Middle Adult Flashcards
1
Q
Middle Adult
Age
A
35-65
2
Q
Developmental Theories
- Middle Adult: ______ vs Self-______
- Helping _____ become responsible, happy adults
- Rediscovering or developing new ______ in the ______ with spouse
- Developing an affectionate but ______ relationship with aging ____
- Reaching the peak in one’s ______
- Achieving mature s____ and c____ responsibility
- Accepting and adapting to b______ changes
- Maintaining and developing _____ships
- Developing leisure time ______
A
- Generativity vs. Self Absorption
- children
- satisfaction, relationship
- independent, parents
- career
- social, civic
- biological
- friendships
- activities
3
Q
History
PMH
A
- HTN
- Anemia
- CHF
- Valvular Disease esp MVP
- Dyslipidemia
- Cancer
- DM 1/2
- OA/RA
- CKD
- Hep B/C
4
Q
History
PSH
SH
FH
A
- TAH (total abdominal hysterectomy)
- TNR
- ORIF-Hips (know any ortho surgeries bc usually need to be on standing anticoags)
- Cholecystectomy
- Support
- Advance Directives
- Cancer
- Blood D/O, Glaucoma
- Age of Demise
5
Q
Risk Factors For Disease
- Al______
- Prescription and Street ____ use
- Sm______
- S______ Lifestyle
- H_____
- Lack of ______ to Shopping
A
- Alcohol
- Drug
- Smoking
- Sedentary
- Housing
- Access
6
Q
Medications
- _______ F___ and D___*
- H____ Supplements
- Medications that cause _______
- ____pharmacy
- Multiple _____
- Multiple _____
A
- ALLERGIES, FOOD and DRUG
- Herbal
- bleeding
- polypharmacy
- providers
- pharmacies
7
Q
Health Maintenance Guidelines
- B_____
- CPE =
- F _ _ _
- S____/C_____
- P _ _
- Mamm_____
A
- Bloods
- Complete Physical Exam
- FOBT
- Sigmoidoscopy/Colonoscopy
- PSA
- Mammogram
8
Q
Health Maintenance Guidelines cont.
- Calculating B _ _
- Imm______
- S _ _?
- H___- C?
- PP _ ?
- D_____ Evaluations
- H_____ and V_____ Screening
When to screen AAFP
A
- BMI
- Immunizations
- STI
- Hep C
- PPD
- Dental
- Hearing, Vision
9
Q
What website to go to for evidence based clinical preventitive services such as screenings, couseling services, and preventative medications?
A
US Preventitive Service Task Force
https://www.uspreventiveservicetaskforce.org/uspstf
10
Q
Screening Guidelines
- Visit (4) for cancer, everyday, DM, Heart
- _ _ _ _ -2019 Clinical Preventive Service Recommendations (Files and Resources)
- Electronic Preventive Services Selector? http://epss.ahrq.gov/PDA/index.jsp
A
- www.cancer.org, www.everydaychoices.org, American Diabetes Association, and American Heart Association
- AAFP
- The USPSTF recommendations app for mobile devices
11
Q
AHA CV Risk Calculator
- 2018 Prevention Guidelines Tool CV Risk Calculator
- What website?
- ASCVD Risk Estimator Plus - American College of Cardiology
- What website?
A
- CV Risk Calculator
- http://static.heart.org/riskcalc/app/index.html#!/baseline-risk
- ASCVD Risk Estimator
- http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/
12
Q
Lipid Screening
- Age ___ or older have their cholesterol and other traditional risk factors checked every ____ to ___ years
- After age ___, your HCP will also want to use an _____ to calculate your __-year risk of experiencing ___ or ____.
A
- 20, 4-6 yrs
- 40, equation, 10yr, CVD or stroke
13
Q
2018 Journal of American College of Cardiology (JACC)
- Total Cholesterol
- Low
- Good
- Borderline to moderately elevated
- High
- HDL Cholesterol
- Low
- Good
- Borderline to moderatley elevated
- High
- LDL Cholesterol
- Low
- Good
- Borderline to moderately elevated
- High
- Triglycerides
- Low
- Good
- Borderline to moderately elevated
- High
A
- Total
- n/a
- <200 (lower the better)
- 200-239
- > 240
- HDL
- <40
- Ideal > 60, > 40 men, > 50 women
- n/a
- > 60
- LDL
- n/a
- <100, <70 if CAD present
- 130-159
- > 160, _>_190 very high
- Triglycerides
- n/a
- <149, ideal <100
- 150-199
- _>_200, 500 very high
14
Q
Blood Glucose
USPSTF recommendations
A
- Recommends screening for abnormal blood glucose as part of CV risk in adults 40-70 yo who are overweight or obsese
- Clinicians should offer or refer pts with abnormal BG to intensive behavioral counseling interventions to promote healthful diet and physical activity
15
Q
HgB A1C
Chart
A
16
Q
Fasting Blood Glucose
- The normal fasting blood glucose range for adults in most labs is ___-___ mg/dL. The normal range may vary slightly from lab to lab
- Imaired fasting glucose lvl=
- Prediabetes glucose lvl=
- Diabetes lvl=
- At what age to test?
- Age ___ then
- Age 50-65 Q__ years
- 65+ Q __ years
A
- 70-100
- > 100
- 100-125
- > 126
- 45
- Q3y
- Q3y
17
Q
Blood Testing –before you order–
- The Health Care Finance Administration (HCFA) requires ______ carriers to establish policies to ensure the medical _____ of services being paid for by the Medicare program
- Carriers in your local area have the authority to establish a list of B____ tests and test pro_____ which may require medical do______ in order for re______ to take place
- Carriers will then only approve payment for those particular test procedures when they have determined them to be medically necessary for the pt. As a result, a claim submitted without a diagnosis c____ that indicates medical necessity based upon local carrers policites. You will then have to pay for these Blood tests out of your own ______
A
- Medicare, necessity
- Blood, procedures, documentation, reimbursement
- code, pocket
18
Q
Cervical Cancer Screening
- Women aged 21-65y
- The USPSTF recommends screening for cervical cancer every
- 21-29 yo =
- 30-65 yo =
- https://www.aafp.org/afp/2019/0215/od1.html
- The USPSTF recommends screening for cervical cancer every
A
- 3y with cervical cytology alone
- 3y with cervical cytology alone, every 5 years with high-risk HPV (hrHPV) testing alone, or every 5y combination of both
No screening >65 unless high risk
19
Q
Cervical Cancer Screening
USPSTF recommendations for women >65
A
Recommends AGAINST screening for cervical cancer in women >65 who have adequate prior screening and are not otherwise at high risk for cervical cancer
20
Q
Mammogram ACP 2019
- Age 40 =
- Age 50-74
A
- Ave risk women without sx should start to discuss with physician benefits, harms, and personal preferences of br CA screening w mammography before 50 yo
- Screen with mammography every other year
American College of Physicians
21
Q
Mammogram USPSTF
USPSTF Recommendations
40-49?
Women who place a higher value on the potential benefit than the potential harms may choose to begin _____ screening btwn age 40-49.
A
40-49 yo, decision to start screening mammography in women prior to age 50 should be an individual one.
biennial
22
Q
Mammogram
What age range do we screen? And how often?
A
- Women 50-74 yo
- USPSTF recommends biennial screening mammography for women aged 50-74y.
23
Q
Mammogram USPSTF
- In addition to false _____ and unnecessary b______, all women undergoing regular screening mammography are at risk for diagnosis and treatment of noninvasive and invasive BR CA that would otherwise not have become a threat to their health or even apparent, during their lifetime (known as “_______”). Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent over______.
- Women with a parent, sibling, or child with br CA are at a ______ risk for br CA and thus may benefit more than average-risk women from beginning screening in their __’s.
A
- positives, biopsies, “overdiagnosis”, overtreatment
- higher risk, 40’s
24
Q
Breast Cancer
- The most likely to benefit from screening are those at ______ risk
- _ MH in a m_____ or s______
- Previous biopsy with atypical _______
- First childbirth =
A
- increased
- FMH, mother, sister
- hyperplasia
- after age 30
25
Q
Breast Cancer
- The age to discontinue mammography is ______
- _____ women have a higher probability of getting and dying from breast CA, but also a greater risk of dying from ____ causes
- Women with ______ conditions limiting their life expectancy are _____ to benefit from screening mammography
- ______ evidence showing that CBE’s and SBE’s affect breast cancer moratlity
A
- uncertain
- Older, other
- comorbid, unlikely to benefit
- Insufficient
26
Q
SBE (Self Breast Exam)
- Family physicians should discuss with each woman the potential benefits and harms of breast cancer screening tests and develop a plan for early detection of breast ca that _____ potential harms
- These discussions should include the _______ regarding each screening test, the risk of breast ca, and individual patient pre_____. The recommendations below are based on current best evidence as summarized by the USPSTF and can help ____ physicians and pts
- These recommendations are intended to apply to women who are ____ at increased risk of developing Breast Ca and only apply to _____ screening procedures.
A
- minimizes
- evidence, preferences, guide
- not, routine
27
Q
Colon Cancer
- Strongly recommends screening men and women ___ y and older for colorectal cancer
- _ _ _ _
- Flexible _______
- _ _ _ _ + Flexible _____
- C_______
- Double _____ Barium _____
- Recommendation will change this year
A
- 50
- FOBT
- Sigmoidoscopy
- FOBT + Flex Sigmoidoscopy
- Colonoscopy
- Contrast Enema
28
Q
Direct Visualization Tests
How often?
- Colonscopy
- CT Colonography
- Flex Sig
- Flex Sig with FIT
A
- Every 10 y
- Every 5 y
- Every 5 y
- Every 10 y
29
Q
Stool Based Tests
How often?
- FOBT?
- FIT?
- FIT-DNA?
Starts at 50 unless family hx, which in this case when do you start?
A
- Every year
- Every year
- Every 1-3 years
If fam member was diagnosed at 45 you minus 5 years and start screening pt at age 40
30
Q
Colon Cancer
- Screening strategy should be based on _____ options, medical con______, patient _____ and ad_____. Risks and benefits of each should be discussed with patients.
- Testing interval depends on the ____.
- _____ done ______ has the greatest reduction in mortality.
A
- available, contraindications, preferences, adherence
- test
- FOBT, annually
31
Q
Colon Cancer
- __-__ yrs for Colonoscopy based on the natural history of a_____ p___.
- __ year intervals for (2)
- Initiating screening at age < __ should be done in ___ risk individuals and those with a ___ member with colon cancer at age < ___
- BEGIN AT AGE __
A
- 8-10, adenomatous polyp
- 5, Flex Sigs and Double contrast barium enema
- <50, high risk , fam member, <60
- 50*
32
Q
Ovarian Cancer Screening
- Recommendations?
- Includes (3) tests
- __ evidence showing that these interventions reduce mortality
- FYI: ______ Cancer
A
- AGAINST routine screening
- CA-125, US, Pelvic Exam
- No
- UTERINE
Bleeding post menopausal - should be screened for uterine cancer
33
Q
Health Maintenance
- D___/Ex______
- Screening for D______
- Screening for I _ _
- Risk Reduction - _______ use, s_____ activity
- Imm_____
- P_ _ Testing
- C _ _
- B____ Work
- Sc_____ Tests
- D____/V_____
A
- Diet/Exercise
- Depression
- IPV
- Substance, Sexual
- Immunizations
- PPD
- CPE
- Blood
- Screening
- Dental/Vision
- TB testing is rly based on individuals. Health care workers, etc.*
- In primary care, rly depends on pts insurance - in this age group: CBC, BMP, LFTs, Thyroid T4 or TSH, VDLR (Syphilis) may be appropriate, and urinalysis*
- Dental and Vision Q2 yrs is fine*
