Health/screening

Question 1

A rare type of cancer involving the skin of the nipple and, usually, the areola. May also have one or more tumors inside the same breast, either ductal carcinoma in situ or invasive breast cancer.

Answer 1

Paget’s disease

that paget guy has breasts… i can see his nipples through his shirt

Question 2

Also known as measles,

Answer 2

Rubeola

Question 3

Koplik’s spots (tiny white spots in buccal mucosa) are present during the prodromal period. The blotchy pink rash is also known as a morbilliform rash

Answer 3

Rubeola S/S

Question 4

Outbreaks caused by poor MMR immunization numbers

Answer 4

Measles

Question 5

an acute or chronic inflammation of the labial mucosa and adjacent skin due to excessive moisture and/or salivation. The corners of the mouth are macerated with fissures and painful reddened skin

Answer 5

Cheilosis

angular cheilosis (perleche)

“cheeeeel essay- i got the dentures right here”

Question 6

Are dentures, poor oral hygiene, drooling, dry mouth (sicca symptoms), oral fungal infection, immunodeficiency, and vitamin deficiency.

Answer 6

Cheilosis Risks

(inflammatory condition that causes cracking, crusting, and scaling of the corners of the mouth.)

enough with the lip chap essa…. CHEeeeeeeeeIL

Question 7

Technique used with a light source, such as the otoscope, to visualize fluid below the skin surface, which will appear as a “glow.”

Answer 7

Transillumination

Question 8

Stroking the inner thigh (proximal to distal) with a blunt instrument such as a handle of the reflex hammer.
testicle and scrotum should rise on the stroked (ipsilateral) side.

Answer 8

Cremasteric reflex

Question 9

U.S. Mortality Statistics
Leading cause of death (all ages/genders):

Answer 9

Heart disease (females 22%, males 24%)
Cancer (females 21%, males 22%)
Accidents/unintentional injuries

Question 10

Cancer Mortality

Top three cancer deaths (all ages/genders):

Answer 10

1. Lung and bronchus
2. Colon and rectum
3. Pancreas

Cancer is more common in older adults; 80% of all cancers in the United States are diagnosed in people aged 55 years or older.

Question 11

Leading Causes of Death in Adolescents

Answer 11

**Death rate for teen males is higher than for females:
Unintentional injuries (40.6%); the most common cause is motor vehicle crashes (risk is highest from 16 to 19 years of age).

**Suicide (19.0%); watch for signs of depression, such as talking about suicide, saying goodbye to friends and family, social isolation, social media updates about death. Interview teen with parent, then alone (without parent). Refer to pediatric psychiatrist/therapist for further evaluation.

**Homicide (14.3%); nonfatal and fatal violence are much higher among young people compared with any other age group.

Question 12

Leading Cause of Mortality by Age Group

Answer 12

Birth to 12 months: Congenital malformations

Aged 1 to 44 years: Unintentional injuries

Aged 45 to 64 years: Cancer

Aged 65 and older: Heart disease

Question 13

Life Expectancy

Answer 13

Average life expectancy in the United States was 78.7 years in 2018 (CDC, 2020). Life expectancy for females is 81.2 years, and life expectancy for males is 76.2 years.

Question 14

Most common cancer:

Most common type of ____cancer:

Answer 14

Skin cancer (5.4 million)

Basal cell carcinoma
Melanoma causes the majority of skin cancer deaths.

Question 15

Most common cancer by gender (prevalence):

Most common cancer among children (aged 0–14 years):

Answer 15

Men: Prostate cancer

Women: Breast cancer

Leukemias (approximately three out of four have acute lymphocytic leukemia).

Question 16

Sensitivity

Answer 16

A sensitive test is very good at identifying/detecting those people who have the disease (true positive).

An easy way to remember is to think of “sensitivity—rule in” or “SIN.”

Question 17

Specificity

Answer 17

A specific screening test is very good at identifying/detecting those people without the disease (true negative).

An easy way to remember is to think of “specificity—rule out” or “SPOUT.”

Question 18

Primary Prevention (Prevention of Disease or Injury/Eliminate or Reduce Risk Factors for an Illness)

Answer 18

“Primary= Protect/Promote”

**Individual actions (healthy individuals): Eat a nutritious diet, exercise, and use seatbelts and helmets.

**Gun safety: Use safety locks for guns; keep guns out of reach of children/teens.

**National programs: Federal health-promotion/disease-prevention programs include immunizations, the Occupational

**Safety and Health Administration’s (OSHA) job safety laws, and Environmental

**Protection Agency (EPA) laws.

**Promote a healthy lifestyle and change risky behaviors (e.g., poor eating habits, tobacco use, not using condoms).

**Build a youth center in an urban high-crime area or a Habitat for Humanity house.

**Use aspirin prophylaxis for primary prevention of cardiovascular disease (CVD) and colorectal cancer in adults aged 50 to 59 years who have a 10% risk or higher (who are not at increased risk of bleeding).

Question 19

Secondary Prevention (Early Detection of a Disease to Minimize Bodily Damage)

Answer 19

“Secondary= screening”

**Screening tests (e.g., Pap smears, mammograms, complete blood count for anemia)

**Screening for depression (interviewing a patient about feelings of sadness, hopelessness)

**Screening for sexually transmitted infections (STIs), such as testing for chlamydia and gonorrhea and asking about sexual history and partners and signs/symptoms

**Screening for alcohol abuse (interviewing a patient using the CAGE questionnaire)

**Testing for hepatitis C virus (anti-HCV) in persons with risk factors, such as an adult born from 1945 to 1965 (baby boomers), long-term hemodialysis, received blood/blood component transfusion (before July 1992), injection drug users, HIV infection, and persistently abnormal alanine aminotransferase (ALT) levels

**Having a person with a history of myocardial infarction (MI), transient ischemic attack (TIA), or stroke take an aspirin or statin daily (to prevent a future stroke or MI)

Question 20

Tertiary Prevention (Reduce Impact of Disease or Injury/Rehabilitation/Support Groups/Equipment)

Answer 20

“Tertiary=treat current issue”

**Support groups: Alcoholics Anonymous (AA), breast cancer support groups, HIV support groups

**Education for patients with preexisting disease (e.g., diabetes, hypertension):

**Avoidance of drug interactions, proper use of wheelchair or medical equipment, and so on.

**Rehabilitation: Cardiac rehabilitation, physical therapy (PT), occupational therapy (OT)

**Vocational rehabilitation programs to retrain workers for new jobs (after they have recovered as much as possible)

Question 21

USPSTF Recommendations: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer (April 2016)

Answer 21

**Aged 50 to 59 years with ≥10% CVD risk: Initiate low-dose aspirin use for primary prevention of cardiovascular and colorectal cancer in patients who are not at increased risk for bleeding with life expectancy of at least 10 years and who are willing to take low-dose aspirin daily for at least 10 years

**Aged ≥70 years: Insufficient evidence about aspirin use for primary prevention

Question 22

USPSTF Recommendations: Breast Cancer (January 2016)

mammo at age:
and every:
until:

high risk should start at:

Answer 22

**Baseline mammogram: Start at age 50 years and repeat every 2 years until age 74 years
Aged ≥75 years: Insufficient evidence for routine mammogram

**Does not apply to women with known genetic mutations (BRCA1 or BRCA2), familial breast cancer, or a history of chest radiation at a young age or women previously diagnosed with high-risk breast lesion who may benefit from starting screening in their 40s

**Evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, MRI, digital breast tomosynthesis (DBT), or other methods in women identified to have dense breasts on an otherwise-negative screening mammogram.

Question 23

Cervical Cancer Screening

Aged 20 years or younger:

Aged 21–29 years:

Aged 30–65 years:

Prior hysterectomy with removal of cervix:

Aged >65 years with adequate prior screening:

Answer 23

Aged 20 years or younger:
-Do not screen (even if sexually active with multiple partners); cervical cancer is rare before age 21 years

Aged 21–29 years:
-Every 3 years with cervical cytology alone

Aged 30–65 years:
-Every 3 years with cervical cytology alone
-every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology

Prior hysterectomy with removal of cervix:
-If hysterectomy with cervical removal was not due to cervical intraepithelial neoplasia (CIN grade 2) or cervical cancer, stop screening

Aged >65 years with adequate prior screening:
-Do not screen if history of adequate prior screening and is otherwise not at high risk for cervical cancer

“no need/ every 3/ 3-5”

Question 24

USPSTF Recommendations: Colorectal Cancer (June 2016)

start at age:
and every:
until:

different kind of screenings

Answer 24

Baseline: Starting at age 50 years until the age of 75 (older age is the most common risk factor)

Aged 76 to 85 years: Against routine screening but “there may be considerations;” individualize screening as needed.

Aged ≥85 years: Do not screen.

There are several methods that are acceptable for screening people with average risk of colon cancer:

-Colonoscopy every 10 years

-Flexible sigmoidoscopy or CT colonography every 5 years

-**High-sensitivity fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every year (if positive, needs colonoscopy)

-Stool DNA (SDNA) every 1 or 3 years (if positive, needs colonoscopy)

“Q 10 colonoscoPY, Q 5 sigmoid or CT, fecal blood test annuALLY”

Question 25

USPSTF Recommendations: Lipid Disorders (November 2016)

fast for:

start at age:
and every:
until:

Answer 25

Total lipid profile after a 9-hour (minimum) fast and universal lipid screening in all adults aged 40 to 75 years

-lipid panel Q 5 years, unless indicated

The U.S. Preventive Services Task Force (USPSTF) recommends the use of low- to moderate-dose statin for adults with no history of CVD (primary prevention) when all of the following criteria are met:

-Aged 40 to 75 years

-The patient has one or more CVD risk factors (e.g., dyslipidemia, diabetes mellitus [DM], hypertension, smoking).

-The patient has a calculated 10-year risk of a cardiovascular event of ≥10%.

-Aged ≥76 years without history of heart attack or stroke (insufficient evidence)

-The likelihood that a patient benefits from statin therapy depends on their absolute baseline risk of having a future CVD event.

Question 26

USPSTF Recommendations: Lung Cancer (December 2013)

start at age:
and every:
until:

Answer 26

Screening for persons who smoke (30 pack-years) or have quit in the past 15 years

Aged 55 to 80 years: Annual screening with low-dose CT (LDCT)

Discontinue screening once 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.

Question 27

USPSTF Recommendations: Prostate Cancer (May 2018)

start at age:
and every:
until:

Answer 27

Aged 55 to 69 years:
-Individualize the decision to undergo periodic prostate-specific antigen (PSA) screening.
-Discuss potential harms (erectile dysfunction, urinary incontinence, prostate biopsy, false-positive results) versus the benefits.
-Do not screen men who do not express preference for screening.

Aged 70 years or older: Do not screen.

Question 28

USPSTF Recommendations: Ovarian Cancer (February 2018)

Answer 28

Grade D: Routine screening is not recommended.

High-risk women: Refer for genetic risk evaluation and counseling. Look for family history of having two or more first- to second-degree relatives with a history of ovarian cancer or a combination of ovarian cancer; women of Ashkenazi Jewish ethnicity with first-degree relative (or second-degree relatives on the same side of the family) with breast or ovarian cancer, female breast cancer before age 50 years, male breast cancer, invasive ovarian cancer, and others.

BRCA1 and/or BRCA2-positive mutation increases risk for breast cancer, male breast cancer, ovarian cancer, prostate cancer, pancreatic cancer, and melanoma.

Question 29

USPSTF Recommendations: Skin Cancer Screening (July 2016)

Answer 29

The USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of screening (visual skin examination) for skin cancer in adults.

Question 30

USPSTF Recommendations: Skin Cancer Behavioral Counseling (March 2018)

Answer 30

-Counsel young adults, adolescents, children, and parents of young children about minimizing exposure to UV radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer.

-Education includes avoidance of sunlight from 10 a.m. to 4 p.m. and use of SPF 15 or higher sunblock, protective clothing, and wide-brim hats.

Question 31

Risk Factors
Breast Cancer

age:
Hx:

Answer 31

-Aged 50 years or older (most common risk factor)

-Previous history of breast cancer
BRCA1 or BRCA2 gene mutation

-History of high-dose radiation therapy to the chest at a young age (such as treatment for Hodgkin lymphoma)

-Two or more first-degree relatives with breast cancer

-Early menarche, late menopause, nulliparity (longer exposure to estrogen)

-Obesity (adipose tissue can synthesize small amounts of estrogen)

Question 32

Hepatitis B Vaccine

Answer 32

Total of three doses:
(0, 1, 6 months);
first vaccine given at birth (monovalent hepatitis B vaccine)

Requires a minimum interval of 4 weeks between doses one and two

If series is not completed, catch up until three-dose series is completed; the Centers for Disease Control and Prevention (CDC) does not recommend a restart of the hepatitis B series.
Vaccine Fact

If a patient had only one dose of hepatitis B vaccine, what is recommended?

Do not restart the hepatitis B series again. If only one dose, give the second dose. Catch up until the three-dose series is completed

Question 33

Flu (influenza)

Trivalent flu vaccine

Answer 33

Once a year
-Give in fall/winter season.

Age 65 years or older
-Fluzone and Fluad are for age ≥65 years.

Question 34

Live attenuated influenza vaccine (LAIV) intranasal

Answer 34

For healthy persons (not pregnant) aged 2–49 years.

-Do not give FluMist to pregnant women, use inactivated flu vaccine injection

-Do not give if immunocompromised (HIV/AIDS) or if a caregiver of severely immunocompromised persons (or avoid contact with these persons for 7 days after getting nasal fl u vaccine).

Question 35

Shingles/zoster

Answer 35

Two doses

First dose of Shingrix for healthy adults aged 50 years or older; separate second dose by 2–6 months.

Question 36

Meningococcal conjugate vaccine quadrivalent (MCV4)

Answer 36

Preteens, teens, and young adults: start at age 11–12 years

Give booster dose at age 16 years. All preteens and teens aged 11–12 years old need a booster at age 16 years.
Teens and young adults are at increased risk for meningococcal disease (first-year college students living in residence halls or military recruits).

Question 37

Pneumococcal conjugate vaccine (PCV13)

Answer 37

Infants; some adults aged 65 years or older

Optional for adults aged 65 years or older who do not have an immunocompromising condition,

Question 38

Pneumococcal polysaccharide vaccine (PPSV23)

Answer 38

One dose at age 65 years

If vaccinated before age 65 years, give a booster in 5 years. The CDC also recommends it for adults aged 19–64 years who smoke cigarettes.

one dose only

“the 23 yr old smoking POLYnesian said - i got that shot once- im totally fine lol”

Question 39

Seasonal Influenza Vaccine

Answer 39

-Start giving the influenza injection at the end of October of each year (fall to winter season).

-As long as influenza viruses circulate, vaccination should continue to be offered, even into
January or later. Most seasons, influenza activity peaks in January or later.

-All healthcare personnel should get vaccinated annually.

-**If a person with an egg allergy only experiences hives, an influenza vaccine can be administered.

DO NOT give to:

-infants < 6 months old

-People with severe, life-threatening allergies to components of the influenza vaccine (e.g., gelatin, gentamicin, preservative), which are not related to an egg allergy, should not be given influenza vaccine

Question 40

Live Attenuated Influenza Vaccine (LAIV) Contraindications

Answer 40

-Pregnancy, chronic disease (e.g., asthma, chronic obstructive pulmonary disease [COPD], renal failure, diabetes, immunosuppression)

-Contraindicated in children on aspirin therapy (aged 2–17 years)

-Children aged 2 to 4 years who have asthma or a history of WHEEZING in the past 12 months

Question 41

How long does it take for the flu vaccine to become effective?

How long does immunity from influenza vaccine last?

Answer 41

It takes about 2 weeks after being vaccinated to develop antibodies.

Protection is thought to persist for at least 6 months. Early vaccination (in July or August) will likely result in suboptimal immunity before the end of the influenza season, especially in older adults.

Question 42

Tetanus Vaccines (Tdap and Td):

Give every _____for lifetime.

Boosters: For “dirty”/contaminated wounds, give a booster if the last dose was more than _____.

Infancy and children younger than____of age: Use DTaP form.

Aged 7 years and older: Use only ____ or ____ forms of the vaccine

DTaP:

Td:

Tdap:

Answer 42

Give every 10 years for lifetime.

give a booster if more than 5 years prior.

7 years of age: Use DTaP form.

Aged 7 years and older: Use only Td or Tdap forms of the vaccine;

DTaP: Give by IM route to infants and children younger than 7 years of age.

Td: Give by IM route; start using at 7 years of age.

Tdap: Give by IM route.
Safety Issue

Question 43

Tetanus Vaccines:

When can the Tdap be used as a booster in adolescents and adults?

What is done if a patient has a tetanus-prone wound and vaccination status is unknown?

Which wounds are considered at highest risk for tetanus infection?

Answer 43

The Tdap can be substituted for a single dose of Td (once in a lifetime) starting at 11–12 years of age.

Administer immediate dose of Td/Tdap vaccine and the tetanus immunoglobulin (TIG) injection as soon as possible.

Puncture wounds, wounds with devitalized (basically dying) tissue, soil-contaminated wounds, crush injuries, and others are at high risk for tetanus infection

Question 44

What vaccine is recommended for persons who are 65 years of age?

If a person is vaccinated with _____ before the age of 65, what is recommended?

Answer 44

Give Pneumovax (PPSV23) at 65 years of age. If patient presents in the fall/winter season, also offer influenza vaccine. If immunocompromising condition, CSF leak, or cochlear implant, do not give PPSV23.

Give a booster dose of Pneumovax 5 years after the initial dose.

Question 45

1. What is the preferred vaccine for shingles prophylaxis?
2. Can a person who has never had chickenpox develop shingles?

3.How long are persons with shingles contagious?

4. When can the live virus vaccine (Zostavax) be used instead of recombinant zoster vaccine (Shingrix)?

Answer 45

1. The CDC recommends Shingrix because it is more effective against shingles.
   -Shingrix is 90% effective
   -Zostavax is 50% effective
   -At age 50 years or older (even if history of shingles), a person needs a total of two doses of Shingrix.
2. No, they cannot. If the person becomes infected with the varicella zoster virus, it will manifest initially as chickenpox.
3. Shingles is infectious until all the skin lesions are dry and crusted. Follow contact precautions. About half of cases of shingles occur in persons aged 60 years or older.
4. Zostavax may still be used to prevent shingles in healthy adults ≥50 years if the person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is unavailable

Question 46

Varicella Vaccine

Varicella live attenuated virus (Varivax): Given____

The second dose is given at age__

Adolescents (age 13 years or older) and adults need ____doses given ______ apart.

Advise women not to get pregnant for ____ after getting vaccine.

Answer 46

by SC route and requires two doses. First dose given in infancy: 12 to 15 months (do not give to infants younger than 12 months).

4 through 6 years.

two doses
4 to 8 weeks apart

1 month

Question 47

If someone has a history of BCG (Bacillus Calmette–Guérin) live vaccination, what is the preferred method of TB testing?

What is the follow-up if a person has a positive TB skin test or TB blood test?

Answer 47

TB blood testing (QuantiFERON, T-SPOT) is preferred. Most people with a positive TB blood test have latent TB infection. TB blood tests (interferon-gamma release assays [IGRAs]), unlike the TB skin test, are not affected by prior BCG vaccination.

Evaluate the person for signs and symptoms of TB.
-Rule out latent or active TB infection.
-Order a chest x-ray and check for signs and symptoms of TB, such as:
* a “chronic” cough
*weight loss,
*night sweats.

Pick the shorter treatment regimens for latent TB treatment because patients are more likely to complete them.

Question 48

Quadrivalent inactivated influenza vaccine (QIV)

Answer 48

those with chronic respiratory disease such as emphysema should receive an annual QIV

-which is appropriate to administer in patients 6 months and older

on all 4’s (Quad- pod position) from emphysema

Question 49

Hepatitis B:

HBsAg

Anti-HBs

Anti-HBc

anti-HBV , anti-HAV, anti-HCV

Answer 49

HBsAg:
(+) = acute or chronic hepatitis B infection

Anti-HBs: (immune from a pre- v- S infection/shot?)
a marker of immunity
(+) = immunity from either vaccine or previous infection

Anti-HBc: (c- CU- CUte or CHRonic )
is a marker of acute, chronic, or resolved hepatitis B virus (HBV) infection

anti-HBV , anti-HAV, anti-HCV
-resolved hepatitis B virus (HBV) infection
-resolved hepatitis A virus (HAV) infection
-resolved hepatitis C virus (HCV) infection

Question 50

Plasma viral load (PVL) should be measured Q

CD4 Q

Answer 50

4 to 8 weeks

3 months.