≥ 45 years
Overweight (body mass index ≥ 25 kg/m2)
Family history diabetes mellitus in a first-degree relative
Habitual physical inactivity
Belonging to a high-risk ethnic or racial group (e.g., African-American, Hispanic, Native American, Asian-American, and Pacific Islanders)
History of delivering a baby weighing > 4.1 kg (9 lb) or of gestational diabetes mellitus
Hypertension (blood pressure ≥ 140/90 mmHg)
Dyslipidemia defined as a serum high-density lipoprotein cholesterol concentration ≤35 mg/dL and/or a serum triglyceride concentration ≥250 mg/dL
Previously identified impaired glucose tolerance or impaired fasting glucose
Polycystic ovary syndrome
History of vascular disease
Diagnosing diabetes
A diagnosis of diabetes is made if HBA1C is greater than or equal to 6.5%, or two fasting plasma glucose values over 125 mg/dl, two-hour plasma glucose values over 200 mg/dL during an oral glucose tolerance test, or a random glucose greater than or equal to 200 mg/dL with symptoms of diabetes.
Interpretation of pap smear results
- Atypical squamous cells (ASC): Some abnormal cells are seen. These cells may be caused by an infection or irritation or may be precancerous.
- Low-grade squamous intraepithelial lesion (LSIL). LSIL may progress to a high-grade lesion but most regress.
- High-grade squamous intraepithelial lesion (HSIL). This is considered a significant precancerous lesion.
- Squamous cell carcinoma.
Guardasil
Quadravalent recomb DNA vaccine (6&11 - genital warts,16&18 - cervical cancer). Females and males 9-26 years. 3 doses around time of sexual debut.
Three C’s of addiction & Five A’s of Counseling for Behavior Change.
Three Cs of Addiction:
Compulsion to use
lack of Control
Continued use despite adverse consequences
The Five A’s of Counseling for Behavior Change:
Ask or Address the behavior needing change.
Assess for interest in behavior change.
Advise on methods to change behavior.
Assist with motivation to change behavior.
Arrange for follow-up.
CAGE questions
- Felt like you needed to CUT down?
- ANNOYED at criticism of your drinking?
- GUILTY feelings of drinking?
- Needed a morning EYE opener.
Changes associated with dyslipedemia (physical)?
Corneal arcus, xanthelasmas, acanthosis nigricans
ADCDE of suspicious sin lesions?
- Asymmetry 2. Border irregularity 3. Color (non-uniform) 4. Diameter >6mm 5. Evolution/change over time
RISE pneumonic (preventative visits)
Risk factors - Identify risk factors for serious medical conditions during history and physical exam.
Immunizations - Provide recommended immunizations / chemoprophylaxis.
Screening tests - Order appropriate screening tests.
Education - Educate patients on ways to live healthier while reducing risks for disease.
General Immunizations
Influenza is recommended annually.
Current recommendations recommend substituting a one-time dose of Tdap for Td booster (tetanus and diphtheria) for ages 11-64 to provide additional pertussis protection, then boost with Td every 10 years.
One dose of zoster vaccine is recommended when patients turn 60.
Screening recommendations for an asymptomatic 55 yo M smoker.
Colorectal cancer, obesity, DM, Lipid disorders, lung cancer (if 30 pack year history), hypertension, alcohol misuse, Hep C, depression.
