Intro To Well Patient Exam Flashcards
Top 10 leading causes of death in US (2014)
- Heart disease
- Cancer (malignant neoplasms)
- Chronic lower respiratory disease
- Accidents (unintentional injury)
- Stroke (CVD)
- Alzheimer’s
- Diabetes
- Influenza and pneumonia
- Kidney disease
- Suicide
Top 3 Cancers by rates of new cancer cases
Breast (female)
Prostate
Lung and bronchus
Top 3 cancers by rates of cancer deaths
Lung and bronchus
Breast (female)
Prostate
What is the leading cause of injury mortality in the US?
Unintentional poisoning
What is the leading cause of mortality in the US?
Cardiac disease
What is the difference between A and B recommendations set forth by the USPSTF?
A = USPSTF recommends this service; high certainty that the net benefit is substantial
B = USPSTF recommends this service; high certainy that the net benefit is moderate or there is moderate certainty that net benefit is moderate to substantial
Which grade of recommendation set forth by the USPSTF indicates recommending a service selectively to individual patients based on professional judgement and patient preference?
Grade C
Which grade given by the USPSTF indicates that they recommend against that service?
Grade D
What is an I statement recommendation as defined by USPSTF?
It means that the USPSTF concludes that current evidence is insufficient to assess balance of benefits and harms of service
Service may be given if patient understands uncertainty about balance of benefits and harms
Why is A the strongest grade given by the USPSTF in terms of recommendation strength?
Because grade A indicates consistent, good quality PATIENT-ORIENTED evidence
Whereas B has limited quality patient-oriented evidence and C has disease-oriented evidence
What is SORT
Strength of Recommendation Taxonomy
Assesses strength, consistency, and quality of evidence
Definition and examples of patient oriented outcomes
Outcomes that matter to patients and help them live longer or better lives
Examples: mortality, symptom improvement, quality of life, lower cost, hospitalizations, etc.
Definition and examples of disease oriented outcomes
Histopathologic, physiologic, or surrogate results that may or may not reflect improvements in patient outcomes
Examples: blood glucose, blood pressure, coronary plaque thickness, carotid artery thickness, etc.
Primary difference between screening and testing
Screening = done on asymptomatic patient
Testing = done on symptomatic patient
Influenza immunization guidelines
Everyone age 6 months+ should have annually
Age 65+ may get high-dose vaccine if available
Pneumococcal vaccine guidelines according to the CDC
PCV13 for all children <2 years, all adults 65+, and people 2-64 years old with certain medical conditions
PPSV23 for all adults 65+ years old, people 2-64 years old with certain conditions, AND adults 19-64 years who smoke cigarettes
HPV vaccine guidelines
3 doses for girls starting age 11-26
3 doses for boys starting at age 11-21
3 doses recommended for MSM or have other risk factors to age 26
Meningococcal vaccine guidelines
MenACWY is routine and MenB is for special populations
Single dose of Menactra or Menveo vaccine at age 11 or 12, with booster dose at age 16 years
Recommend in upper teen years as they approach communal living areas like dorms or military
What does Tdap stand for
T = tetanus
d = diptheria
ap = acellular pertussis
Tdap vaccine guidelines
One dose of Tdap, then every 10 years thereafter give Td booster
For people who are infants, may wish to give a Tdap to protect the adult as well as infants they care for from pertussis
Give Tdap once per pregnancy, usually around 27-36 weeks gestation, regardless of last Td or Tdap
What are the 3 primary live vaccines that cannot be given to immunocompromised individuals?
Varicella
Varicella Zoster (shingles)
MMR
Varicella vaccine guidelines
2 doses for anyone without documentation of 2 varicella vaccines in lifetime or who hasn’t had physician-documented chicken pox
Contraindicated in pregnancy, immune-compromising conditions and HIV with CD4 count <200
Varicella Zoster (shingles) vaccine guidelines
Start at age 50, all adults should get one whether or not they have had a previous case of shingles
Contraindicated in pregnancy, immune compromising conditions and HIV with CD4 count <200
MMR vaccine guidelines
Adults born before 1957 considered immune
Certain adults need second booster
Contraindicated in pregnancy, immune compromising conditions and HIV with CD4 count <200
Hep A vaccine recommendations
Reserved for special high risk populations: MSM, drug users (injection and non injection), people travelling to or adopting from areas where hep A is endemic, etc.
Hep B vaccine recommendations
Reserved for special high risk populations: healthcare workers, public safety workers, high risk sexual populations
Hib vaccine recommendations
Recommended for all children <5 years in US, and the vaccine is usually given to babies starting at 2 months old. In certain situations, people at increased risk for invasive Hib disease who are fully vaccinated need more doses of Hib
Unimmunized older children and adults with certain medical conditions should also get Hib vaccine
AAA screening recommendations per USPSTF
Screen men who have every smoked at ages 64-75 for AAA with ultrasonography
Breast cancer screening recommendations
Mammograms begin at age 50, then do every 2 years until age 75
(ACA recommends starting age 40 then annually)
Colon cancer screening recommendations
Begin at age 50, typically stop at 75
3 options: fecal occult blood testing, sigmoidoscopy, or colonoscopy
Cervical cancer screen recommendations
Start paps at 21, then every 3 years to age 65
For women over 30, can to Pap+HPV screen every 5 years
Lung cancer screening guidelines per USPSTF
Annual screening recommended with LDCT in adults 55-80 who have 30 pack year history and currently smoke OR have quit within the past 15 years
Screening should be discontinued if health problem develops that limits life expectancy or decreased ability or willingness to have curative lung surgery
USPSTF level A evidence
BP screen in adults 18+
Cervical cancer screen in women 21-65
Colorectal cancer screen in 50-75
HIV screen in non-pregnant adolescents and adults 15-65
Tobacco use counseling and interventions: non-pregnant adults
Syphilis screen in non-pregnant persons at increased risk
USPSTF level B evidence
AAA screen
Alcohol misuse screen
Aspirin prevention medication
Breast cancer screen
Chlamydia screen
Depression screen
Diabetes screen
Fall prevention
Gonorrhea screen
Healthy diet and PE counselling for CVD risk
Hep B screen
Hep C screen
Intimate partner violence screen
Lung cancer screen
Obesity screen
Osteoporosis screen
STI counselling
Skin cancer counselling
Tb screen
PSA guidlines
USPSTF recommends against PSA-based screening for prostate cancer (Grade D)
Expected to become Grade C for men ages 55-69: USPSTF recommends that clinicians inform men in this age group about potential harms and benefits of reducing the chance of dying of prostate cancer but may experience harms of screening including false positive results, overdiagnosis and overtreatment complications such as incontinence and impotence
Lipid disorder guidelines for Grade A classification
Screen for lipid disorders:
Men age 35+
Women age 45+ who are at increased risk for CHD
PSA guidelines for men 70+
Grade D recommendation — USPSTF recommends against PSA-based screening for prostate cancer in men 70+
Lipid disorder guidelines for Grade B classification
Screen for lipid disorders:
Men ages 20-35 years who are at increased risk for CHD
Women ages 20-45 who are at risk for CHD
Lipid disorder guidelines for Grade C classification
No recommendation for or against screening:
Men ages 20-35 years
Women age 20+ who are not at increased risk for CHD
Guidelines for level B evidence: AAA screening
Men 65-75 who have ever smoked
Guidelines for level B evidence: alcohol misuse
Screening (CAGE) and counselling ages 18+
Guidelines for level B evidence: aspirin preventative medication
Adults age 50-59 with >10% 10 yr risk cardiovascular risk
Guidelines for level B evidence: breast cancer screening
Women starting age 50 q2years
Guidelines for level B evidence: chlamydia screening
Sexually active women 24+ at increased risk
Guidelines for level B evidence: Depression screening
Adults including postpartum
Guidelines for level B evidence: diabetes screening
40-70 years who are overweight or obese
Guidelines for level B evidence: fall prevention in older adults
Age 65+ encourage exercise or physical therapy
Guidelines for level B evidence: gonorrhea screening
Sexually active women 24+, women at increased risk
Guidelines for level B evidence: healthy diet and physical activity counselling to prevent cardiovascular disease
Adults with cardiovascular risk factors (if overweight or obese and have additional CVD risk factors)
Guidelines for level B evidence: Hepatitis B screening
Non-pregnant adolescents and adults (at high risk for infection)
Guidelines for level B evidence: hepatitis C virus infection screening
Adults at high risk (one time)
Guidelines for level B evidence: intimate partner violence screening
Women of childbearing age
Guidelines for level B evidence: lung cancer screening
55-80 with 30 pack year smoking history and currently smoke OR have quit in the past 15 years
Guidelines for level B evidence: obesity screening/counselling
Adults
Guidelines for level B evidence: osteoporosis screening
Women 65 years and younger women at increased risk
Guidelines for level B evidence: STI counselling
Sexually active adolescents and adults at increased risk
Guidelines for level B evidence: skin cancer behavioral counseling
10-24 yrs with fair skin
Guidelines for level B evidence: statin preventative medication
Adults 40-75 yrs with no hx of CVD, 1 or more CVD risk factors and 10 year risk or >10%
Guidelines for level B evidence: tuberculosis screening
Adults at increased risk
