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FNP 1 > Middle Aged Adult- module 9 > Flashcards

Middle Aged Adult- module 9 Flashcards

1
Q

RX used to help with BPH

A

alpha-adrenergic antagonists (alpha-blocker)–> relax bladder neck muscles and muscle fibers in prostate to allow for easier urine flow (Flomax, Rapliflo)

The goal is to alleviate symptoms and slow progression. If no improvement refer to urologist (maybe TURP procedue)

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2
Q

EKG level for low risk pts ?

intermediate/ high risk?

A

D

I

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3
Q

Rating level for screening skin cancer - counseling

A

I

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4
Q

Rating for cholesterol screening of adults 40-75 years with no hx of CVD, 1 or more risk factors, and calculated 10 year CVD event risk of 7.5% to 10 %
what would you recommend?

A

Level C

low to moderate statin dose recommended

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5
Q

Urinary frequency, urgency, difficulty
Nocturia
Difficulty starting urination
Dribbling AND straining with incomplete bladder emptying

A

BPH

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6
Q

Rating level for alcohol? age?

A

18 years. B Rating

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7
Q

Erikson’s Stage of Development 40-65 years

A

Generativity vs. Stagnation

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8
Q

BRCA Testing Recommendation for pts with family hx breast, ovarian, tubal, or peritoneal cancer→ should receive genetic counseling BEFORE testing

A

B

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9
Q

4 things rated D (do not screen) if asymptomatic

A

COPD → spirometry
Ovarian CA
Pancreatic CA
Thyroid CA

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10
Q 
Possible causes of \_\_\_\_\_ 
Meds: antidepressants, antihypertensives
Diabetes 
Dyslipidemia
Endocrine problems
Opioid abuse
Hormonal imbalance
Neurologic issues
Chronic renal failure
A

Erectile Dysfunction

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11
Q

PLISSIT Sexual Dysfunction Assessment Model to evaluate pts need and help with intervention (helps recognize pts sexual concerns)

A 
P=  give permission to preserve sexual traditions 
LI= limited information about anatomical aspects of sexual function 
SS= specific suggestions 
IT= intensive therapy
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12
Q 
Colon CA screening interval and considerations  
Stool DNA (with FIT)
A 
3 years 
Specificity lower 87% (more false-positive)
92% sensitivity
ABN results need colonoscopy
Covered by Medicare
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13
Q

What do women with uterus need to add to TX?

A

must add progesterone to any estrogen taken

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14
Q

Rating level for screening PVD (ankle brachial index)

A

I

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15
Q

Rating level for screening vit d deficiency

A

I

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16
Q

Screening level for Obese patients with increased CVD risk

A

B

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17
Q

Rating level for screening OSA (sleep studies)

A

I

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18
Q

Prostate produces fluid for semen. If enlarged constricts urethra.

A

Prostate

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19
Q

According to ACS women aged 55 and older should get a mammogram how often?

A

Choice to switch to every 2 years or continue every year

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20
Q

Screening level for colon cancer in ppl 76-85

Consider overall health and prior screening hx

A

C

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21
Q

in whom are mammogram false positives more common

A

women who are younger, have dense breasts, and are taking estrogen

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22
Q

Second leading cause of CA death in US

Median age death: 73

A

Colon Cancer

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23
Q

rating level for drug screen > 18 years?

A

I

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24
Q

Rating level for screening thyroid dysfunction

A

I

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25
Q

Rating level for screening syphilis if at increased risk

A

A

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26
Q

Factors that increase the risk of breast CA

A

BRCA1 or BRCA2 mutation in self or first-degree relative

Risk assessment tools reveal risk of 20-25% or greater

Radiation therapy to chest between 10-30years old

Genetic diseases (Li-Fraumeni, Cowden, Bannayan-Riley-Ruvalcaba)

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27
Q

*USPSTF guideline for average women (not high risk) breast cancer screening (mammogram) age 50- 74

A

Biennially

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28
Q

What does it mean when FSH and LH are both elevated?

if LH decreased or normal?

A

both= primary testicular disorder

if LH decreased or normal= secondary pituitary disorder

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29
Q

ACS recommends women with______chance of developing breast CA have yearly mammogram AND MRI

moderate risk (15-20%) should also consider MRI

A

20%

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30
Q

USPSTF recommends selectively offering or providing service to individual pts based on professional judgement and pt preferences. moderate certainty of small net benefit

A

Grade C

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31
Q

mammogram rating level for women aged 75 and older?

A

I

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32
Q

no current recommendation for screening. Calculate 10yr risk of CVD. No optimal screening interval established
Healthy People 2020
Men age 35
Women age 45
Unless increased risk then start screening at age 20

A

Cholesterol in middle age

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33
Q

Rating level for lung cancer for ages 55-80
30 ppy hx smoking
Currently smoke
Quit within 15yrs

A

Level B

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34
Q

Age-Related Menopause Health Concerns (d/t decreased estrogen levels)

A 
bone health
CV risk
Weight changes (gain)
Cancer risk
Sexual dysfunction
*ask patients if they are using any herbal treatments
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35
Q

What is important to remember about testosterone?

A

bound to protein→ need to know how much-unbound testosterone is available for use

FREE TESTOSTERONE is the unbound form (check both)

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36
Q

Rating level for screening CKD (Creatinine, GFR)

A

I

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37
Q

Screening level for Prostate Cancer age 55-69* (non high risk)

A

C
weigh risk/ benefits with pt
- talk to them about PSA-> threshold for biopsy
could be 55? 69?

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38
Q

What sexual history to obtain for ED evaluation?

A

Onset, duration, circumstances
Erection quality
Changes with ejaculation, libido, curvature of penile shaft
Multiple partners?

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39
Q

Rating level for screening Hep C

A

B

High risk population/ no vaccine available

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40
Q

Rating level for screening HSV

A

D

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41
Q

Rating level of screening for Gonorrhea/ chlamydia for men

A

I

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42
Q

USPSTF recommends against this service. no net benefit/ harms may outweigh the benefits

A

Grade D

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43
Q

USPSTF concludes that current evidence is insufficient to access benefit/ harms of the service

44
Q

Genitourinary Syndrome of Menopause Symptoms

A 
Decreased lubrication 
pain with sex 
bleeding after sex 
decreased arousal, orgasm, desire
irritation/ burning/ itching of  vulva or vagina 
painful urination 
urinary frequency/ urgency
45
Q

Rating level for screening HIV in agres 15-65

A

A

Yearly or sexual contact

46
Q

What can help tx Genitourinary Syndrome of Menopause

A

Hormone therapy for moderate to severe symptoms

vaginal moisturizers and lubricants can help alleviate symptoms and painful intercourse

47
Q 
Colon CA screening interval and considerations  
CT colonography (virtual colonoscopy)
A

5 years
Low dose CT
Still being studied- not widely available

If anything ABN colonoscopy is required

48
Q

FDA approval of hormonal therapy

A

Moderate to severe hot flashes/ night sweats
symptoms of vaginal atrophy
prevention of osteoporosis
- oral pills/ tablets, transdermal patches, topical creams/ gel/mist, vaginal rings

49
Q

BRCA Testing Recommendation for pts with family hx not associated with increased risk

50
Q

Vaccine schedule for middle age

TDAP

A

1 dose and then booster every 10 years

51
Q

Rating level for screening Oral cancer

52
Q

Permanent cessation of menses for 12 consecutive months
Decline in ovarian follicles and estrogen production
↓ovulation =↓ progesterone

53
Q

Rating level of screening for Gonorrhea/ chlamydia for women < 24 or at increased risk

54
Q

USPSTF guideline for average women (not high risk) breast cancer screening (mammogram) before age 50

A

biennially with risk/ benefit discussion

55
Q

What physical exam and diagnostics to evaluate for ED?

A

PE: genital anatomy and ID any related abnormalities
Diagnostics: tx underlying cause. HbA1C, lipid profile, hormone profile

56
Q

mammogram rating level for women aged 50-74

How often?

A

B

Biennial (every other year)

57
Q

Screening level for colon cancer in ppl aged 50-75 years

58
Q
  • Colon CA screening interval and considerations

Colonoscopy

A 
10 years * 
Bowel prep required
Anesthesia recommended
Biopsies obtained
Polyps removed
Able to visualize proximal colon
59
Q

when can flexible sigmoidoscopy not be used?

A

Risk: colonic perf, bleeding. Lower than colonoscopy

Not widely available in US

60
Q

Secondary causes of Hypogonadism

A

Secondary causes: age, genetic conditions, pituitary tumor, alcoholism, corticosteroid use, chronic diseases (HIV)

61
Q

In what population is it more common to miss up to 20% of negatives (false negatives) in mammograms

A

women with dense breasts

62
Q

ASA rating level for ppl < 50

63
Q

women notice physical changes a/w fluctuating hormone levels
Varying cycle length with unpredictable flow
↑ levels of FSH
Anovulatory cycles
Hot flashes (vasomotor symptoms caused by decreased estrogen), night sweats, decreased libido, sleep difficulties

A

Peri-menopause

64
Q

CAGE Acronym

A

Cut Down
Annoyed
Guilty
Eye Opener

65
Q

USPSTF recommends the service. high certainty that net benefit is substantial

66
Q

when can a stool DNA fit test (cologuard) not be used?

A

Hx polyp
ABN screening in past 6 months
Fam Hx colon CA

67
Q

how often should someone be screened screened for colon cancer if hx of adenomatous polyps

A

screened Q3-5 years

68
Q

Rating level for screening Hep B

A

B

only screen high risk population

69
Q

Rating level for hearing and vision screening in middle age adults

70
Q

OTC medications that can cause urinary sx

  • Anticholinergics
  • Sympathomimetics
  • Diuretics -
A

Anticholinergics (benadryl) → impair bladder contractility
Sympathomimetics (pseudoephed) → increase urinary outflow resistance
Diuretics (lasix) - more urinating

71
Q

Protein produced by cells of prostate gland
Not developed as a screening tool
Benign conditions can cause elevation (prostate infection, UTI)

A

Prostate Specific Antigen (PSA)

72
Q

Vaccine schedule for middle age

Influenza

73
Q

ASA rating level for

- Age 50-59 and 60-69 with > 10% 10 year CVD risk

A 
50-59= B 
60-69= C
74
Q

When to refer to endocrinologist based on T level?

A

T (>300ng/dl)

75
Q

Colon CA screening interval and considerations

Flexible sigmoidoscopy

A 
5 years 
Bowel prep required
Can be done w/o anesthesia
↓sen & specifity 
Better option if combined with FIT
76
Q

what is no longer recommended by USPSTF or ACS

A

Clinical Breast Exam and Self-Breast Exam

77
Q

Reduced libido, ED, reduced muscle mass/strength, increased truncal adiposity, osteoporosis, depression, fatigue

A

CM of Hypogonadism

78
Q

Rating for cholesterol screening of adults 40-75 years with no hx of CVD, 1 or more CVD risk factor, and calculated 10 year CVD event risk of 10% or greater
what would you recommend?

A

Level B

low to moderate statin dose recommended

79
Q

Primary Causes of Hypogonadism

A

Primary causes: injury, infection, loss of testicles, chemo/radiation, genetic abnormalities (Klinefelter’s)

80
Q

What medical hx is important to evaluate for ED?

A 
DM
Smoking
HTN/dyslipidemia
renal/liver/vascular disease
Psychiatric disorders
81
Q

A Rating, Start at age 18. take at home before treating

A

Blood Pressure

82
Q

rating level for Depression

A

B

PHQ-2 then PHQ-9 if needed

83
Q

Screening level for Prostate Cancer age 70+ *

A

D
Recommended against
Typically not treated at this age

84
Q

Rx treatmenet of hypogonadism

- Caution in whom?

A

testosterone replacement CI in pts with breast/prostate CA,
Caution: BPH, LUTS, cardiac/renal/hepatic disease, or worsening OSA
IM once weekly or every other week
Gels
Patches

Once a pt starts replacement therapy the testicles will stop production, does increase after continued supplementation.
Is expensive and causes mood swings

85
Q 
Low sensitivity (determining who really has CA) and high specificity (high false negative)
Poor inter-rater reliability
Not endorsed by USPSTF for the asymptomatic individual→ consider sx: change in stream, urinary frequency
A

Digital rectal exam for prostate ca

86
Q

non-invasive tumor with cells that may become cancerous in the lining of breast ducts. Argument that this is overidentified and leads to over treatment

A

DCIS (ductal carcinoma in situ)

87
Q

B Rating
Age 40-70 yrs
RF: Overweight or obese, Fam. hx DM, PCOS
Consider: American Indians Alaskan Natives
Asian Americans
Hispanics
Pacific Islanders

A

Blood Sugar = B Rating for middle aged adults

88
Q

What physical exams are needed to evaluate for BPH

Labs?

A

Digital Rectal Exam (to rule out prostatitis or nodules present)
Genital Urinary Exam

Labs: UA, creatinine (to check renal fx) , PSA (infection or neoplasm in prostate? )

89
Q

According to ACS women aged 45-54 should get a mammogram how often?

A

Every Year

90
Q

Average onset of Menopause

A

age 51 (40-58)

91
Q

USPSTF recommends the service. High certainty of moderate - substantial benefit

92
Q

Diagnostics for Hypogonadism - when to draw testosterone lab? subsequent draws?

A

testosterone level (needs to be drawn at the highest point of circadian rhythm– typically 8-11 AM. Subsequent blood draws need to be done at the same time of day. Time frame matters less as the patient ages.

93
Q

Colon CA screening Guiac-based fecal occult blood test (gFOBT). interval and considerations

A

1 year
No bowel prep (some dietary restrictions)
Done at home
Low sensitivity & specificity

94
Q

Increased Risk for Colon CA → earlier or more frequent screening

A

Hx colorectal CA or adenomatous polyps
IBD (Crohn’s or UC)
Fam Hx colorectal cancer or polyps
Fam Hx hereditary colorectal CA syndrome

95
Q

Colon CA screening Fecal immunochemical test (FIT)

interval and considerations

A 
1 year 
Improved Sen & Specificity
Single specimen
Done at home
No bowel prep
96
Q

Many cases are asymptomatic

Most cases not aggressive

A

Prostate Cancer

97
Q

Failure of testes to produce adequate levels of testosterone (androgen deficiency)
Prevalence 39% over age 35

A

Hypogonadism

98
Q

what can cause premature menopause?

A

chemotherapy, oophorectomy, medication SE, radiation, or impaired ovarian function

99
Q

why are Breast MRIs not recommend as routine screening

A

Higher risk false positives

More expensive/ not routinely covered by insurance

100
Q

How often should you screen for lung cancer with LDCT ?

When to stop

A

Annually?

Stop if not smoked for 15 years

101
Q

RX meds to help tx ED?

Other things that might help?

A

phosphodiesterase-5 inhibitors→ viagra, cialis, levitra. Medication injected into penis or pills dissolved into urethra.
Vacuum erection device covered by durable medical equipment if organic cause
- refer to urology if not resolved

avoid alcohol before sex, counseling, avoid drugs that may cause sexual dysfunction

102
Q

What year does colon cancer typically screening start?
or
_____ years prior (screening) to the age of family member being diagnosed

A

45

10 years prior (screening) to the age of family member being diagnosed

103
Q

Signs of Genitourinary Syndrome of Menopause

A 
Decreased moisture 
decreased elasticity 
pallor/ redness 
loss of vaginal rugae 
tissue fragility, fissures, petechiae 
urethral eversion or prolapse, prominence of meatus 
introital retraction 
recurrent UTIs
104
Q

4.0 ng/mL considered normal. Some cancers can exist in normal range

A

Prostate Specific Antigen (PSA)

105
Q

mammogram rating level for women aged

40-49?

A

C

Women may choose to start biennial

106
Q

What are you screening for 1 time in adults born b/t 1945-1965?

107
Q

BPH behavior modifications

A

decreasing fluids before bed, avoid above OTC meds (Anticholinergics, Sympathomimetics, Diuretics)

FNP 1 (18 decks)

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