Preventative Care Flashcards
Ages for breast cancer screening.
Women: 50-74
How frequently should women be screened with mammography?
every 2 years
Time to benefit for mammography to prevent 1 breast cancer death per 1000 screened.
10 years (so insufficient evidence for mammograms after 75)
Ages for cervical cancer screening.
Women: 21-65
What is adequate prior screening for cervical cancer?
-Three consecutive negative cytology results (q3y)
-Two consecutive negative HPV results (q5y)
Within 10 years before cessation of screening AND most recent test within 5 years.
What should be done for older women who have never been screened for cervical cancer?
Screen ever 2-5 years ending at age 70 or 75
What women are exempt for cervical cancer screening?
Those s/p hysterectomy (with removal of cervix) who do not havehistory of CIN grade 2, CIN grade 3 or cervical cancer
What age should discussions of prostate cancer screening be done?
Men: 55-69
What is used for prostate cancer screening?
PSA
What is the false positive rate for PSA?
80% when thresholds of 2.5-4 mcg/L are used
What age for CRC screening?
Adults 45-49 (B rec)
Adults 50-75 years old (A rec)
Adults 76-85 (C rec)
STOP over 85
What are options for CRC screening?
Colonoscopy every 10 years
Flex Sig q5y + FOBT q3y
CT colonography q5y
Fecal DNA q3y
FOBT or FIT every year
Follow up colonoscopy if <20 small (<10mm) hyperplastic polyps.
10 years
Follow up colonoscopy if 1-2 adenomas <10 mm.
7-10 years
Follow up colonoscopy if 1-2 sessile serrated polyp <10 mm.
5-10 years
Follow up colonoscopy if 3-4 Adenomas or SSPs <10 mm.
3-5 years
Follow up if hyperplastic polyp >10 mm.
3-5 years
Follow up if over 10 adenomas found.
1 year
Follow up if adenoma or SSP >10mm
3 years
Follow up if adenomas have villous or tubulovillous histology or high grade dysplasia.
3 years
Follow up for serrated adenoma.
3 years
Who is screened for lung cancer?
55-80 (USPSTF) with 30 pack year smoking or quit within past 15 years.
*Medicare only covers through age 74 (so stop at ages 75-80)
What is the only cancer screening that should be continued in those with 5 to <10 years life expectancy?
Lung Cancer Screening
Who should be screened for diabetes?
Adults 40-70 who are overweight or obese
Who should be screened for AAA?
Men 65-75 who have ever smoked (at least 100 cigarettes in lifetime)
When should osteoporosis screening start?
65 for all women and 60 if high risk on FRAX
How often does medicare cover DEXA scans?
every 2 years
Should men be screened for osteoporosis?
USPSTF says insufficient evidence, NOF recommends all men 70 and older
What is the time to benefit for statins for primary prevention?
1-2 years
Do statins for primary prevention reduce mortality in adults over 75?
no, but they do modestly reduce CVD (per PROSPER, JUPITER and HOPE3)
What age does USPSTF consider statins for primary prevention?
40-75
When do patients 40-75 need a high intensity statin?
If LDL >190
When do patients 40-75 always need a moderate intensity statin (at least)?
Diabetes
Per USPSTF, when should primary prevention statin be considered in those 40-75?
Those who have 1 or more CVD risk factor (ex. HLD, DM, HTN or smoking) and 10 year risk of 10% or greater
Who should be screened for hepatitis C?
All US adults born between 1945-1965 (ages 57-77 in 2022)
Who needs primary prevention aspirin per USPSTF?
Adults 50-59 with >10% CVD risk
How often should adults >65 be asked about their alcohol use?
yearly
When should older adults get stress tested prior to exercise?
When they are starting a vigorous exercise program (ex. strenuous cycling or jogging)
Should older adults be tested for STIs?
only if increased risk, but HIV testing is cost effective 1x in those 65-75
When do PCPs perform visual acuity exams under Medicare?
At the initial preventive physical exam (not for the annual wellness visits)
When do PCPs perform hearing exams under Medicare?
At the initial preventive physical exam and the initial AWV
Does the USPSTF recommend screening for mistreatment in older adults?
no
Which flu shot should older adults get?
the high dose or standard (not live attenuated intranasal)
What is the benefit of the high dose flu vaccine?
reduces rate of flu by 24.2%
To who and how should the pneumonia vaccine be administered?
adults 65 and older get PCV13 (congugate) followed by PPSV23
What do you do if someone got the PPSV23 prior to age 65?
Give PCV13 one year after (or at age 65) and PPSV23 five years after last PPSV23 and one year after PCV13
Who needs TDap?
Those older than 65 with close contact with infants <12 months
What shingles shot should older adults get?
Shingrix (inactivated subunit vaccine), 2 doses 2 months apart
What type of vaccine is zostavax?
live attenuated
What if the older adult has already gotten zostavax?
give shingrix at least 2 months after
What is the age for the shingles vaccine?
50 and older
What is the AGS consensus on Vitamin D and calcium?
recommend 1000 IU/day of vitamin d and calcium 500-1200 mg/day to community dwelling older adults 65 and older to prevent falls and fractures
What part of medicare covers flu vaccine?
Part B
What part of medicare covers zoster vaccine?
Part D
What part of medicare covers pneumonia vaccine?
Part B
