OSCE

Question 1

What is the USPSTF recommendation regarding screening for Abdominal Aortic Aneurysm?

Answer 1

1. USPSTF recommends one-time screening for AAA with ultrasonography in men ages 65-75 years who have ever smoked (Grade B)
2. USPSTF recommends selectively offering screening for AAA with ultrasonography in men ages 65-75 years ho have NEVER smoked (Grade C)
3. USPSTF recommends against screening for women who have never smoked (Grade D)
4. Grade I - women 65-75 years who have ever smoked

Question 2

What is the likelihood that a 65-75 y/o male who has ever smoked and has a normal screening U/S dies from a AAA?

Answer 2

AAA-associate mortality over 5-12 years is low (0-2.4%) in men with normal U/S results

Question 3

What if the patient only smoked a little bit as a young adult?

Answer 3

Occasional tobacco use for a short time in the past is unlikely to have a pronounced biological effect. However, observational studies have found that even a relatively modest smoking history (half-pack or less/day for fewer than 10 years) does increase the likelihood of developing a large AAA.

Question 4

Which 65-75 y/o male patients with no smoking history should be screened for a AAA?

Answer 4

Important risk factors: older age, first degree relative with a AAA
Other risk factors: history of other vascular aneurysms, CAD, cerebrovascular disease, atherosclerosis, hypercholesterolemia, obesity, HTN
Reduced risk: African American race, Hispanic ethnicity, diabetes

Question 5

What is the USPSTF recommendation regarding screening for Breast Cancer?

Answer 5

1. USPSTF recommends biennial screening mammography for women aged 50-74 (Grade B)
2. The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (Grade C).
3. Grade I - using adjunctive screening methods in women with dense breasts
4. Grade I - screening women 75+ years
5. Grade I - screening with digital breast tomosynthesis (DBT)

Question 6

What is the most important risk factor for breast cancer in most women?

Answer 6

Advancing age

Question 7

Having a first-degree relative with breast cancer is associated with an approximately ___ increased risk for breast cancer in women aged 40-49 years.

Answer 7

2x

Question 8

Of all of the age groups, which group is most likely to avoid breast cancer death through mammography screening?

Answer 8

Women 60-69 y/o

Question 9

What are some of the risks of screening mammography?

Answer 9

False positive results, unnecessary biopsies, diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health or even apparent during their lifetime

Question 10

Who do the breast cancer screening recommendations NOT apply to?

Answer 10

Symptomatic women, women with pre-existing breast cancer of a previously diagnosed high-risk breast lesion, known underlying genetic mutation, history of chest radiation at a young age

Question 11

What is the USPSTF recommendation regarding screening for Cervical Cancer?

Answer 11

1. Screen women aged 21-29 every 3 years with cytology; screen women aged 30-65 every 5 years with cytology and HPV co-testing (preferred) or every 3 years with cytology alone (acceptable) - Grade A
2. USPSTF recommends against HPV testing in women younger than 30 years - Grade D
3. USPSTF recommends against screening for cervical cancer in women younger than 21 - Grade D
4. USPSTF recommends against screening in women older than 65 who have had adequate prior screening and are not otherwise at high risk for cervical cancer - Grade D
5. USPSTF recommends against screening in women who have had a hysterectomy with removal of the cervix and who do not have a history of CIN2 or 3 or cervical cancer

Question 12

Should women who have never been sexually active be screened for cervical cancer?

Answer 12

Yes, the grade A recommendation applies regardless of sexual history

Question 13

To whom does the cervical cancer screening NOT aply?

Answer 13

Women who have received a diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to DES, or women who are immunocompromised.

Question 14

What has been the effect of cervical cancer screening?

Answer 14

Cervical cancer deaths in the US have decreased dramatically since the implementation; most cases occur in women who have not been appropriately screened

Question 15

What is the USPSTF recommendation regarding screening for Colorectal Cancer?

Answer 15

1. USPSTF recommends screening for colorectal cancer starting at age 50 and continuing until age 75 years. (Grade A)
2. The decision to screen for colorectal cancer in adults aged 76-85 years should be an individual one, taking into account the patient’s overall health and prior screening history. (Grade C)

Question 16

To whom does the grade A colorectal cancer screening recommendation apply?

Answer 16

Asymptomatic adults 50 years and older who are at average risk of colorectal cancer and who do not have a family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer (Lynch syndrome, FAP), a personal history of inflammatory bowel disease, a previous adenomatous polyp, or previous colorectal cancer

Question 17

What is the most important risk factor for colorectal cancer for the majority of adults?

Answer 17

Older age

Question 18

A positive family history (excluding known inherited familial syndromes) is thought to be linked to about ___% of cases of colorectal cancer.

Answer 18

20

Question 19

What are two additional factors associated with higher colorectal cancer incidence and mortality?

Answer 19

Male sex and black race

Question 20

Who is more likely to benefit from colorectal cancer screening from age 76-85 years? When is screening most appropriate in this group?

Answer 20

Those who have never been screened for colorectal cancer; those healthy enough to undergo treatment if colorectal cancer is detected and those who do not have comorbid conditions that would significantly limit their life expectancy

Question 21

List the direct visualization screening test for colorectal cancer.

Answer 21

1. Colonsocopy - every 10 years
2. CT colonography - every 5 years
3. Flexible sigmoidoscopy - every 5 years (or every 10 years with FIT every 1 year)

Question 22

List the stool-based tests for colorectal cancer.

Answer 22

1. gFOBT - every year
2. FIT - every year
3. FIT-DNA - every 1 or 3 years

Question 23

What is the USPSTF recommendation regarding screening for Lung Cancer?

Answer 23

Screen adults 55-80 y/o who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years with low-dose CT; screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

Question 24

What are important risk factors for lung cancer? Other risk factors?

Answer 24

Important risk factors include age, total exposure to tobacco smoke, and years since quitting smoking; other risk factors include specific occupational exposures, radon exposure, family history, and history of pulmonary fibrosis or COPD.

Question 25

___ substantially reduces a person’s risk for developing and dying of lung cancer.

Answer 25

Smoking cessation

Question 26

What is the USPSTF recommendation regarding screening for Osteoporosis to Prevent Fractures?

Answer 26

Screen for osteoporosis with bone measurement testing in women 65 years and older, and in postmenopausal women younger than 65 years at increased risk of osteoporosis as determined by a formal clinical risk assessment tool (Grade B)

Question 27

What are risk factors for osteoporosis fractures?

Answer 27

Age, low BMI, excessive alcohol consumption, current smoking, long-term corticosteroid use, previous fractures, and history of falls within the past year

Question 28

What is the USPSTF recommendation regarding screening for Ovarian Cancer?

Answer 28

Grade D - USPSTF recommends against screening for ovarian cancer in asymptomatic women who are not known to have a high-risk hereditary cancer syndrome

Question 29

Why does the USPSTF recommend against screening for Ovarain Cancer?

Answer 29

The positive predictive value of current screening tests (transvaginal ultrasound, CA-125, both) is low, and most women with a positive screening test do not have ovarian cancer.

Question 30

What is the USPSTF recommendation regarding screening for Prostate Cancer?

Answer 30

For men aged 55-69 years, the decision to undergo period PSA-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. (Grade C).

Grade D - do not screen in men 70+ y/o

Question 31

What are causes of an elevated PSA?

Answer 31

Prostate cancer, enlarged prostate (BPH), prostatitis

Question 32

RCTs show that PSA-based screening programs in men aged 55-69 years may prevent approximately ___ deaths from prostate cancer over approximately 13 years per ____ men screened.

Answer 32

1.3; 1000

Question 33

What are the important risk factors for prostate cancer? Other risk factors?

Answer 33

Important risk factors - older age, African American race, family history of prostate cancer (cigarette smoking is associated with a higher risk of mortality)

Other risk factors with weaker associations and less evidence - diets high in fat and low in vegetable consumption

Question 34

What is the USPSTF recommendation regarding screening for Testicular Cancer?

Answer 34

Grade D - do not screen for testicular cancer in adolescent or adult males (this recommendation did not involve a review of evidence for males with a history of cryptorchidism)

Question 35

What topics should be included in the risk factors and health maintenance outline?

Answer 35

1. Active diseases
2. Current medications
3. Health maintenance
4. Family history
5. Environment risks
6. Behavior/lifestyle risks

Question 36

List the Grade A USPSTF Screening Recommendations.

Answer 36

1. Asymptomatic Bacteriuria Screening (Pregnant Women)
2. Cervical Cancer Screening (Women 21-65)
3. Colorectal Cancer Screening (Adults 50-75)
4. Folic Acid for the Prevention of Neural Tube Defects (Women capable of pregnancy)
5. HIV Screening (Adolescents, Adults, Pregnant Women)
6. HBV Screening (Pregnant Women)
7. High Blood Pressure Screening and Home Monitoring (Adults)
8. Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum (Newborns)
9. Rh(D) Blood Typing Screening (Pregnant Women)
10. Syphilis (Pregnant Women, Asymptomatic Adults and Adolescents at increased risk)
11. Tobacco Smoking Cessation (Adults, Pregnant Women)

Question 37

List the Grade A USPSTF Screening Recommendations by Population.

Answer 37

Females only: Cervical Cancer Screening (21-65), Folic Acid supplementation
Males only: none
Both: Colorectal Cancer Screening (50-75), HIV Screening (15-65 + those younger and older at increased risk), High Blood Pressure Screening (Adults), Syphilis (increased risk), Smoking Cessation (Adults)
Pregnant Women: Asymptomatic Bacteriuria Screening, HIV, HBV, and Syphilis Screenings, Rh Blood Typing, Smoking Cessation
Newborns: Prophylactic Ocular Topical Meds

Question 38

List the Grade B USPSTF Screening Recommendations.

Answer 38

1. Abdominal Aortic Aneurysm Screening (Men 65-75 who have ever smoked)
2. Alcohol Misuse Screening and Behavioral Counseling Interventions (Adults)
3. Aspirin Use to Prevent Morbidity and Mortality from Preeclampsia (Pregnant Women at High Risk for Preeclampsia)
4. Aspirin Use to Prevent CVD and CRC (Adults 50-59 with a 10+% 10-year CVD risk)
5. BRCA-Related Cancer: Risk Assessment, Genetic, Counseling, and Genetic Testing (Women at Increased Risk)
6. Breast Cancer Preventive Medications (Women at Increased Risk)
7. Breast Cancer Screening with Mammography (Women 50-74)
8. Breastfeeding (Pregnant women, new mothers, their children)
9. Chlamydia and Gonorrhea Screening (Sexually Active Women)
10. Dental Caries - Fluoride Varnish (Infants and Children) and Oral Fluoride Supplementation (6 months-5 years)
11. Depression Screening (12+ year)
12. DM2 and Abnormal Blood Glucose Screening (Adults 40-70 who are overweight or obese)
13. Falls Prevention in Community-Dwelling Older Adults (Adults 65+)
14. Gestational DM Screening (Pregnant Women after 24 weeks)
15. Healthful Diet and Physical Activity for CVD Disease Prevention Counseling (Adults with CVD Risk Factors)
16. Hepatitis B Screening (Non-pregnant Adolescents and Adults at High Risk)
17. Hepatitis C Virus Infection Screening (Adults at high risk + those born between 1945-1965)
18. Intimate Partner Violence Screening (Women of childbearing age)
19. Latent TB Infection Screening (Asymptomatic adults at increased risk for infection)
20. Lung Cancer Screening (Adults 55-80 with a 30 pack-year smoking history and currently smoke or have quit within 15 years)
21. Obesity in Children and Adolescents Screening (6+ years)
22. Obesity Screening and Management (Adults)
23. Osteoporosis to Prevent Fractures Screening (Postmenopausal women younger than 65 at increased risk, women 65+)
24. Preeclampsia Screening (Pregnant Women)
25. Rh (D) Blood Typing Screening (Unsensitized Rh (D) Negative Pregnant Women)
26. STI Behavioral Counseling (Sexually Active Adolescents and Adults)
27. Skin Cancer Prevention Behavioral Counseling (young adults, adolescents, children, parents of young children)
28. Statin Use for the Primary Prevention of CVD (adults 40-75 with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year risk of 10%+)
29. Tobacco Use Primary Care Interventions (children and adolescents)
30. Vision in Children Screening (3-5 years)

Question 39

Important history components - Active Diseases

Answer 39

1. Active diseases, including HTN, DM, Hyperlipidemia, Cancer, Mental Health
2. Menopause?

Question 40

Important history components - Past Medical/Surgical History

Answer 40

Past medical and surgical history

Question 41

Important history components - current medications/complementary therapies/allergies

Answer 41

1. Current medications (side effects, efficacy, polypharmacy)
2. Complementary therapies
3. Allergies

Question 42

Important history components - health maintenance

Answer 42

Everyone: hypertension, lipid disorder, DM2, colorectal cancer, lung cancer, low-dose aspirin prevention, falls prevention

Women: cervical cancer, breast cancer, osteoporosis, folic acid

Men: AAA, prostate cancer

Immunizations

Vision/Eye doctor
Hearing
Oral health/dentist

Question 43

Important history components - Environmental risks

Answer 43

Recent travel
Seatbelts/Helmets
Falls
UV Exposure
Occupational health (exposures, TB screening*)

Question 44

Important history components - behavior/lifestyle risks

Answer 44

Tobacco use/cessation
Alcohol and drug use (CAGE-AID)/counseling
BMI/healthy weight/nutrition/physical activity
Sleep
Sexual history (risk factors, condom use, family planning, STD history - HIV, HBV, HCV, Syphilis, Chlamydia/Gonorrhea*)
Intimate partner violence/Safety at home
Depression
Guns/violence
Advanced directives

Question 45

Important history components - family history

Answer 45

Family history of first degree relatives (grandparents, parents, siblings, children)
BRCA screening )F with family history of breast cancer as follows - bilateral, dx before 50, dx in multiple family members, dx in 1+ male family members, family hx ovarian cancer or with 2 BRCA-related cancers)

Question 46

What is the CAGE-AID screening?

Answer 46

Have you felt you ought to cut down on your drinking or drug use?
Have people annoyed you by criticizing your drinking or drug use?
Have you felt bad or guilty about your drinking or drug use?
Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover?
Scoring: Yes to 1 or 2 → possible problem, Yes to 3 or 4 → probable dependence

Question 47

PHQ2?

Answer 47

Over the past two weeks, have you felt little interest or pleasure in doing things? Have you felt down, depressed, or hopeless?

Question 48

HITS?

Answer 48

How often does your partner physically hurt you, insult or talk down to you, threaten you with harm, or scream/curse at you?