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)
2
Q
EKG level for low risk pts ?
intermediate/ high risk?
A
D
I
3
Q
Rating level for screening skin cancer - counseling
A
I
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
5
Q
Urinary frequency, urgency, difficulty
Nocturia
Difficulty starting urination
Dribbling AND straining with incomplete bladder emptying
A
BPH
6
Q
Rating level for alcohol? age?
A
18 years. B Rating
7
Q
Erikson’s Stage of Development 40-65 years
A
Generativity vs. Stagnation
8
Q
BRCA Testing Recommendation for pts with family hx breast, ovarian, tubal, or peritoneal cancer→ should receive genetic counseling BEFORE testing
A
B
9
Q
4 things rated D (do not screen) if asymptomatic
A
COPD → spirometry
Ovarian CA
Pancreatic CA
Thyroid CA
10
Q
Possible causes of \_\_\_\_\_ Meds: antidepressants, antihypertensives Diabetes Dyslipidemia Endocrine problems Opioid abuse Hormonal imbalance Neurologic issues Chronic renal failure
A
Erectile Dysfunction
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
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
13
Q
What do women with uterus need to add to TX?
A
must add progesterone to any estrogen taken
14
Q
Rating level for screening PVD (ankle brachial index)
A
I
15
Q
Rating level for screening vit d deficiency
A
I
16
Q
Screening level for Obese patients with increased CVD risk
A
B
17
Q
Rating level for screening OSA (sleep studies)
A
I
18
Q
Prostate produces fluid for semen. If enlarged constricts urethra.
A
Prostate
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
20
Q
Screening level for colon cancer in ppl 76-85
Consider overall health and prior screening hx
A
C
21
Q
in whom are mammogram false positives more common
A
women who are younger, have dense breasts, and are taking estrogen
22
Q
Second leading cause of CA death in US
Median age death: 73
A
Colon Cancer
23
Q
rating level for drug screen > 18 years?
A
I
24
Q
Rating level for screening thyroid dysfunction
A
I
25
Rating level for screening syphilis if at increased risk
A
26
Factors that increase the risk of breast CA
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)
27
*USPSTF guideline for average women (not high risk) breast cancer screening (mammogram) age 50- 74
Biennially
28
What does it mean when FSH and LH are both elevated?
if LH decreased or normal?
both= primary testicular disorder
if LH decreased or normal= secondary pituitary disorder
29
ACS recommends women with______chance of developing breast CA have yearly mammogram AND MRI
moderate risk (15-20%) should also consider MRI
20%
30
USPSTF recommends selectively offering or providing service to individual pts based on professional judgement and pt preferences. moderate certainty of small net benefit
Grade C
31
mammogram rating level for women aged 75 and older?
I
32
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
Cholesterol in middle age
33
Rating level for lung cancer for ages 55-80
30 ppy hx smoking
Currently smoke
Quit within 15yrs
Level B
34
Age-Related Menopause Health Concerns (d/t decreased estrogen levels)
```
bone health
CV risk
Weight changes (gain)
Cancer risk
Sexual dysfunction
*ask patients if they are using any herbal treatments
```
35
What is important to remember about testosterone?
bound to protein→ need to know how much-unbound testosterone is available for use
FREE TESTOSTERONE is the unbound form (check both)
36
Rating level for screening CKD (Creatinine, GFR)
I
37
Screening level for Prostate Cancer age 55-69* (non high risk)
C
weigh risk/ benefits with pt
- talk to them about PSA-> threshold for biopsy
could be 55? 69?
38
What sexual history to obtain for ED evaluation?
Onset, duration, circumstances
Erection quality
Changes with ejaculation, libido, curvature of penile shaft
Multiple partners?
39
Rating level for screening Hep C
B
| High risk population/ no vaccine available
40
Rating level for screening HSV
D
41
Rating level of screening for Gonorrhea/ chlamydia for men
I
42
USPSTF recommends against this service. no net benefit/ harms may outweigh the benefits
Grade D
43
USPSTF concludes that current evidence is insufficient to access benefit/ harms of the service
Grade I
44
Genitourinary Syndrome of Menopause Symptoms
```
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
Rating level for screening HIV in agres 15-65
A
| Yearly or sexual contact
46
What can help tx Genitourinary Syndrome of Menopause
Hormone therapy for moderate to severe symptoms
| vaginal moisturizers and lubricants can help alleviate symptoms and painful intercourse
47
```
Colon CA screening interval and considerations
CT colonography (virtual colonoscopy)
```
5 years
Low dose CT
Still being studied- not widely available
If anything ABN colonoscopy is required
48
FDA approval of hormonal therapy
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
BRCA Testing Recommendation for pts with family hx not associated with increased risk
D
50
Vaccine schedule for middle age
| TDAP
1 dose and then booster every 10 years
51
Rating level for screening Oral cancer
I
52
Permanent cessation of menses for 12 consecutive months
Decline in ovarian follicles and estrogen production
↓ovulation =↓ progesterone
Menopause
53
Rating level of screening for Gonorrhea/ chlamydia for women < 24 or at increased risk
B
54
USPSTF guideline for average women (not high risk) breast cancer screening (mammogram) before age 50
biennially with risk/ benefit discussion
55
What physical exam and diagnostics to evaluate for ED?
PE: genital anatomy and ID any related abnormalities
Diagnostics: tx underlying cause. HbA1C, lipid profile, hormone profile
56
mammogram rating level for women aged 50-74
| How often?
B
| Biennial (every other year)
57
Screening level for colon cancer in ppl aged 50-75 years
A
58
* Colon CA screening interval and considerations
| Colonoscopy
```
10 years *
Bowel prep required
Anesthesia recommended
Biopsies obtained
Polyps removed
Able to visualize proximal colon
```
59
when can flexible sigmoidoscopy not be used?
Risk: colonic perf, bleeding. Lower than colonoscopy
Not widely available in US
60
Secondary causes of Hypogonadism
Secondary causes: age, genetic conditions, pituitary tumor, alcoholism, corticosteroid use, chronic diseases (HIV)
61
In what population is it more common to miss up to 20% of negatives (false negatives) in mammograms
women with dense breasts
62
ASA rating level for ppl < 50
I
63
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
Peri-menopause
64
CAGE Acronym
Cut Down
Annoyed
Guilty
Eye Opener
65
USPSTF recommends the service. high certainty that net benefit is substantial
Grade A
66
when can a stool DNA fit test (cologuard) not be used?
Hx polyp
ABN screening in past 6 months
Fam Hx colon CA
67
how often should someone be screened screened for colon cancer if hx of adenomatous polyps
screened Q3-5 years
68
Rating level for screening Hep B
B
| only screen high risk population
69
Rating level for hearing and vision screening in middle age adults
I
70
OTC medications that can cause urinary sx
- Anticholinergics
- Sympathomimetics
- Diuretics -
Anticholinergics (benadryl) → impair bladder contractility
Sympathomimetics (pseudoephed) → increase urinary outflow resistance
Diuretics (lasix) - more urinating
71
Protein produced by cells of prostate gland
Not developed as a screening tool
Benign conditions can cause elevation (prostate infection, UTI)
Prostate Specific Antigen (PSA)
72
Vaccine schedule for middle age
| Influenza
yearly
73
ASA rating level for
| - Age 50-59 and 60-69 with > 10% 10 year CVD risk
```
50-59= B
60-69= C
```
74
When to refer to endocrinologist based on T level?
T (>300ng/dl)
75
Colon CA screening interval and considerations
| Flexible sigmoidoscopy
```
5 years
Bowel prep required
Can be done w/o anesthesia
↓sen & specifity
Better option if combined with FIT
```
76
what is no longer recommended by USPSTF or ACS
Clinical Breast Exam and Self-Breast Exam
77
Reduced libido, ED, reduced muscle mass/strength, increased truncal adiposity, osteoporosis, depression, fatigue
CM of Hypogonadism
78
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?
Level B
low to moderate statin dose recommended
79
Primary Causes of Hypogonadism
Primary causes: injury, infection, loss of testicles, chemo/radiation, genetic abnormalities (Klinefelter’s)
80
What medical hx is important to evaluate for ED?
```
DM
Smoking
HTN/dyslipidemia
renal/liver/vascular disease
Psychiatric disorders
```
81
A Rating, Start at age 18. take at home before treating
Blood Pressure
82
rating level for Depression
B
| PHQ-2 then PHQ-9 if needed
83
Screening level for Prostate Cancer age 70+ *
D
Recommended against
Typically not treated at this age
84
Rx treatmenet of hypogonadism
| - Caution in whom?
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
```
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
```
Digital rectal exam for prostate ca
86
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
DCIS (ductal carcinoma in situ)
87
B Rating
Age 40-70 yrs
RF: Overweight or obese, Fam. hx DM, PCOS
Consider: American Indians Alaskan Natives
Asian Americans
Hispanics
Pacific Islanders
Blood Sugar = B Rating for middle aged adults
88
What physical exams are needed to evaluate for BPH
| Labs?
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
According to ACS women aged 45-54 should get a mammogram how often?
Every Year
90
Average onset of Menopause
age 51 (40-58)
91
USPSTF recommends the service. High certainty of moderate - substantial benefit
Grade B
92
Diagnostics for Hypogonadism - when to draw testosterone lab? subsequent draws?
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
Colon CA screening Guiac-based fecal occult blood test (gFOBT). interval and considerations
1 year
No bowel prep (some dietary restrictions)
Done at home
Low sensitivity & specificity
94
Increased Risk for Colon CA → earlier or more frequent screening
Hx colorectal CA or adenomatous polyps
IBD (Crohn’s or UC)
Fam Hx colorectal cancer or polyps
Fam Hx hereditary colorectal CA syndrome
95
Colon CA screening Fecal immunochemical test (FIT)
interval and considerations
```
1 year
Improved Sen & Specificity
Single specimen
Done at home
No bowel prep
```
96
Many cases are asymptomatic
| Most cases not aggressive
Prostate Cancer
97
Failure of testes to produce adequate levels of testosterone (androgen deficiency)
Prevalence 39% over age 35
Hypogonadism
98
what can cause premature menopause?
chemotherapy, oophorectomy, medication SE, radiation, or impaired ovarian function
99
why are Breast MRIs not recommend as routine screening
Higher risk false positives
| More expensive/ not routinely covered by insurance
100
How often should you screen for lung cancer with LDCT ?
| When to stop
Annually?
Stop if not smoked for 15 years
101
RX meds to help tx ED?
Other things that might help?
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
What year does colon cancer typically screening start?
or
_____ years prior (screening) to the age of family member being diagnosed
45
10 years prior (screening) to the age of family member being diagnosed
103
Signs of Genitourinary Syndrome of Menopause
```
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
4.0 ng/mL considered normal. Some cancers can exist in normal range
Prostate Specific Antigen (PSA)
105
mammogram rating level for women aged
| 40-49?
C
| Women may choose to start biennial
106
What are you screening for 1 time in adults born b/t 1945-1965?
hep C
107
BPH behavior modifications
decreasing fluids before bed, avoid above OTC meds (Anticholinergics, Sympathomimetics, Diuretics)
