OSCE - Screening Flashcards
What immunizations should adults be asked about during routine screening visits?
HPV Flu Tdap, td Shingles (60+) Pneumococcal: 13 or 23 valent
What populations should receive PCV13 and which should receive PCV23?
PCV13: 65y+ or risk factors and immunocompromised
PPV23: smokers, asthmatics
Which populations of women should be screened for cervical cancer?
Women 21-65 should get Pap smear every 3 years
Women 30-65 can get pap smear with HPV testing every 5 years
Which populations of women should be screened for breast cancer?
Women 50-74 should receive mammograms every 2 years
Women
Who gets screened for osteoporosis?
Women >65y or under 65 with fracture risks
What is the screening test for osteoporosis?
DEXA scan = dual energy xray absorptiometry
Who gets screened for AAA?
Men between 65-75y with a smoking history,should get an abdominal ultrasound. Men with risk factors are also screened (HTN, family history, overweight, atherosclerosis, caucasians)
Who gets screened for colon cancer?
Men and women between 50 and 75y are screened with FOBT every year, flexible sigmoidoscopy every 5 years, and colonoscopy every 10 years
Describe what a mammogram is
Your breasts are compressed between two firm surfaces to spread out the breast tissue. An X-ray captures black and white images of your breast tissue so doctors can look for signs of cancer.
Should patients be taught self-breast exam techniques?
No
What are the benefits of routine mammography screening?
Reduced mortality, especially between 60-69y
What are the harms of routine mammography screening?
Psychological stress
False positives can cause more imaging, biopsies and treatment
Over diagnosis
Radiation exposure
What are the risk factors for breast cancer?
Age Genetic mutations: BRCA1/BRCA2 No pregnancies Late age of first pregnancy No breastfeeding Obesity Early menarche/ Late menopause (Estrogen)
What is the treatment for breast cancer?
Radiation
Chemotherapy
Surgery
What is considered adequate screening for cervical cancer?
3 consecutive negative cytology results or 2 consecutive negative HPV tests in a woman over 65 years old all within the previous 10 years
What are the benefits of routine cervical cancer screening?
Decreased cervical cancer incidence and mortality
What are the harms of routine cervical cancer screening?
Abnormal results lead to more testing and invasive diagnostic procedures which can cause vaginal bleeding, pain, infection, and inadequate sampling
Increased anxiety/distress
Treatment associated risk
Overdiagnosis (non-clinically significant cancers)
What are the risk factors for cervical cancer?
HPV infection
HIV infection (compromised immune system)
Smoking
Many sexual partners, early sexual activity, STI hx
DES exposure in utero
Previous high grade precancerous lesion or cervical cancer
What are the treatments for cervical cancer?
Ablation, excisional therapy for high grade precancerous lesions
Hysterectomy or radiation for cancer
Describe FOBT
Test for looking for blood in stool
A spoon/collecting device used to get stool sample which is placed on a card that is sent to doctor or lab
Describe sigmoidoscopy
A thin flexible tube inserted into the rectum and advanced into colon with a camera at the tip
Looks for polyps/abnormal tissue in the rectum and colon
Requires bowel prep with laxative or enema and may require medication adjustments
Takes about 15 minutes
Describe a colonoscopy
A long flexible tube inserted into the rectum with a camera at the tip
Looks for polyps/abnormal tissue in rectum and colon
Requires bowel prep with laxative or enema
Requires sedation
You will need someone to drive you home
What are the benefits of routine colon cancer screening?
Reduced cancer mortality
Less invasive tests reduce number of colonoscopies even though abnormal results require follow up colonoscopy
What are the harms associated with colonoscopy?
Perforation of the colon (4/10,000)
Serious complications (major bleeding, severe pain) 25/10,000
Poor reaction to sedative
What are the harms associated with flexible sigmoidoscopy?
Serious complications (major bleeding, severe pain) 3/10,000
What are the risk factors for colon cancer?
Family Hx Inherited syndromes Inflammatory bowel disease Obesity Smoking Alcohol Lack of physical activity African american race
What are the guidelines for screening for lung cancer?
Individuals 55-80y with a 30 pack year smoking history that are actively smoking or quit within the past 15 years should receive a low dose CT yearly
Stop when quit date is 15y ago
Stop when costs outweigh benefits of screening
What harms are associated with routine lung cancer screening?
False negatives False positives Incidental findings Overdiagnosis Radiation exposure
What are the risk factors for lung cancer?
Smoking Age > 55y Occupational exposures Radon exposure Family history COPD or pulmonary fibrosis
What are the treatments for lung cancer?
Surgical removal (early non-small cell lung cancer)
Chemotherapy
Radiation
Describe DEXA scans
Imaging to detect decreases in bone density
Painless
Low radiation exposure
Takes about 10 to 30 minutes
What is the benefit of routine DEXA scan?
Prevents osteoporosis related fractures, chronic hip pain, disability, loss of independence and mortality
What are the harms of DEXA scans?
False positives False negatives Anxiety Cost Time
What are the risk factors of osteoporosis?
Females White women Age Low BMI Early menopause Parental history of hip fracture Smoking Alcohol Corticosteroid use
What are the treatments for osteoporosis
Medications: bisposphonates, PTH, raloxifene, estrogen, calcitonin
Calcium - 1500mg
Vitamin D - 800 IU
What are the guidelines for screening for ovarian cancer?
Do not screen
-No mortality benefit by screening with transvaginal ultrasound and CA-125 serum testing
What are the risk factors of ovarian cancer?
BRCA mutation
Lynch syndrome (HNPCC)
Family history
What factors decrease risk of ovarian cancer?
Oral contraceptive use Pregnancy Breastfeeding Bilateral tubal ligation Removal of ovaries
What are the screening guidelines for prostate cancer?
Do not screen with PSA
Identifies too many non-clinically significant cancers
What are the risk factors for prostate cancer?
Age Black men Family history of prostate cancer Exposure to agent orange BPH is NOT a risk factor Prostatitis Smoking
What are the treatments for prostate cancer?
Surgery
Radiation
Androgen deprivation therapy
What are the screening guidelines for testicular cancer?
Do not screen
Very little benefit because most cases are found incidentally
What are the risk factors for testicular cancer?
Cryptorchidism
History of testicular cancer
Trisomy 21
Klinefelter
What are the treatments for testicular cancer?
Orchiectomy
Radiation
Chemotherapy
>90% of newly diagnosed cases are cured
