Health screening in the general population

Question 1

what are the JNC 8 recommendations for initiation of hypertension treatment?

Answer 1

1. moderate evidence for ACE inhibitor, angiotension receptor blocker, calcium channel blocker, thiazide diuretic in nonblack population even those with diabetes
2. for black population calcium blocker or thiazide diuretic is recommended as initial therapy

Question 2

what are the 2013 ACC / ACH guidelines for treatment of blood cholesterol?

Answer 2

SCREEN
age 20-79 - asses risk factors every 4-6y

TREATMENT INITIATION

1. ASCVD
2. primary LDL elevations greater than 190 mg/dL
3. 40-75yo with diabetes and LDL 70-189 mg/dL without clinical ASCVD
4. no ASCVD or diabetes who are 40-75 with LDL 70-189 mg/dL AND 10y ASCVD risk of 7.5% or higher

TREATMENT
high or moderate intensity statin regimen in patients with elevated ASCVD risk for primary prevention of CVD

Question 3

what are the guidelines for colon cancer screening in average and high risk individuals?

Answer 3

average - The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. Grade: A recommendation.

high risk - earlier screening in patients with family hx of colon cancer (HNPCC) or high-risk conditions (ulcerative colitis)
Blacks: higher risks than whites, often found at a later stage, consider screening starting at age 45

Question 4

why is routine calcium scoring and other vascular studies NOT indicated for asymptomatic individuals?

Answer 4

USPSTF concludes that current evidence insufficient

USPSTF Grade I

Question 5

what is the recommendation for low dose CT in heavy smokers over 55 yo? risks?

Answer 5

adults 55-80 who have a 30 pack year smoking history and currently smoke or have quit within the last 15 years

Question 6

what is the controversy surrounding PSA testing?

Answer 6

1. not recommended for men 40-54
2. men 55-69 years - cost / benefit (q2y)
3. not recommended over 70 or any man with less than 10-15 year life expectancy

Question 7

what are the current recommendations for mammography?

Answer 7

B - biennial screening mammography for women aged 50 to 74 years

C - The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.

Question 8

what are the current recommendations for adult immunizations?

Answer 8

personal immunity - Tdap/Td, flu

herd - Tdap, flu

special - pneumo, varivax, zoster, meningococcal, HPV, MMR