Preventative Health/Red Book Guidelines Flashcards
Name 4 things to screen for in an older child (10-14)
Smoking
Weight and nutrition
Alcohol
Physical activity
Name 8 things to potentially screen for in a young adult (15 - 29)
Smoking Weight and nutrition Alcohol Physical activity Pregnancy/Contraception Chlamydia/STI Cervical cancer BP
Name 9 things to potentially screen for in a middle aged person (30 - 49)
SNAP Pregnancy/Contraception BP + Absolute CV Risk assessment Cholesterol T2DM Cervical cancer
Name 11 things to potentially screen for in a more mature person (50 - 64)
SNAP BP + Absolute CV Risk assessment Cholesterol T2DM Cervical cancer Breast cancer Colorectal cancer Osteoporosis
Name 13 things to potentially screen for in an elderly person (65+)
SNAP BP + Absolute CV Risk assessment Cholesterol T2DM Cervical cancer Breast cancer Colorectal cancer Osteoporosis Falls risk Vision and hearing
Name 7 other things that can be screened for in GP for people in high risk categories (think Aboriginal and Torres Strait Islander, women, co-morbidities, environmental exposures etc)
Depression Kidney disease Stroke Oral hygiene Glaucoma Domestic violence Skin cancer
Name 9 things to screen for in a young child (0 - 10)
Immunisations Nutrition Physical activity Vision Hearing Height, weight, head circumference BMI Developmental milestones Behaviour
A woman walks into the GP interested in becoming pregnant. Name 5 general areas to ask about on Hx. Name 4 examinations to do. What are the recommendations about vaccinations before pregnancy? Give 5 pieces of lifestyle advice
Hx - PMx, family, past obstetric Hxs, make reproductive life plan (how many kids and when), substance use
Ex - BP, BMI, Pap smear, breast examination
Vaccinations - give live vaccines 28 days before attempting to become pregnant. Ensure woman is vaccinated against MMR, varicella, influenza, DTPa
Lifestyle - discuss fertility cliff, folic acid supplementation (0.5mg 1 month before and 3 months after conception, up to 5mg if high risk - diabetes, anti-epileptic use, or FHx of neural tube defect), SNAP guidelines, psychosocial counselling, avoidance of environmental hazards (chemical or infectious - TORCH)
Name 5 genetic conditions that can potentially be screened for in a pregnant woman
Familial hypercholesterolaemia Cystic Fibrosis Down Syndrome Hereditary Haemochromatosis Thalassaemias Fragile X syndrome
Name 3 vaccinations recommended for people over 65
Influenza (yearly)
Pneumococcal (once only, unless high risk)
Herpes zoster (once only)
Name 3 questions to ask to screen for falls risk in a person over 65
Have you had 2 or more falls in the last 12 months?
Are you presenting following a fall?
Are you having difficulty with walking or balance?
Name 5 suggestions to reduce falls risk
Home or community based exercise program - medium intensity and ongoing (recommend aerobic exercise 30 minutes/day, 5 days/week; muscle strength training 2-3 times/week) Review medications Vitamin D supplementation if deficient Podiatry if foot problems Appropriate glasses OT assessment if has had previous fall
Who should be screened for visual acuity, and how?
Symptomatic people over 65, with Snellen chart
Who should be screened for hearing loss, and how?
Everyone over 65 - screen by asking about hearing difficulty, or by whispered voice test
Who should be screened for dementia? Name 3 interventions that can reduce dementia risk
People with symptoms, or people with Hx of head trauma, Down syndrome, cardiovascular risk, PMx of depression, or FHx of Alzheimer’s disease
Reduce dementia risk through physical activity, social engagement, cognitive training
Name 3 symptoms of dementia
Poor memory, cognitive decline, brittle emotions, change in behaviour
Go through the immunisation schedule (0, 2, 4, 6 months, 12 months, 18 months, 4 years, high school)
0 - Hep B
2 - Hep B, Pneumococcal, DTPa, Hib, Polio, rotavirus
4 - Hep B, Pneumococcal, DTPa, Hib, Polio, rotavirus
6 - Hep B, Pneumococcal, DTPa, Hib, Polio, rotavirus
12 - MMR, Meningococcal (C), Hib
18 - MMR, VZV, DTPa
4 years - MMR, polio
High school - VZV, HPV, DTPa
Name 4 extra vaccinations for Aboriginal and Torres Strait Islander populations in high risk areas
At birth - BCG 12-18 months - pneumococcal 12-24 months - Hep A 6 months to 5 years, and over 15 years - influenza and pneumococcal (if medically at risk) Over 50 years - pneumococcal
Name 6 things to ask about when screening for STIs
Sexual behaviours and orientation Current sexual activity Number and gender of partners Contraception Immunisation status Other risk factors for blood-borne illnesses (tattoos, IVDU, time in jail)
Name 5 STIs to potentially screen for, and how these STIs are screened (what tests can be used). When, for women, is a good time to screen for STIs?
Chlamydia - urine, genital swab, rectal swab and sent for PCR
Gonorrhoea - throat swab, rectal swab for PCR
HIV - blood test
Syphilis - blood test (serology)
HBV, HCV, HAV - blood test
Useful to screen at same time as Pap smear
Name 4 things to ask about when taking a smoking Hx
Quantity, frequency of smoking
What they are smoking
Interest in quitting, and previous attempts
Nicotine dependence - time to first cigarette, withdrawal symptoms if previously tried to quit
Name 3 interventions for smoking cessation
Smoking cessation advice, quit goals, pharmacotherapy (varenicline, bupropion), referral and follow-up
Name 2 ways to screen for obesity. How often should this be done in low-risk people? What is a healthy range for each of these?
BMI and waist circumference every 2 years in low risk people
BMI - under 25
Waist circumference - under 94cm (men) and 80cm (women)
Name 5 steps in weight loss counselling/management. At what point is bariatric surgery considered?
- Education on benefits of weight loss
- Lifestyle program - reduced calories, increased exercise
- Set goals and follow-up
- Pharmacotherapy if lifestyle fails after 3 months (Orlistat)
- Maintenance program to prevent weight gain after initial weight loss
Consider bariatric surgery if BMI > 35, patient failed other interventions, and have co-morbidities that would improve with weight reduction
Name 2 populations at increased risk of T2DM. How should these people be screened for T2DM, and how often? Name populations at high risk of T2DM. How should these people then be screened, and how often?
Increased risk - everyone over 40, all ATSI over 18. Screen using AUSDRISK, every 3 years
High risk - AUSDRISK score over 12, PMx of AMI or stroke, GDM, PCOS, antipsychotic medication, previous impaired OGTT or FGT. Screen high risk with fasting blood sugar every 12 months
Name the 11 components of AUSDRISK calculator
Age Sex Cultural background (ATSI or asian) Place of birth FHx of DM PMx of glucose impairment Medication for BP Smoking Vegetable and fruit consumption Exercise Waist circumference
What are the cutoffs for normal, impaired glucose tolerance, and diabetes on a fasting blood sugar, and OGTT?
Normal - under 5.5mmol/L, or 7.8
Impaired - 5.5-6.9mmol/L, or 7.8 - 11.1
Diabetes - over 7 or 11.1
What is the cutoff for diabetes on HbA1C?
over 6.5%
Name 3 recommendations for prevention of diabetes in those with pre-diabetes (impaired glucose tolerance, fasting glucose, GDM, elevated AUSDRISK)
Increased activity
Healthy, low fat diet
Referral to dietician and exercise physiologist
For a patient with a suspected TIA, what tool can be used to assess risk of stroke? What score indicates a high risk of stroke? Name 2 other important clinical factors
ABCD2 - Age (over 60), BP (over 140/90), Clinical features - unilateral weakness, speech impairment, Duration, Diabetes. Score over 4 and/or AF = high risk of stroke
Other clinical factors - presence of AF, or signs indicating carotid disease (carotid bruit)
Name 5 factors that place a patient in a high risk category for kidney disease. Name 3 screening tests, and how often these should be done
Smoking over 40 pack years HT Obesity FHx of kidney disease Diabetes ATSI over 30.
Do BP, ACR and eGFR every 1-2 years
What are the cutoffs for the 5 stages of kidney disease?
Stage 1 - eGFR over 90 but signs of kidney damage (albuminuria, proteinuria, haematuria)
Stage 2 - eGFR 60 - 90 but signs of kidney damage (albuminuria, proteinuria, haematuria)
Stage 3a - eGFR 45 - 60
Stage 3b - eGFR 30 - 45
Stage 4 - eGFR 15 - 30
Stage 5 (end-stage) - eGFR under 15
Name 5 reasons to refer someone with CKD to a nephrologist
Stage 4 or 5 CKD, or: Persistant macroalbuminuria (ACR over 30mg/mmol) Rapidly declining eGFR CKD with resistant HT Unexplained anaemia and eGFR under 60
Who is at average, increased and high risk for developing melanomas? What preventative measures are recommended for each risk category?
Average risk - light-skinned people. Give opportunistic preventative advice (importance of sunscreen and protection from sunlight when UV levels are 3 or more)
Increased risk - FHx of melanoma, tendency to burn or freckle, over 30 years, PMx of solar lentigos, other skin cancers, or episodes of sunburn as a child. Give opportunistic preventative advice and opportunistic skin examination.
High risk - Multiple atypical/dysplastic naevi + FHx of PMx of melanoma. Give preventative advice and skin exam every 3-12 months. Encourage self-examination every 3 months.
Who is at average, increased and high risk for developing non-melanotic skin cancer? What preventative measures are recommended for each risk category?
Average risk - fair or light skin colour, under 40 years. Give opportunistic preventative advice
Increased risk - skin that burns or freckles, FHx of skin cancer, over 40 years, Male, presence of multiple solar keratoses, strong exposure to UV light. Give opportunistic preventative advice and opportunistic skin examination.
High risk - previous NMSC (60% grow another in 3 years), exposure to arsenic, immunosuppression. Give preventative advice and skin exam every 12 months. Encourage self-examination every 12 months.
What are the current recommendations for cervical cancer screening of asymptomatic women?
Pap smear every 2 years from age of 18 or 2 years after first sexual intercourse, whichever comes later
What are the current recommendations for women who return positive Pap smears (LSIL, HSIL, or glandular abnormality/adenocarcinoma)?
LSIL - Repeat pap in 12 months; if positive again, refer to colposcopy. If woman is over 30 and has no recorded negative Pap smear in last 2-3 years, offer colposcopy or repeat Pap in 6 months
HSIL - Refer to colposcopy +/- biopsy
Glandular abnormality/adenocarcinoma - Refer to colposcopy
What are current recommendations for breast cancer screening of asymptomatic women?
Mammogram every 2 years between 50-69 years
What tool can be used to see whether a woman is at higher risk of developing breast or ovarian cancer? Name 3 things it accounts for
Familial Risk Assessment - Breast and Ovarian Cancer (FRA-BOC) calculator. Accounts for personal and familial genetic testing, racial background, FHx of ovarian and breast cancer
True or false: clinical breast examinations to screen for breast cancer are not supported by evidence, but breast awareness (self-examination) is
False - neither are supported by evidence! Only recommendation is for 2 yearly mammogram (for average risk women)
True or false: screening for ovarian cancer is not recommended as a preventative activity
True - no screening test is effective for ovarian cancer
What are current recommendations for colorectal cancer screening of asymptomatic patients?
Faecal occult blood test (FOBT) every 2 years from 50-75
What factors place someone as moderately increased and high risk groups for colorectal cancer? What recommendations are suggested for these groups?
Moderately increased - 1st degree relative with CRC under 55 years, or multiple relatives diagnosed with CRC at any age. Colonoscopy every 5 years from 50 years, or 10 years before age of first diagnosis of CRC in family
High risk - 3 or more relatives with CRC, or 2 relatives with CRC with high risk features (CRC before 50, multiple CRCs in same person, Lynch-syndrome related cancer), or 1 relative with suspected FAP, or someone with APC gene mutation. Refer to genetic and bowel cancer specialist
What are the guidelines for screening of prostate cancer?
Don’t screen for prostate cancer unless the man requests it and he is fully educated on pros and cons. If he does ask, then both PSA and DRE should be done.
Name 5 reasons why routine PSA screening is not recommended for prostate cancer
Poor specificity of test
Often indolent course of prostate cancer
SE of biopsy - infection, bleeding
SE of surgical intervention - erectile dysfunction, urinary incontinence, urinary irritation, loss of vitality
SE of diagnosis of prostate cancer - suicide and cardiovascular events spike in few weeks after diagnosis is given
Name 5 factors that would make someone at high risk of depression
FHx of depression
PMx of psychiatric disorder or chronic medical condition
Unemployment, low SES
Older adults following significant life event (illness, bereavement, institutionalisation, cognitive decline)
Family violence or child abuse sufferers
What are the 2 best tests to test initially for depression in GP?
Ask - ‘over past 2 weeks, have you felt down, depressed or hopeless?’; and,
‘over the past 2 weeks, have you felt little pleasure in doing things?’
Name 3 other tests that can be done for assessing depression in GP
K10
Edinburgh Postnatal Depression Scale
HEADSS assessment (for adolescents)
Name 6 questions to ask someone with suicidal ideation to work out the degree of risk that they pose to themselves
How frequent and persistent is their suicidal thinking?
Do they have a plan for suicide, and how detailed and realistic is it?
What method have they chosen, and how lethal is it?
Do they have the means to carry out this method?
Have they planned or attempted suicide before?
Has anyone close to the person attempted or committed suicide?
Name 4 groups of women at increased risk of suffering intimate partner violence
Adolescent women
Pregnant women
Women with mental illhealth
Women with unexplained, recurrent symptoms or injuries, or who represent frequently
Name 3 groups of men at increased risk of committing intimate partner violence
Men with anger, substance abuse, or marital problems, or who were abused/witnessed abuse as a child
Name 5 questions/statements that can be given to a woman who you suspect as suffering from intimate partner violence
Has your partner ever physically threatened or hurt you?
Is there tension in your relationship? How do you resolve arguments?
Sometimes partners react strongly in arguments and use physical force. Is this happening to you?
Are you afraid of your partner?
Violence is very common in the home. I ask a lot of my patients about abuse because nobody should have to live in fear of their partners.
Name 6 risk factors for primary osteoporosis
FHx of fragility fracture Long-term smoking High alcohol intake Vitamin D deficiency Low body weight Recurrent falls Low levels of physical activity, or immobility Loss of height, vertebral deformity, kyphosis Premature menopause
Name 6 medical conditions or medications that can cause secondary osteoporosis
Endocrine disorders (Cushing’s, hypogonadism, hyperparathyroidism, hyperthyroidism)
Inflammatory conditions (RA, SLE, Sjogren’s etc)
Malabsorption (coeliac)
CKD or CLD
Previous anorexia
Drugs - corticosteroids, anti-epileptics, aromatase inhibitors, anti-androgen, excess thyroxine
Go through recommendations for prevention of osteoporosis for people of normal risk
12 monthly assessment of risk factors and preventative advice (1200mg/day of calcium, SNAP, falls reduction strategies, sufficient sun exposure for vitamin D) in women over 45 and men over 50
Who is at increased risk of osteoporosis? What are screening/prevention guidelines for these people?
Women over 50 and men over 60 with any risk factors for primary or secondary osteoporosis. Do BMD with DXA scan every 2 years, investigate for secondary causes of OP and manage risk factors
