Health Screening Flashcards
when should colonoscopy screening begin for people w/ no family hx
age 50
when is colonoscopy screening stopped?
when age expectancy is less than 10 yaers
three screening option for adults >50 for colorectal cancer
annual fecal occult blood testing (FOBT)
flexible sigmoidscopy every 5 years w/ FOBT every 3 years
colonoscopy every 10 years
who should receive a PAP smear
women aged 21-65 who have a cervix
when should pap smears be done for average-risk women age 21-29
at three year intervals
when should pap smears be done for women age 30-65
Pap every 3 years of pap plus HPV every 5 years if both inital tests are negative
who should get bone mineral density testing?
women 65 and older , men with hx of fractures and other potential risks of osteoporosis
what screening test is used for osteoporosis
DXA of the hip and spine
most common clinical manifestation of osteoporosis
vertebral fracture (2/3 are asymptomatic)
what is an osteopenic T score?
1-2.5 standard deviations below the young adult mean
what is an osteoporotic T score?
2.5 standard deviations or more below the young adult mean BMD
what is a Z score?
comparision of the patient’ BMD to an age-matched populations
what Z score is below the expected range for age?
-2.0 or lower (look for xo-exisiting problems that can contribute to osteoporosis
how much calcium should postmenopausual take *supplemental)
500-1000 mg/day in divided doses
how much Vitamin D should postmenopausal women take?
800 international units dialy
First line therapy for postmenopausual women w/ osteoporosisi
alendronate or risedronate or IV if they can’t tolerate these
what is the only IV bisphosponate that has demonstrated efficacy for fracture prevention and is the agent of choice?
zoledronic acid
what is a monoclonal antibody used to treat osteoporosis. It is administered subQ
denosumab
clinical manifestation of chronic adrenal insufficiency
weakness, fatigue, anorexia, N/V/C/D, salt craving, posturnal diziness, Hypotension, hyperpigementations
electrolyte distrubances seen with chronic adrenal insufficiency
hyponatremia
hyperkalemia
Tx for acute adrenal crisis
hydrocortisone
how does someone with hyperaldosteronism present?
hypertension and hypokalemia
Tx of primary aldosteronism
normalize BP and serum potassium with spironolactone and potassium supplements
definitive tx is surgery to remove the adenoma (most common cause)
risk factors for hyperlipidemia
smoking, HTN, DM< advanced age, family history
what does dylipidemia mean
elevated LDL and low HDL
what is an acute phase reactant tha tincreases during inflammation and is a moderate predictor for CHD risk independent of other major CHD risk factors
C-reactive protein (CRP_
how much does cholesterol increase on average per year
2 mg/dL in early adult hood
does caloric excess raise cholesterol or triglycerides more
triglycerides
what med for HTN can increase LDL temporarily
thiazide diuretics
what med can reduce HDL cholesterol and increase serum triglycerides (cardiac med)
beta blockers
what are some causes of secondary hypercholesterolemia
hypothyroidism, nephrotic syndrome, obstructive liver disease
when should patients get a fasting lipid profile
everyone older than age 20
what is a desirable ratio of total cholesterol to HDL cholesterol
4.5
if LDL is high and HDL Is low what drug (that is also a vitamin) can be used?
Niacin
individuals with the highest risk (CHD< DM) should have an LDL goal of what?
<70
What can increased HDL?
aerobic exercise, smoking cessation, weight loss
what drugs are good for elevated triglycerides
gemifibrozil, fenofibrate
a fibrate plus a statin can lead to what
increase risk of rhabdomyolysis
who should get TSH screening
Women >50, who have had external neck irradiation, thyroid surgery, newly pregnant women
if the patient appears clinically and biochemically hypothyroid but the TSH isn’t elevated what shoudl be done
test for pituitary insufficiency
how long does it take for a new dose of levothyroxine to take effect?
4-6 weeks
first line tests for cushings
late night salivary cortisol, urinary cortisol and low-dose dexamethasone supression tests
most common cause of cushing’s
iatrogenic due to pharm doses of glucocorticoids
clinical manifestations of cushing’s
supraclavicular fat pads centripetal obesity hirsutism skin atrophy wide purplish striae proximal muscle weakness
drugs to tx cushing’s due to a ACTH tumor that wasn’t cured by pituitary surgery
cabergoline or pasireotide
