periodic health and screening Flashcards
Indications of low-dose CT to screen lung ca annually x3
1) age 55-74
2) >= 30 pack yr
3) currently smoking OR quit < 15 yrs
Pap tests starting age and intervals
> > Starting at age 25 - 69 y/o
(can stop if 3 normal tests in the past 10 years)
> > Every 3 years
mammogram screening starting age and interval
Age: 50-74 y/o
Interval: every 1-2 yrs (q2-3 yrs by CTFPHC)
> 75 yr: no mammogram if life expectancy < 5 yrs
FOBT/FIT screening starting age and interval
From 50 - 75 y/o
» FOBT/FIT q2 yrs OR
» Sigmoidoscopy q10 yr
Indications of HPV vaccines
boys and girls < 26 y/o
girls =< 45 y/o even if already sexually active
screening guideline for osteoporosis
1) BMD when 65 y/o OR > 50 y/o w/o risk factors
2) use CAROC or FLAX to risk stratify
3) consider bisphosphonates for moderate (> 10%) to high (>20%) risk
4) ensure calcium 1200mg/d and vitamin D 1000IU/d
Indications of STI screening (Gonorrhea/Chlamydia, VDRL, HIV, HBV)
IF high risks
1) < 25 y/o
2) > 2 partners in past yr
3) not using barrier contraception
4) using “survival sex”
5) homeless
6) anonymous sex
7) prostitute
8) partner with STI
9) previous STI
Regular preventative immunization
- flu vaccine q1yr
- pneumococcal vaccine x 1 > 65 yo
- tetanus vaccine q10yr
- Herpes Zoster vaccine > 50 y/o
Indications of pneumococcal vaccine between age 2 - 64
Any of the high risks
1) DM
2) CRF
3) HIV
4) smoker
5) homeless
6) IVDU
7) cirrhosis
Indications of DM screening
1) < 40 yr: A1C q6-12mo if risk factor or “very high risk”
2) > 40 yr: A1C q6-12mo if "very high risk"
A1C q3yr (q1-5yr by CTFPHC)
What is the 5A approach to smoking cessation
Ask if pt smokes Advice pt to quit Assess willing to quit (stage of change) Assist in quit attempt Arrange follow-up
How to assist in the stage of “preparation” to achieve smoking cessation?
Preparation stage: STAR
- Set a quit date within 2 weeks (can focus on decrease amount ~ 25%)
- Tell family, friends, coworkers and request support
- Anticipate challenges
- Remove tobacco products (make home smoke free)
How to “assist” in quit attempt ( to increase success rate of smoking cessation)
- STAR
- offer >= 4 (motivational) counseling sessions
- combo nicotine replacement + meds: most effective than nicotine or meds alone
What are the first-line meds to assist on smoking cessation?
Varenicline + Nicotine replacement
- Start Varenicline 1 week prior to quit ( can use prior to pt being ready to quit)
- And combine with nicotine replacement
What are the conditions needed to be cautious when prescribing Varenicline for smoking cessation?
- renal failure (CrCl <30 ml/min)
- depression
- suicide
(** can still be used in pts with MH disorders)
S/E of varenicline for smoking cessation
- nausea
- insomnia
- strange dreams
What is the dose of varenicline for smoking cessation?
- 0.5 mg QD x 3 days then
- 0.5 mg BID x 4 d then
- 1 mg BID x 3 months
What are the 2nd and 3rd line of meds for smoking cessation?
2nd line: Bupropion SR (can start 1-2 weeks prior to quit date and combine with nicotine replacement)
3rd line: Clonidine (start 3d prior to quit date) OR Nortriptyline (start 10-28d prior to quit date)
What are the contraindications to take Bupropion?
- seizure
- eating disorder
- MAOI
- CYP 2D6 inhibitor
What are the common S/E of Bupropion?
- elevated BP
- insomnia
- dry mouth
What are the common roadblocks of smoking cessation?
- withdrawal
- fear of failure
- weight gain
- depression
- enjoyment
- friends
What are the conditions needed to be cautious when prescribing nicotine replacement?
- post MI
- arrhythmia
- angina
What are the common s/e of Clonidine ?
acting centrally on alpha-2 adrenergic as an agonist ( has alpha-antagonist effect in the posterior hypothalamus and medulla)
- dry mouth
- dizziness
- sedation
- constipation
- hypotension
What are cautious conditions and the common s/e of Nortriptyline?
- sedation
- dry mouth
- blurred vision
- retention
be cautious in pt with MI or arrhythmia
Preferred meds to quit smoking for pt with hx of depression?
Bupropion SR or Nortriptyline
safe NRT for pt with CVS hx
Nicotine patch is safe
To minimize weight gain when quitting smoking
bupropion SR, 4mg gum + lozenges
delay weight gain
meds to assist pregnant women on quitting smoking
- encourage to quit w/o meds (all class C+D)
- if necessary, use intermittent nicotine instead of patch
How to arrange follow-up after assisting pt on smoking cessation?
- follow-up within 1 week of quitting
- second appointment within 1 month
IF relapse: review, elicit recommitment
melanoma screening criteria
NOT for population-based screening
Only refer if HIGH RISK for 6-monthly full body exam
- Older, male
- personal or family history of melanoma
- > 15 nevi
- light skin, red hair
- multiple sunburns
- actinic skin damage
Colorectal cancer screening guideline
Age 50-74
- gFOBT or FIT every 2 years OR
- flex sigmoidoscopy q 10 yrs
Breast cancer screening guideline
Use shared decision-making
- 40-50 y/o: NO screening
- 50-74 y/o: mammogram every 2-3 years for average risk
Pancreatic cancer screening guideline
Screen ONLY if HIGH risk - family hx of pancreatic cancer - high-risk syndrome e.g. Peutz-Jeghers syndrome BRCA1 with affected relative
Investigation for unexplained weight loss
- weight, series
- height: for BMI
- hemoglobin
- Na, K, eGFR
- urea and creatinine
- PSA (prostate serum antigen)
- Fecal occult blood
- chest x-ray
risk of long-term use of PPI
- B12 deficiency
- C. difficile infection
- dementia
- fractures
pediatric IV supplement for diarrhea
- Bolus: 20ml per kg
- Maintenance: hourly rate - 4-2-1 ml/kg/hr
