Lecture 5

Question 1

what is primary prevention

Answer 1

• prevents disease from occurring at all

Question 2

what is secondary prevention

Answer 2

• detects and cures disease in an asymptomatic phase

Question 3

what is tertiary prevention

Answer 3

• treats disease and reduces complications

Question 4

examples of primary prevention

Answer 4

• immunizations
• fluoridation of water
• enforce safety belt laws

Question 5

examples of secondary prevention

Answer 5

• test asymptomatic patients for HIV

- routine Pap smears

Question 6

when could a colonoscopy screen be considered primary prevention

Answer 6

• if a precancerous polyp is removed prior to the polyp becoming cancer

Question 7

examples of tertiary prevention

Answer 7

• optimal blood sugar control for diabetes

Question 8

when is diagnostic testing used in patients

Answer 8

• when patient has pretest probability above the test threshold

Question 9

during screening, patient has a _____ risk of having a particular disease

Answer 9

• smaller risk

Question 10

a positive screening test _______ the probability of disease from a level at which we _______ do diagnostic testing to a level at which we ______ do diagnostic testing.

Answer 10

• increases
• wouldn’t
• would

Question 11

screening should be thought of as a _________ rather than a __________

Answer 11

• cascade of events

- one time test

Question 12

how can screening tests sometimes hurt people

Answer 12

• risks of screening tests

- pick up findings or lead to treatment that doesn’t ultimately improve or prolong someone’s life.

Question 13

two important biases that can explain why screened patients appear to live longer than those who aren’t screened

Answer 13

• lead time bias

- length time bias (length based sampling)

Question 14

what is lead time bias

Answer 14

• a condition is found earlier by screening, but the actual time the person would have lived has not changed
• survival time longer but the person is not better off

Question 15

what is survival time

Answer 15

• time from diagnosis to death

Question 16

example of lead time bias

Answer 16

• lung cancer screenings for metastatic lung cancer

Question 17

what is length time bias

Answer 17

• the fact that cancers found by screening are slower growing and less malignant than cancers found by symptoms.

Question 18

what does away with length time and lead time biases

Answer 18

• a well conducted randomized control trial.

Question 19

they way that a RCT minimizes lead time bias is that we compare

Answer 19

• mortality rates rather than survival rates

Question 20

morality rate

Answer 20

• people who die from a condition during a defined period of time / number of people at the start of the period.

Question 21

mortality rate is measured from the ____________ into the study

Answer 21

• time of entry

Question 22

is mortality rate affected by lead time or length-biased sampling?

Answer 22

• no

Question 23

is cost of the service a component of the USPSTF grading system?

Answer 23

• no

Question 24

recommendations from the USPSTF apply to those people who

Answer 24

• have no signs or symptoms of the specific disease or condition under evaluation

Question 25

two step process of secondary prevention

Answer 25

• screening test

- follow-up diagnosis and treatment

Question 26

criteria when judging whether a condition should be included in preventative care

Answer 26

• the burden of suffering caused by the condition
• the effectiveness, safety, and cost of the preventative intervention or treatment
• the performance of the screening test

Question 27

first round of screening is called

Answer 27

• prevalent screening

Question 28

second and third rounds of screening are called

Answer 28

• incident screening

Question 29

compliance bias

Answer 29

• compliant patients tend to have better prognosis regardless of their preventative activities.

Question 30

incidentaloma

Answer 30

• masses or lesions detected incidentally by an imaging examination

Question 31

5 d’s of prevention

Answer 31

• death
• disability
• discomfort
• dissatisfaction
• destitution