Intro To Well Patient Exam Flashcards by Sarah Gillen

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

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Top 3 Cancers by rates of new cancer cases

Breast (female)
Prostate
Lung and bronchus

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Top 3 cancers by rates of cancer deaths

Lung and bronchus
Breast (female)
Prostate

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What is the leading cause of injury mortality in the US?

Unintentional poisoning

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What is the leading cause of mortality in the US?

Cardiac disease

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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

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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

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Which grade given by the USPSTF indicates that they recommend against that service?

Grade D

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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

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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

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What is SORT

Strength of Recommendation Taxonomy

Assesses strength, consistency, and quality of evidence

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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.

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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.

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Primary difference between screening and testing

Screening = done on asymptomatic patient

Testing = done on symptomatic patient

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Influenza immunization guidelines

Everyone age 6 months+ should have annually

Age 65+ may get high-dose vaccine if available

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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

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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

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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

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What does Tdap stand for

T = tetanus

d = diptheria

ap = acellular pertussis

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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

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What are the 3 primary live vaccines that cannot be given to immunocompromised individuals?

Varicella
Varicella Zoster (shingles)
MMR

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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

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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

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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