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OMS III > Prev Med > Flashcards

Prev Med Flashcards

1
Q

what guidelines will be tested

A

USPSTF, they are the most reliable preventative medicine guidelines, and the standard of care

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2
Q

What guides you choice in choosing a test

A

mortality benefit

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3
Q

Most important preventative medicine question:

Which cancer screening method lowers mortality the most? (which of the following is most likely to benefit the patient?)

A

mammography screening above age 50

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4
Q

Breast Cancer

Age to start mammography canbe controversial (40-50), but the age of maximum benefit is clear

A

> 50

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5
Q

Breast Cancer

screening overview

A

mammography should be done starting at age 40 to 50every 2 years. the reduction is mortality is greated above age 50.screening can stop at age 75

on average you will detect 10 cases of breates cancer by screening 1000 women above age 50, but you will detect only 2 cancers by screening 1000 women between the ages of 40 and 49.

the MRI, CT, andUS do not yet have a clear place in terms of screening for breast cancer.

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6
Q

breast self examination

A

is the wrong answer, although it may seem to benefit there is no proof

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7
Q

Breast Cancer

selective estrogen receptor modulators (SERMs)

A

tamoxifen, raloxifene

result in a 50 to 66% reduction in breast cancer when compared with placebo

greatest benefitis is in those with 2 first-degree relatives with breat cancer (mother or sister).

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8
Q

Breast Cancer

aromatase inhibitors

A

useful in preventingmetastases in those with provenbreast cancer butthey are not proven to bneeift those who are asymptomatic

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9
Q

Breast Cancer

Her/Neu2

A

gues the use of trastuzumab, which bocksthereceptor inthosewith ptovencncer

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10
Q

Breast Cancer

BRCA

A

associated with increased risk of breast and ovariancancer. however, this does not mean it is clearly bneeficial screening test. the missing piece is: what to do when th epatient is positive for BRCA? this is not clear. the only truly unambiguous statement about BRCA testing is that a psotivie test means on increased risk of cancer

management remains undetermined

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11
Q

when BRCA is positive

A

offering prophylactic bilateral mastectomy is the wrong answer

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12
Q

Cervical Cancer Screening

A

the first pap smear is done at age 21. pap every 3 years ages 21-30. pap smear devinitely lowers mortality. bc htere ar enoly 7000-10000 cases of cerical cancer a year, but 185000 cases of breast cancer, pap smear is not nearly as beneficial as mammoraphy.pap semar is done every 3 years. papillomavirus vaccine is routine for all women between the ages of 11 and 26. combined pap and hpv testing at ages 30 to 65 stretches the interval to 5 years

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13
Q

pap smear is done from

A

21 to 65 years of age

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14
Q

adding hpv testing to pap increases interval to

A

5 years

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15
Q

chlamydia screen women

A

15-25 years old

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16
Q

Colon Cancer Screening

A

the lifetime risk of colon cancer for an american is 6-8%. each year 50000 people die of colon cancer in the us.95% of these deaths are preventable with screening

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17
Q

Colonscopy

A

every 10 years after age 50

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18
Q

virtual colonoscopy

A

misses cancers in polyps less than 0.5 cm

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19
Q

capsule endoscopy

A

detects small bowel bleeding, not a colon cancer cancer screening method

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20
Q

dre

A

not proven to lower mortality in any disease, always a wrong choice

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21
Q

Prostate Cancer Screening

A

unfortunately ther is no clearly beneficial test to lower mortality in prostate cancer screening. neither the prostate specific antigen nor the digital rectal exam has proven sufficiently sensitive or specific to lower mortality. althouth PSA does detect prostate cancer, the lesions detected are most often not ones that need treatment. of patients with prostate cancer, 25% have a normal PSA, and 25% of those with an elevated PSA do not have cancer

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22
Q

if the question asks mortality nefit for PSA

A

say no

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23
Q

if the question says teh patient wants/requests a PSA

A

say yes

24
Q

Lung cancer screening

A

Long-tem smokers with 30 pack years of smoking should be screened by chest CT at age 55. CXR detects many lesions that turn out to be insignificant and misses many small cancers. High-resolution CT scanning lowers lung cancer mortality in those with a long history of smoking. screen annually

25
Q

what is always th sinlg emost beneficial disease preventive method of any type

A

smoking cessation

26
Q

Lipid Screening

recommended for healthy patients when

A

men are above age 35

women are above age 45

27
Q

Lipid Screening

unhelathy patients

A

recommended for all patients with diabetes, htn, coronary artery disease, or the equivalents of coronary artery disease (carotid disease, peripheral vascular disease, aortic disease)

28
Q

Hypertenstion

screening

A

blood pressure testing is indicated for all pts above the age of 18 at every bisit

htn screening has never been properly evaluated in a meaningful way and probably never will, bc you would have to withhold bp measurement and observe for years to detect a mortality difference which would be unethical

screening adults should be every 2 years

29
Q

Diabetes Mellitus

screening

A

when the pt has htn or hyperlipidemia

no recommendation when the pt is asymptomatic

30
Q

Diabetes Mellitus numbers

A

2 measurements ofver 125 or hba1c>6.5%

31
Q

Vaccinations for adults

2 most beneficial

A

influenza and pneumococcus

32
Q

Influenza and Pneumococcal Vaccine overview

A

live attenuated vaccine should not be used in pts over 50 with the medical conditions:

chronic heart, lung, kiver, and kidney disease including asthma
hiv/aids
steroid users
immunocompromised pts in general such as cancer or functional or anatomic asplenia
diabetes mellitus

33
Q

egg allergy is not a contraindication to

A

flue vaccine

34
Q

pneumococcal and influenza vaccine are recommended for all pts with

A

chronic heart, lung, kiver, and kidney disease including asthma
hiv/aids
steroid users
immunocompromised pts in general such as cancer or functional or anatomic asplenia
diabetes mellitus

35
Q

pneumococaal vaccine for adults

A

first give 13 polyvalent then after 6-12 months follow up with 23 polyvalent

36
Q

indications for influenza vaccine

A

everyone yearly
healthcare workers
pregnant patients

37
Q

indications for pneumococcal vaccine

A 
everyone above age 65
cochlear implant
csf leaks
alcoholics
one vaccine above 65 only
single revaccinatino after 5 years if the pt is immunocompromised or the first injection was prior to age 65
tobacco smokers
38
Q

zoster vaccine prevents what in adults

A

shingles

39
Q

herpese zoster vaccine

A

ahtluth varicella vaxxination is routenile indicated in all children, there is a higher-dose version of the varicella vaccine that is indicated in all patients above age 60. this prevetns post-herpetic neuralgia

40
Q

Hep a and b vaccines are the most beneficial in those with

A

chronic liver disease

41
Q

Hep a and b vaccine indications

A

always indicated in kids

indicated in adults if:

chronic liver disease

men how have sex with men or mutliple sex partners

household contacts with hep a and b

injection drug users

42
Q

indications for hep a vaccine

A

travelers to countries of high endemicity

43
Q

indications for hep b vaccine

A

end-stage renal disease(dialysis)

healhtcare workers

diabetes

44
Q

Tetanus vaccine

A

td every 10 years

one tdap (tetanuse with acellular pertussis) as on of the boosters

tetanus immune globulin in those never vaccinate

45
Q

Meningococcal vaccine indications

A

age 11

asplenia

terminal complement deficiency

military recruits

residents of college dormitories

travelers to mecca or medina in saudi arabia for the hajj (pilgrimage)

46
Q

when to give tetanus

A

never vaccinated: immune globulin

dirty wound: booster after 5 years

clean wound: booster after 10 years

47
Q

what is the following indication for meningococcal vaccine

A

asplenia

48
Q

Osteoporosis screening

A

every woman should be screened wth bone densitometry at the age of 65 with a dexa scan

49
Q

hip fx in an elderly pt

A

carries a high risk of mortality preventing fx with biphosphonates to increase bone density is potentially more life saving than bblockers in coronary disease. in an older woman a hip fracture is more deadly than a mi

50
Q

AAA screening

A

all men abov ethe age of 65 with a smoking hx should be screened once with an us to exclude an aneurysm. also screen 65-75 with a family hx

51
Q

aaa should be repaired if it is wider than

A

5 centimeters

52
Q

smoking cessation

all pts

A

should be asked do you smoke

be advised to stop

attempt: find out who wants to stop

be assisted: prescribe a method of aiding nicotine dependence

arrange to meet with the pt again to find out if they have set a wuit date and have really managed to stop

53
Q

Intimate partner violence ( domestic violence)

A

all pts hould be asked about the possibility of intimate partner violence. pts will most often not volunteer thi info. yoiu cannot report this form of injury without the consent of the pt

54
Q

Alcoholism overview

A

a self-diagnosed disease. not defined as an amount of alcohol used or leading to loss of employment as many still maintaintheir jobs

55
Q

alcoholism

ask

A

C: do they feel theneed to cut down the amount they are drinking?

A: do they feel angry when asked about their drinking?

G: Do they feel guilty about the amount they drink?

E: Do they feel the need for a morning eye-opener?

56
Q

Routine screening mehtods that are always incorrect

A

cxr, ekg, and stress testing are never correct as screening methods in the otherwise healthy general popularion

OMS III (21 decks)

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