Preventative Health Screening

Question 1

what is the USPSFT?

Answer 1

the United States Preventitive Services Task Force (USPSTF)

• an indepednent panel of experts in primary care that make screening recommendations which are considered the “gold standard” for clinical prevention

Question 2

explain that grading system of the USPSTF grading sytem

Answer 2

• A = there is a high certainty that there is a substantial benefit of using this recommendation
• B = there is high certainty that the net benefit is moderate
• C = consider, offer this recommendation
• D = moderate/high certainty that the service has no net benefit/has harms that outweight benefits
• E = not enough evidence

Question 3

what are the suggestions of practice for each grade of the UPSPTF grading system?

Answer 3

• A and B = offer or provide this service
• C = offer or provide this service for selected patients depending on individual circumstances
• D = discourage use of this service
• I = not enough evidence.

Question 4

who are considered first degree relatives of an individual?

Answer 4

The parents, brothers, sisters, or children of an individual.

Question 5

what three criteria are important when deciding what conditions to screen for?

Answer 5

• Burden of suffering caused by the condition (is what they’re experience bad enough to warrent screening?
• Effectiveness, safety, and cost of the preventive
intervention or treatment
• Performance of the screening test:

• *Sensitivity**-the true positive rate
• *Specificity**-the true negative rate

Question 6

how prevalent/preventable is CVD?

Answer 6

Question 7

who should be screened for hypertension?

Answer 7

Screen ALL adults aged 18 years or older (A)

Question 8

discuss the USPSTF recommendations of screening for hypertension in terms of

• who to screen?
• what do obtain before starting treatment?
• at what intervasl to screen certain populations

Answer 8

• screen all adults 18 or older
• USPTF recommends measurements outside of a clinical setting before starting treatment
  
  • ABPM: abmulatory BP
  • HBPM: home BP
• screen interval:
  
  • annual screening for
    
    • for adults 40 yrs or older, or
    • those with increased risk of high BP
      
      • overweight, obse, AA
  • every 3-5 years for
    
    • those under 40 (but over 18) with normal BP (135/80) who do not have other risk factors

Question 9

in an asymptomatic patient - should we screen for CVD with an EKG?

Answer 9

no.

the UPSTF against screening with resting or exercise electrocardiography (ECG) to prevent cardiovascular disease (CVD) events in asymptomatic adults at low risk of CVD events. (Grade D)

Question 10

when should we screen patients who use tobacco for CVD?

Answer 10

always

Question 11

what are the 5 As of smoking cessation?

Answer 11

1) ASK every patient about tobacco use
2) ADVISE all tobacco users to quit
3) ASSESS their willingness to attempt to quit
4) ASSIST with attempts to quit
5) ARRANGE follow-up

Question 12

what the does USPSTF recommend in terms of screening for abdominal aortic aneurysms (based on age, gender, medical hx, ect)

Answer 12

 Recommendations:

• 1-time screening with ultrasonography in MEN aged 65-75 years who have ever smoked (Grade B).
• Men who have never smoked- Clinician selection (C)
• Recommends AGAINST screening for AAA in women who have never smoked (D)
• Women who have smoked-evidence is inconclusive (I) 


Question 13

what does the UPSTF recommends

Question 14

what does the USPSTF recommend for screening for carotid artery stenosis (CAOD)?

Answer 14

recommends AGAINST screening for CAOD in an asymptomatic adult population (Grade D)

Question 15

what are the USPSTF screening recommendations with regards to diabetes?

Answer 15

• screen for abnormal blood glucose as a part of a CV risk assessment in adults aged 40-70 years who are overweight/obsese

Question 16

what does the USPSTF recommend in terms of screening for lung cancer?

Answer 16

• annual screening for lung cancer with low-dose computed tomography (LDCT) in adults from 50-80 years who have a 20 pack-year AND currently smoke/have quit within the past 15 years
• screening should BE stopped:
  
  • once a person has not smoked for 15 years
  • develops a health problem that substantially limited life expectancy or the ability/willingess to have curative lung surgery
    
    • _​_Grade B

Question 17

what does the USPTF recommend in terms of screening for breast cancer?

Answer 17

• Mammogram every 2 years for women 50-74 (Grade B)
• Women between 40-49 - who place a higher value on the potential benefit than the potential harms- may choose to begin biennial screening (Grade C)
• 75 years or older - insufficient data (I)
• NOT recommended:
  
  • SBE (self breast exam)
  • Other modalities not recommended above mammography

Question 18

what breast cancer screening protocol the American Cancer Society (ACS) recommend for women with average risk of breast cancer

Answer 18

• guidlines for women of average risk for breast cancer:
  
  • age 40-44: have the choice to start annual mammograns if they choose
  • age 45-50: should get annual mammograms
  • age 55+: screening should continue as long as they remain in good health/are expected to live for at least 10 years.
    
    • for this age group, should get mammograms at least every 2 years, but can do annual screenings if they choose.

Question 19

what breat cancer screening protocol does the _American Cancer Societ_y recommend for high risk women and what does consitutes high risk?

Answer 19

• women who are at a high risk for breast cancer based on the following factrors should get a breast MRI and a mammogram every year starting at 30:
  
  • ​have a lifetime risk of 20-25% or greater based on family history
  • have a known BRCA1 or BRCA2 mutation
  • have a first degree relative with BRCA1/BRCA2
  • had radition therapy to the chest between between 10-30 years or age
  • have li-fruamen, cowden syndrome, bannayan riley or ruvalcaba syndrome

Question 20

the american cancer society recommends against MRI screening for which women?

Answer 20

those whose lifetime risk is less than 15%

Question 21

the USPSTF recommends cervical cancer screening (and what KIND of cervical screening) for which populations

Answer 21

hrHPV = high risk papilloma virus testing

• for women aged 21-29:
  
  • screen every 3 yrs w/ cervical cytology
• for women aged 30-65: screen either
  
  • every 3 yrs w/ cervical cytology, or
  • every 5 yrs w/ hrHPV testing alone, or
  • every 5 years with combination w/hrHPV testing + cytology testing (= cotesting)

note that this recommendation is INDEPENDENT of sexual history.

Question 22

what USPSTF recommends against cervical cancer screening for which populations?

Answer 22

• against screening women > 65 years with adequate prior screening and are not at high risk
  
  • adequate prior screening is either of the following within the past 5 years:
    
    • 3 consecutive negative cytology results
    • 2 consecutive negative co-testing results
• against screening women for who have had a hysterectomy/their cervix removed

Question 23

what does the USPSTF recommend for colorectal cancer (CRC) screening?

Answer 23

starting at age 50-75 yrs

Question 24

what does the USPSTF recommend in terms of Colon Cancer Screening (CRC)?

Answer 24

• Recommends screening for colorectal cancer starting at age 50 years-75 years. (Grade A)
• Age 76-85: individualized (C)
• > 85 NOT recommended (D)

Question 25

what does the ASC (American Cancer Society) recommend for colorectal cancer screening?

Answer 25

Question 26

what are the screening options for CRC?

Answer 26

Stool-based tests:
• Highly sensitive fecal immunochemical test (FIT): every year

• Highly sensitive guaiac-based fecal occult blood test (gFOBT): every year • Multi-targeted stool DNA test (mt-sDNA): every 3 years

Direct visualization:
• Colonoscopy every 10 years

• CT colonography (virtual colonoscopy) every 5 years
• Flexible sigmoidoscopy (FSIG) every 5 years

Question 27

the USPSTF recommends screening for prostate cancer in which patients?

what exam is done to screen for prostate cancer?

Answer 27

Men aged 55-69 years: decision for screening with prostate speciifc antigen (PSA) should be individualized (C)

Question 28

what are the potential harms and benefits of screening for prostate cancer that you should discuss with your patients?

Answer 28

• False-positive require additional testing and possible prostate biopsy
• Overdiagnosis and overtreatment
• Treatment complications: incontinence and erectile dysfunction

Question 29

the USPSTF recommends against screening prostate screening (PSA test) for which patients?

Answer 29

• those 70 or older
• those who do not express a preference for sceening

Question 30

the USPSTF recommends against screening for testicular cancer in what populations?

Answer 30

• in adolescent or adult men (Grade D)

Question 31

what are the non-modifiable risk factors for osteoporosis?

Answer 31

• Age. The older you are, the greater your risk of osteoporosis
• Body size. Small, thin-boned women are at greater risk
• Ethnicity. White and Asian women are at highest risk
• Family history

Question 32

what are the modifiable risk factors for osteoporosis?

Answer 32

• Sex hormones. Abnormal absence of menstrual periods (amenorrhea),
• low estrogen level (menopause), and low testosterone level in men
• Anorexia nervosa. Characterized by an irrational fear of weight gain
• Calcium and vitamin D intake
• Medication use. Long-term use of glucocorticoids
• Lifestyle. An inactive lifestyle or extended bed rest
• Cigarette smoking

Question 33

what osteoporosis protocol does the USPSTF recommend?

Answer 33

• women:
  
  • who to screen:
    
    • every woman aged 65 +
      
      • with bone measurement test (Grade B)
    • women younger than 65 that have increased risk (Grade B)
  • interval: between 4-8 years depending on patient progress
• men: insufficient evidence (Grade I)

Question 34

what is the DXA/DEXA scan?

define the scores.

Answer 34

• = dual energy x-ray absorptiometry (DXA)
  
  • most useful and reliable bone density test
• scores:
  
  • T score of -1 to -25: means opsteopenia
  • T score less than -2.5: osteoporosis
  • T-score of less than -2.5 SD with fragility fractures indicates severe osteoporosis

Question 35

what is the screening protocol for chlamydia as