Lecture 1: Wellness Visit Flashcards
What are the top 3 leading causes of death in the US?
- Heart Disease
- Cancer (malignant neoplasms)
- Chronic lower respiratory disease
What is the #1 leading cause of injury mortality in the US?
Unintentional Poisoning
What are the top 3 cancers by rate of new cancer cases?
- Breast (female)
- Prostate
- Lung and Bronchus
What are the top 3 cancers by rate of cancer deaths?
- Lung and Bronchus
- Breast (female)
- Prostate
What does the USPSTF do?
Works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications
What does a grade of A, B, C, D, or I from the USPSTF mean?
A = recommends service. High certainty that the net benefit is substantial
B = recommends service. High certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
C = recommends selectively offering or providing this service to individual pts based on professional judgement and pt preferences. There is at least moderate certainty that the net benefit is small
D = recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh benefits
I = current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined
What does patient-oriented evidence mean?
Measures outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life
What is a screening test vs. diagnostic test?
Screening: testing an asymptomatic pt for a specific disease just because they are a certain age, gender, and/or meet other criteria
Diagnostic: testing a symptomatic pt for a specific disease because you, the physician, thinks his symptoms may point to a specific cause
Most physicians refer to what organizations when offering recommended vaccinations?
- CDC (center for disease control)
- ACIP (advisory committee on immunization practices)
What is the recommendation for influenza vaccine?
- All people age 6 months or older should have annual vaccine
- Age 65 or older may opt for the high-dose vaccine
What is the recommendation for Pneumococcal Vaccines (PCV13 and PPSV23)?
- PCV13 for all children younger than 2 y/o, all adults 65 years or older, and people 2-64 y/o with certain medical conditions
- PPSV23 for all adults 65 years or older, people 2-64 with certain medical conditions, and adults 9-64 who smoke cigarettes
What is the recommendation for HPV vaccine for girls, boys, and MSM?
- 3 doses for all girls at age 11-26
- 3 doses for all boys at age 11-21
- 3 doses recommended for MSM or who have other risk factors to age 26
What is the routine Meningococcal Vaccine and the one for special populations; what is the recommendation for administration?
- MenACWY is routine
- MenB for special populations
- Single dose of Menactra or Menevo at age 11 or 12, w/ booster dose at age 16
- Recommended in upper teen years as they approach communal living areas like dorms or military
What is the recommendation for Tdap vaccine; what about during pregnancy?
- Give one dose Tdap, then every 10 years give Td booster
- For people who are around infants, may wish to give a Tdap to protect the adult as well as infants they care for from pertussis (whooping cough)
- Give Tdap once per pregnancy, usually around 27-36 weeks gestation, regardless of last Td or Tdap vaccine timing
Which 3 vaccines are contraindicated in pregnancy, immune-compromsing conditions and HIV w/ CD4 count <200?
- Varicella (chicken pox)
- Varicella Zoster (shingles)
- Measles, Mumps, Rubella (MMR)
Recommendation for the Varicella (chicken pox) vaccine?
- 2 doses for anybody who doesn’t have documentation of 2 varicella vaccine in lifetime or who hasn’t had physician-documented chicken pox
Recommendation for Varicella Zoster (Shingles) vaccine; what is the goal of this vaccine?
- Starting at age 50, all adults should get one, whether or not they had a previous case of shingles
- Goal is to prevent not just the painful rash, but the postherpetic neuralgia which is debilitating and can last months to years
Adults born before when are considered immune to MMR?
1957
What screening’s are considered level A evidence by the USPSTF; what are the age groups for each?
- Blood pressure screening: adults 18+
- Cervical cancer screening: women 21-65 yrs
- Colorectal cancer screening: 50-75 yrs
- HIV screening: non-pregnant adolescents and adults 15-65
- Tobacco use counseling and interventions: nonpregnant adults
- Syphilis screening: non-pregnant persons at increased risk
Who do we screen for abdominal aortic aneurysm and what level of evidence?
- Level B evidence
- Men 64-75 who have ever smoked
- Using ultrasonography
Who do we screen for breast cancer and what level of evidence?
- Level B evidence
- Women starting at 50 y/o and then every 2 years until age 75
Who do we screen for diabetes and what level of evidence?
- Level B evidence
- Pt’s 40-70 y/o who are overweight or obese
Who do we screen for Lung Cancer and what level of evidence?
- Level B evidence
- Pt’s 55-80 w/ 30 pack year smoking hx and currently smoke OR have quit in past 15 years
Who do we screen for Osteoporosis and what level of evidence?
- Level B evidence
- Women strarting at 65 y/o
- Younger women at increased risk
Who do we give Hepatitis A vaccine to?
- MSM, drug user, injection and non-injection, people traveling to or adopting from areas where hep A is endemic, etc.
Who do we give Hepatitis B vaccine to?
Health care and public safety workers, high risk sexual population
Who is the Haemiphilus Influenza type b (Hib) vaccine recommended for?
- All children younger than 5 y/o in the US
- Usually given to babies starting at 2 mo.
What is the recommendation for Colon Cancer Screening?
- Beginning at age 50 y/o and continuing to age 75
- Recommended AGAINST screening age 76-85
What is the recommendation for Cervical Cancer Screening (Pap Smear)?
- Start Pap at 21 y/o then every 3 years to age 65
- Paps not necessary before age of 21 and not necessary before starting contraceptives in females less than 21 y/o
- Paps NOT recommended for women after 65 y/o unless at high risk for cervical cancer, also NOT recommended for hysterectomy w/ cervix removal unless high grade precancerous lesion or personal hx of cervical cancer
What is the recommendation for Pap smear and HPV screening?
- USPSTF does not recommend screening for HPV, alone or in combination w/ cytology (Pap smear), before age 30
- For women over 30, may opt to do Pap plus HPV screening every 5 years
What is considered a Grade A screen for lipid disorders in men and women?
- Men age 35 years or older
- Women age 45 years and older who are at increased risk for CHD
What grade does a prostate cancer screen for men ages 55-69 and men age 70 and older get?
Men ages 55-69 = grade C recommendation
Men age 70+ = grade D recommendation
What is the leading cause of injury death in the US for ages 25-64?
Unintentional Poisoning
What is the leading cause of injury death in the US for ages 5-24?
Unintentional MV Traffic
What is the leading cause of injury death in the US for ages 65+?
Unintentional Fall
What is the leading cause of injury death in the US for ages 1-4?
Unintentional Drowning
What is the leading cause of injury death in the US for ages <1?
Unintentional suffocation
Who do we screen for depression and what grade of evidence?
- Level B evidence
- Adults including postpartum
Who do we recommend fall prevention for; what level of evidence?
- Level B evidence
- Adults 65+
- Exercise or physical therapy
