Medical Screening Part 1 Flashcards
1
Q
what is a red flag?
A
s/s that are a strong predictor of pathology
2
Q
what is an orange flag?
A
psychiatric sx (depression, personality disorders)
3
Q
what is a yellow flag?
A
beliefs, emotions, pain behavior
4
Q
what is a blue flag?
A
perceptions about work and health (believing work is the source of the problem and workmates/superiors are unsupportive)
5
Q
what is a black flag?
A
systemic obstacles (legislation, insurance, family issues)
6
Q
what are some general red flags to look out for? (long ass list!!!)
A
Insidious onset w/no known mechanism of injury
Sx out of proportion to injury (person may just be dramatic/sensitive or fearful)
No change in sx despite position, rest, and tx
No pattern to the sx; unable to reproduce sx
Sx persist beyond expected healing time
Recent or current fever, chills, night sweats, infection
Unexplained weight loss, pallor, nausea, dizziness, vomiting, B/B changes (constitutional sx)
HA or visual changes
CHANGE in VS (have to get a baseline to see changes)
BL sx
Pigmentation changes, edema, rash, nail changes, weakness, numbness, tingling, burning
Hx of CA
> 40 yo, gender, ethnicity, race
Night pain
Progressive neurology sx
Cyclic presentation (menstrual cycle)
Jt pain with skin lesions
7
Q
from a literature review of initial red flag questions to use, what are the 23 items that correctly ID 100% of (+) responders?
A
Abnormal sensations (numb, pins, needles)?
HAs?
Night pain?
Sustained morning stiffness?
Light-headedness?
Trauma (MVA, falls)?
Night sweats?
Constipation?
Easy bruising?
Changes in vision?
Changes in menstruation patterns?
Balance disturbances?
Chest pain with rest?
SOB?
Ms weakness?
Failure of conservative intervention (30 days)?
Excessive sweating?
Edema/weight gain?
Heartbeat in your abdomen when you lie down (abdominal aorta)?
Cramps in your legs when you walk for several blocks?
Abdominal pain?
Changes in integrity of your nails?
Prolonged use of corticosteroids?
8
Q
what are the top 10 leading causes of death in the US?
A
heart disease
cancer
COVID
unintentional injuries
stroke
chronic lower respiratory diseases
AD
DM
flue and pneumonia
kidney disease
9
Q
when should we refer out?
A
if the PT has reasonable cause to believe that a dx/condition are present that require services beyond the scope of the practice of PT
10
Q
if we have reasonable concern and evidence of abuse, what should we do?
A
report your findings to authorities
11
Q
what diagnostics tests should we know the results about?
A
X-ray
MRI
CT scan
US
bone scan
DEXA scan
EMG/NCV
EKG
EEG
urine analysis
blood work
stress test
12
Q
a test with high sensitivity that is (-) tells us what?
A
you can effectively rule out the dsyfxn and be confident it is NOT there
13
Q
a test with high specificity that is (+) tells us what?
A
you can effectively confirm the dysfxn and be sure it IS there
14
Q
t/f: CA rates are rising, but so is survivorship with CA
A
true
15
Q
what are the early warning signs of CA? (CAUTION)
A
Change in B/B
A sore that fails to heal in 6 wks
Unusual bleeding or discharge
Thickening/lump (breast or elsewhere, often lymph nodes)
Indigestion or difficulty swallowing
Obvious change in wart, mole, or freckle
Nagging cough, hoarseness, rust colored sputum
16
Q
what are the changes in a wart, mole, or freckle that would make us be concerned about CA? (ABCDE)
A
Assymetrical borders
Border irregularities
Color-pigementation isn’t uniform
Diameter >6mm (pencil eraser)
Evolution (change in status)
17
Q
bc may CAs don’t display SC in the early stages, what is the best approach to catches CA b4 it becomes a problem?
A
routine screenings
18
Q
what are some of the routine CA screenings?
A
mammograms
colonoscopy
pap smear and pelvic exam
prostate exam
skin exam
19
Q
what are the clinical tests for monohemispheric brain tumor screening?
A
Spasticity of conjugate gaze
Platysma sign
Finger rolling test
Digit quinti sign
Souques interosseous sign
Pronator drifting sign
Mayer sign
Finger tapping sign
Digit quinti rolling sign
Foot tapping test
Babinski sign
Chaddock sign
20
Q
what is the forearm rolling test?
A
make fists, hold forearms horizontally and roll arms
21
Q
what is a (+) forearm rolling sign?
A
1 arm orbits around the other
22
Q
what is the finger rolling test?
A
use the index fingers pointing towards each other ~1 finger length apart and roll fingers
23
Q
what is a (+) finger rolling sign?
A
1 finger orbits around the other
24
Q
what is the Souques interosseous sign?
A
the pt raises both UEs to 180 deg shoulder flexion
25
what is a (+) Souques interosseous sign?
the involved fingers ext and abd
26
what is the finger tapping test?
index finger to thumb IP quickly 10x
27
what is a (+) finger tapping test?
>5 reps difference
28
what is the foot tapping test?
sit, knee and ankle at 90 deg, keep heel on floor and tap foot 10x
29
what is a (+) foot tapping test?
>5 reps difference
30
what is the Babinski sign?
stimulate the lat plantar foot with a blunt object
31
what is a (+) Babinski sign?
extension of the great toe
32
what is used to test for cerebral lesions?
DTRs
33
what are the various pain patterns?
dermatomes
myofascial trigger points
visceral pain
34
what are the visceral quadrants?
RUQ, RLQ, LUQ, LLQ
epigastric region, suprapubic region
35
what is the purpose of visceral palpation?
to ID masses, tenderness, and irregularities
36
where does the spleen refer to?
top of the L shoulder
37
where does the heart refer to?
L shoulder and arm
midscapular region
38
what are the modifiable risk factors for CAD?
physical activity
smoking
cholesterol
BP
alcohol
39
HDL below ___ is risk factors for CAD
40
40
LDL above ___ is a risk factors for CAD
130
41
total cholesterol above ___ is a risk factor for CAD
200
42
SBP above ____ is a risk factors for CAD
140
43
DBP above ____ is a risk factor for CAD
90
44
what are the non-modifiable risk factors for CAD?
age
gender
fam hx
race
post-menopause
45
what are the contributing factors to CAD?
obesity
stress
personality
PVD
hormones
fasting blood glucose >100
46
what waist circumference in females indicates obesity?
>88cm
47
what waist circumference in males indicates obesity?
>102cm
48
what are some cardiac s/s?
Chest pain
Irregular heartbeat (palpitations)
Dyspnea, orthopnea
Fainting, dizziness
Rapid onset of fatigue
Peripheral edema
Cold hands/feet
Dec peripheral pulses
LE claudication
Cyanotic nail beds
Pain into left shoulder (dif with genders)
49
what is Frank's sign?
a 45 deg angle crease in the earlobe that may indicate risk for heart disease or stroke
50
the preventative care checklist recommends screening the AAA in what aged men?
men 65-80 yo
51
is it recommended to screen the AAA in men and women over 80 yo?
nope
52
what is the normal width of the AAA?
2-3 cm
53
how do we palpate the AAA?
pt in supine with hips/knees flexed
at the upper abdomen 1/2 bw the xiphoid and umbilicus just L of midline, press firmly and deep to palpate the pulsation of the aorta
place your thumb on 1 side and your index /middle finger on the other side
palpate for a prominent lateral expansion of the aorta
54
what is a red flag with AAA palpation?
aortic pulse width >3cm
back pain with palpation
bruit on auscultation
55
where is the spleen located?
on the L side of the body in line with the anterior axillary line
56
what things can be wrong with the spleen?
rupture, tumor, mono
57
what does mono do to the spleen?
may cause an enlarged spleen
58
what kind of injuries usually lead to spleen damage?
traumatic injuries like MVAs
59
what is Kehr's sign of the spleen?
with the pt in supine, raise the foot of the bed (trendelenberg position)
position causes pain into the left shoulder, indicating an enlarged spleen
60
what is the proposed mechanism of Kehr's sign of the spleen?
the enlarged spleen pushes against the diaphragm and send pain to the left shoulder
61
Kehr's sign often occurs ____ min after a spleen injury
30
62
what is a red flag with Kehr's sign?
presence of blood or other irritant in the peritoneal cavity resulting in severe L shoulder pain a few min after the LE are elevated
63
are there metrics to support Kehr's sign?
nope
64
what are some pulmonary s/s?
Sharp localized pain
Fever, chills
Sx aggravated by cold air or exertion
Inc pain when lying on involved side
Dec pain in recumbent
Cough w/ or w/o blood
Sputum
SOB or DOE
Crackles, wheezes, pleural friction rub on auscultation
Clubbing of nails
Pain with deep inspiration
Dec O2 sat
Weak/rapid pulse with dec BP=pneumothorax
65
what does a weak/rapid pulse with a decrease in BP indicate in the pulmonary system?
pneumothorax
66
if there is white sputum, what is a possible pathology?
bronchitis
CF
67
if there is rusty sputum, what is a possible pathology?
pneumonia
68
if there is hemoptysis, what is a possible pathology?
pneumonia
acute bronchitis
lung CA
TB
69
when would we see stringy mucus?
after an asthma attack
70
what structures are included in the integumentary system?
skin, hair, nails
71
lots of ____ system disorders have integ manifestations in their s/s
endocrine
72
what is decreased turgor a sign of?
dehydration
73
what is Stemmer's sign?
inability to lift skin due to fibrosis or lymphedema
74
what are Beau's lines?
temporary arrest of nail growth due to systemic insult/fever/infection/renal or hepatic px resulting in horizontal lines across ALL nails
75
why do Beau's lines occur?
bc during illness, blood is shunted away from non-vital structures like the nails and to vital organs
76
what is nail clubbing a possible sign of?
chronic hypoxemia
resp/CV pathology
thyroid dysfxn
ulcerative colitis
cirrhosis
CA
77
what does malignant melanoma look like on the nails?
it looks like bruising under the nails, but there has been no trauma to cause the bruising
78
t/f: cologuard can have a lot of false negatives
true
79
if someone gets a (+) on a Cologuard screening, what do they have to do?
get a colonoscopy
80
what is Blumberg's sign?
rebound tenderness
81
what is the technique for perform the Blumberg sign?
in supine, select a site away from the painful area and place your hands on the abdomen and push down slow and deep, wait a moment, then lift up quickly
82
what is a red flag with the Blumberg sign?
pain on release
83
what does the Blumberg sign tell us?
that there is some GI problem present
84
should we send someone to the ED if we find a (+) Blumberg sign?
no
85
if a pt is experiencing sx of discomfort 30 min after eating, if it more likely a problem in the stomach or intestines?
stomach
86
if a pt is experiencing sx of discomfort 2 hrs after eating, if it more likely a problem in the stomach or intestines?
intestines
87
if a pt experiences pain in the midbelly, is it more likely a problem in the stomach or intestines?
stomach
88
if a pt experiences pain to the side of the abdomen, is it more likely a problem in the stomach or intestines?
intestines
89
epigastric pain causes pain with radiation where?
to the back
90
an ulcer in the small intestine would cause ___ blood in the stool
dark
91
hemorrhoids would cause _____ blood in the stool
bright red
92
what are GI s/s?
pain with eating/not eating
epigastric pain with radiation to the back
blood/dark, tarry stool
fecal incontinence/urgency, diarrhea/constipation
nausea, vomiting, loss of appetite
(+) Blumberg sign
93
if a pt has melena (black, tarry stools) what may be the pathology?
upper GI bleed (loss of >150-200 mL of blood)
94
if a pt has blood red stools, what may be the pathology?
colon-rectal tumor
colon diverticulitis
hemorrhoids
95
if a pt has silvery stools, what may be the pathology?
pancreatic CA
96
if a pt has pencil thin, ribbon stools, what may be the pathology?
distal colon/anal CA
97
what is McBurney's point for appendicitis?
increased in abdominal pain when pressing down at the point 1/3 bw the R ASIS and umbilicus (NOT rebound pain)
98
what is the most discriminating feature of the pts hx with appendicitis?
RLQ pain
99
is there a correlation bw the magnitude of appendicitis and the speed of conduction of pain?
yes, the more the magnitude, the greater the specificity of the pain
100
what is the psoas sign for appendicitis?
when in R SL, hyperextend the RLE to see if it creates an inc in abdominal pain
101
what is the obturator sign for appendicitis?
in supine, raise the pt's RLE to 90 deg knee/hip flexion then rotate the LE into IR at the hip to see if it increases abdominal pain
102
what is Rovsing's sign?
pushing on the LLQ produces an increase in abdominal pain with appendicitis bc it increases pressure to the appendix on the other side
103
what are the hepatic s/s?
RUQ pain
Referred pain to T spine (scap, R shoulder, R UT, R subscapular region)
Weight change (fluid buildup)
Ascites/LE edema (can develop pounds of fluid in a day if the liver isn’t fxning properly)
White (not pink) fingernails
Cold hands/feet
Jaundice/bruising; yellow sclera
CTS sx
Intermittent pruritis
Weakness and fatigue
Dark urine/clay-colored stools
Brain fog
Chronic fatigue
104
what is a better way to see jaundice in someone with darker skin than looking for yellow skin?
look at their scleras (whites of the eyes)
105
what is asterixis (liver flap)?
wrist flapping when brought into ext
involuntary contraction of the hip adductors when brought into passive flex and abd of the hips
106
t/f: there is a significant correlation bw the number of asterixis flaps and MELD scores
false
107
what are MELD scores?
the scores used to determine if someone needs a liver transplant
108
what is asterixis a sign of?
hepatic encephalopathy
109
how do we palpate the liver?
palpate just under the rib cage and have the pt take a deep breathe to get the ribs out of the way and sink in deeper to feel the hard surface of the liver
110
what is (+) palpation of the liver?
pain with palpation
feeling more than a couple inches of the liver (enlarged)
111
when is the gallbladder active?
in digestion of fats
112
how is the gallbladder palpated?
place your finger to the R of the rectus just below the rib cage and ask the pt to take a deep breath
113
what is a red flag with gallbladder palpation?
sudden pain and abdominal ms tensing that ceases inspiration, suggestive of gallbladder pathology
114
what is Murpy's sign of the gallbladder?
hook your fingers under the costal margin and have the pt inhale
115
what is a (+) Murphy's sign of the gallbladder?
sharp pain or unable to complete inspiration
116
what are the risk factors for gallbladder pathology? (8 Fs)
fat
40
female
flatulent
fertile
fatty foods
fair
fam hx
117
what are some endocrine s/s?
Jt pain, ms pain, paresthesias (hard to dif from MSK issue)
Dry, scaly skin
Constipation
Fatigue
Dyspnea
Brittle nails/hair
Heat/cold intolerance
Weight change
Periorbital edema
Hoarseness
Polydipsia/polyuria
118
what are some renal s/s?
(+) percussion over kidney
Fever, chills
Dull aching pain aggravated by prolonged sitting
Blood in urine (hematuria)
Cloudy/foul smelling urine
Painful/frequent urination
Pain is constant
Back pain at the level of the kidneys (costovertebral angle tenderness)
Skin hypersensitivity
HTN
Bleeding tendencies; ecchymosis
HA
pruritis
119
what structures are included in the renal system?
urethers, kidney, bladder
120
what does (+) percussion over the kidneys indicate?
kidney stones/infection
121
what does cloudy/foul smelling urine indicate?
UTI
122
what does constant renal pain indicate?
kidney stones
123
what is the referral patterns of the renal system referred to as?
flank pain
124
how can we "palpate" the kidneys?
with the pt in supine, place the L hand under the pt bw the ribs and illiac crest
place your R hand on the R abdomen just below the ribs with your fingers pointing left
ask the pt to take an "abdominal" breath and try to capture the R kidney bw your fingers
125
what is a red flag with kidney palpation?
reproduction of sxs
126
how do perform percussion at the kidneys?
place your hands at the costovertebral angle at the end of the ribs and hit your flat hand with your other fist (6 in tap)
127
what is the key to using consistent force on both sides for kidney percussion?
using the same hand on both sides to tap
128
if a pt has red urine, what may be the pathology?
glomerulonephritis
TB
trauma
lupus
renal cystic disease
129
if a pt has orange/brown/dark yellow urine, what may be the pathology?
dehydration
increased bilirubin
130
why do many older adults have dark urine?
bc many are incontinent, so they avoid drinking fluids so they don't have an accident, but then become dehydrated
131
if a pt has milky/casts in the urine, what may be the pathology?
infection
132
if a pt has dec flow of urine, what may be the pathology?
obstruction
UTI
prostate hyperplasia
133
what are the QOL issues with incontinence?
embarrassment
dec socialization
risk of falls (from trying to get to the toilet too quickly)
cost
134
who is more likely to have incontinence?
those 60-80 yo
those who've had 3+ kids
those with a BMI over 25
those on diuretics
those who've had a hysterectomy or prostate removed
135
what meds can inc risk of incontinence?
diuretics
Ca2+ channel blockers
antidepressants
136
how do diuretics inc risk of incontinence?
they inc frequency and urge of urination
137
how do CA2+ channel blockers inc risk for incontinence?
by increasing retention
138
how do antidepressants inc risk for incontinence?
by causing incomplete emptying
139
who should be screened for prostate CA?
men over 50 yo with LBP or suprapubic pain
140
what are s/s of prostate pathology?
LBP/suprapubic pain
difficulty starting or stopping urine flow
change in frequency/dec urine flow
nocturia, hematuria
incontinence/dribbling
sexual dysfxn
PSA >4ng/mL
141
what are the gynecological s/s?
Cyclic pain (comes and goes with menstrual cycle-endometriosis, ovarian cysts)
Abnormal bleeding
Nausea, vomiting
Vaginal discharge
Chronic constipation
Low BP (blood loss)
Missed or irregular periods
Pain with cough/intercourse
Evan’s sign
142
what is another name for Evans sign?
hot foot syndrome
143
what are the six of Evan's sign?
warm, dry foot
144
what is Evan's sign indicative of?
cervical CA
145
what is the suspected etiology of Evan's sign?
sympathetic interruption from the lumbosacral plexus via tumors or other lesions causes vasodilation with loss of perspiration
146
are trans fats good or bad?
bad!
147
what is the recommended cholesterol level?
no more than 200-250 mg total
148
what is the recommended sodium level?
below 1000mg
149
what is the recommended fiber level?
25-30 mg/day
150
what food is often fortified with fiber in the US?
cereals
151
what is the recommended protein intake?
1-1.5g/kg of body weight
152
what is the recommended level of vit D? is this realistically enough?
1000mg, but this is likely not enough for most people
153
what is the sunshine vitamin?
vit D
154
what form of vit D does the body create?
vit D3 (cholecalciferol)
155
what is the recommended sun exposure time to get enough vit D?
10-15 min a few times a week
156
why may we get more colds in the winter?
bc we have dc vit D from dec sunlight
157
what factors affect vit D absorption from sunlight?
how much skin is exposed
UV index
skin color
158
how much skin exposure is required for adequate vit D?
50-75%
159
what is the ideal UV index for vit D?
>3 bw 10:30-12 noon
160
UV index of <3 means there is an inc risk of ____ rays w/o the benefits of _____ rays
UVA, UVB
161
early morning and evening sunlight provides _____ rays while mid-day has ____ rays
UVA, UVB
162
t/f: when exposed to sunlight, you produce a mechanism to repair DNA which lowers your risk of CA, but when you get too much and sunburn, it can cause skin CA
true
163
t/f: darker skin tones need more sunlight to get the same levels of vit D
true
164
vit D and Ca2+ are threshold nutrients, which means what?
deficiencies are bad, but once you reach an adequate amount higher doses aren't beneficial
165
lower serum levels of vit D are associated with what?
clinically significant sx of depression and higher infections
166
t/f: vit D may be linked to regulation of inflammation and reduction of "cytokines storms" reducing infections
true
167
t/f: vit D may be protective against MSK pain
true
168
~___% of our vit D comes from our food
10
169
the body only makes what kind of vit D?
vit D3 (cholecalciferol)
170
what are potential benefits of vit D supplementation?
it may abate jt pain, ms cramps, illness, and fatigue
enhance bone health
171
if a pt has severe and intense HA, what may be the pathology?
meningitis
aneurysm
brain tumor
172
if a pt has throbbing and pulsating HA, what may be the pathology?
migraine
fever
HTN
aortic insufficiency
173
if a pt has a temporal HA, what may be the pathology?
eye/ear px
migraine
temporal arteritis (with visual changes)
174
if a pt has an occipital HA, what may be the pathology?
herniated c spine disc
eye strain
HTN
175
if a pt has a parietal HA, what may be the pathology?
meningitis
constipation
tumor
176
what are the first 4 questions for the structured migraines interview that if they answer no to, you can finish at?
have you ever had recurrent HAs?
have you ever had mod to sever HA accompanied by nausea and/or vomiting?
have you ever had mod to severe HAs accompanied by hypersensitivity to sound or light?
have you ever had visual disturbances lasting 5-60 min followed by HA?
177
if a pt answers yes to any of the 1st 4 questions of the structured migraines interview, what other questions do we ask?
typically, what kind of HA do you get?
typically, are your HAs mild, mod, or severe?
what would make them worse?
what do you do to relieve the HAs
typically, how long do your HAs last?
have you been given a medical explanation and/or a dx for your recurrent HAs?
178
if a pt has spots in their vision, what may be the pathology?
impending retinal detachment
fertility drugs
179
if a pt has floating spots in their vision, what may be the pathology?
diabetic retinopathy
180
if a pt has loss of peripheral vision, haloes around light, what may be the pathology?
glaucoma
181
if a pt has flashes in their vision, what may be the pathology?
migraine
retinal detachment
182
if a pt has cloudy or fuzzy vision, what may be the pathology?
cataracts
183
what is the Amsler grid test?
a test of vision where a dot is placed in the center of a piece of graph paper and the pt is asked to cover one eye and look at the dot and describe if any lines are broken, wavy, missing, etc
184
what may be the pathology behind thinning walls of the retina?
PD
185
what may be the pathology behind capillary leaks (retinopathy)?
DM
186
what may be the pathology behind blood vessel kinks/tear in the eye?
HTN
187
what may be the pathology behind inflammation in the eye?
autoimmune disorders (lupus)
188
what may be the pathology behind yellowish cornea or plaques in the blood vessels of the retina?
high cholesterol
189
what may be the pathology behind bulging eyes?
thyroid disease (Graves disease)
190
what are the substances that can be abused other than drugs?
tobacco
caffeine
alcohol
food
191
what are the risks associated with tobacco?
CV disease
Tobacco amblyopia
COPD
PVD
Ischemic heart disease
Peptic ulcer
Small babies; obstetric or fertility probs
Impaired insulin absorption
Inc risk of CA
Poor recovery from LBP, sx
Premature aging
192
tobacco increases the risk of developing what kinds of CAs?
mouth, lung, bladder, kidney, breast, cervix
193
does tobacco have (+) effects?
nope
194
what are the (+) effects of caffeine?
inc attention and alertness, dec fatigue
lower risk of CV disease
lower risk of DM
inc metabolic rate
195
what are the (-) effects of caffeine?
anxiety
inc vasoconstriction and BP
reduced control of fine motor movts
stim of urination
196
what is "caffeine in moderation"?
3-5 mg/kg body weight
197
what amount of caffeine can produce sx of being jumpy, edgy, anxious, and having fine motor control issues?
over 8 mg/kg body weight
198
t/f: several cups of coffee with your post-exercise meal results in faster ms recovery
true
199
more than ___ mg/kg caffeine body weight will achieve an ergogenic effect
3
200
what are sx of caffeine overdose?
irritability
inc RR/HR
arrhythmias
inc sesitivity
ms twitches
201
what are the risks of pathology associated with alcohol?
Alcoholic dementia
Subdural hematoma from falls
Convulsions from withdrawal
Delirium tremens
Cardiomyopathy
HTN
Hepatic cirrhosis
Pancreatitis
Dupuytren's contracture
Myopathy
Peripheral neuropathy
202
if we suspect a pt is coming to PT intoxicated, what should we do?
do NOT continue with PT and find them a safe way home
203
what causes FAS (fetal alcohol syndrome)?
the mother drinks alcohol during pregnancy
204
what are the consequences of FAS?
significant cog issues and info processing issues
distinct facial features
205
what are some distinct facial features in FAS?
epicanthal folds
flat nasal bridge
thin upper lip
upturned nose
206
why may we begin to see a decline in obesity for the first time in decades?
bc of weight loss drugs
207
why should weight loss drugs be coupled with exercise?
bc they cause a loss of lean body mass, so we can counteract this with exercise so they aren't dependent on the drug their whole lives
208
what are the risks of pathology associated with obesity?
Arteriosclerosis and HTN
CVA and MI
Sleep apnea
Hypoventilation and exertional breathlessness
Gallstones
DM
Reflux
OA
Abdominal striae and varicose veins
Impaired fertility
Dependent edema
209
what are the benefits of being physically active?
up to a 60% greater efficacy of vaccines (in children and adults)
significantly lower risk of CA-bladder, breast, colorectal, prostate
lower recurrence of CA
improved cognition
better wellbeing-decreased anxiety and depression
concussion recovery (engage in low level activity early)
pregnancy-many improved issues
