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Clin Med I > Preventative Med in Adults > Flashcards

Preventative Med in Adults Flashcards

1
Q

Primary prevention

A

remove/reduce disease risk factors; e.g., immunization, giving up or not starting smoking

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2
Q

Secondary prevention:

A

promote early detection of disease or precursor states e.g., routine cervical pap smear

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3
Q

Tertiary prevention

A

limiting impact of established disease e. g., partial mastectomy and RT to remove and control localized breast cancer

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4
Q

Requirements of an Effective Screening Test

A
  • Disease is an important cause of morbidity and mortality
  • Screening can detect disease in early, pre symptomatic phase
  • Screening and treating patients with early disease or risk factors produces better health outcomes than treating patients when they present with symptoms
  • Screening test is acceptable to patients and clinicians - safe, convenient, acceptable false-positive rate, acceptable costs
  • Benefits of early detection and treatment are sufficient to justify potential harms and costs of screening
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5
Q

USPSTF Grading System (prior to May 2007)

A

A: Strongly recommended
B: Recommended
C: No recommendation: fair evidence it can improve health outcomes, but balance of benefit and harm too close to make general recommendation
D: Not recommended-fair evidence of ineffectiveness, or harm outweighs benefits
I: Insufficient data to recommend for or against

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6
Q

Hypertension screening

A

all persons >18 (A)

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7
Q

Height/weight screening

A

all persons: If BMI> 30, offer counseling: AAFP

Screen children over the age of 6

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8
Q

Lipid Disorders screening

A

screen all men >35 and women >45 (A)

                     - screen men 20-35 who are at risk (B)
                     - screen women 20-45 who are at risk (B)
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9
Q

Chlamydia-

A
  • all sexually active non-pregnant women ≤ 24 (A)
    - all older non-pregnant women at increased risk (A),
    - all pregnant women ≤ 24 and older pregnant women of increased risk (B)
    - No screening for men (I)
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10
Q

Syphilis

A

screen all persons at increased risk for syphilis (A)

-screen all pregnant women (A)

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11
Q

Bone density screening

A

women >65 at high risk for osteoporosis (B)
-Women > 65 without a previously known fracture, or secondary cause of osteoporosis
-Screen women than that of a 65 y/o white woman
without other risk factors (B)

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12
Q

Colorectal cancer

A

screen all persons with fecal occult blood testing (FOBT), sigmoidoscopy or colonoscopy > 50 and up to age 75 (A)

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13
Q

Prostate Cancer screening: USPSTF

A

USPSTF recommends AGAINST PSA-based screening for prostate cancer (D)
American Urologic Society, 2013 Guidelines:
-No PSA in men < 40
-No PSA in men at average risk, 40-54 years old
-In men 55-69, PSA screening based on “shared decision-making”
-In men over 70, no screening
If screening, PSA and digital rectal exam (DRE) are complimentary

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14
Q

USPSTF Breast cancer screening

A

biennial screening mammogram women 50-74(B)
Cervical cancer screening: USPSTF recommendations:
Women ages 21-65 with Pap every 3 years
Women ages 30-65 who want to lengthen the screening interval-screen with
a combination of cytology and human papilloma virus (HPV) testing every 5 years (A)

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15
Q

USPSTF recs for screening for Abdominal Aortic Aneurysm

A

Men 65-75 who have ever smoked (B)

Women 65-75: do not screen (D)

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16
Q

Lung cancer screening: National Lung Screening Trial (NLST)

USPSTF

A

Recommending low-dose spiral (helical) CT in the following:
-high risk: > 55, smoked >30 pack years (unless has quit 15+ years)
> 50, smoked >20 pack years + one other risk factor
-No screening recommended in mod/low risk patients
Moderate risk > 50, >20 pack years or 2nd hand smoke, no other risk factors
Low risk: < 50, non-smoker
ALL patients should be asked about tobacco and tobacco product use, and counseled appropriately

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17
Q

Hypertension (high blood pressure)

A

Screening every 2 yrs with BP < 120/80

Screening every year with systolic blood pressure 120-139 or diastolic blood pressure 80-90

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18
Q

Type 2 diabetes (B)

A

Adults with sustained BP >135/80: perform fasting glucose, 2-hr post-load glucose,
HgA1C
ADA recommends FBS, and if FBS > 126 mg/dl, =DM; needs confirmatory testing

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19
Q

HIV screening

A

Rec in all pregnant women and anyone at risk (A)

20
Q

Depression screening

A

Rec in non-pregnant adults (>18) when staff-assisted depression care supports are in place to ensure accurate diagnosis, effective treatment, and follow-up (B)

21
Q

Assess use of alcohol (B)

A

Per AAFP, screening for everyone >18 and desirable to screen in 12-17

22
Q

Chemoprophylaxis

Aspirin (ASA) use for the prevention of CV disease:

A

To reduce MI in men ages 45-79 (A)
To reduce stroke in women ages 55-79 (A)
NOT recommended in men < 45 or women < 55
NOT recommended in anyone over age 80 (l)

“Encourage use when the potential CVD benefits outweigh the potential of a GI bleed.” - no upper GI pain, no history of GI ulcer
NOT RECOMMENDED for prevention of colorectal CA in asymptomatic patients at average age risk: (D)

23
Q

Counseling

USPSTF:

A

Injury prevention = Grade l
Sexual behavior: STD prevention, contraception in adults and sexually active = Grade B
Dental health: regular visits, floss, brush, fluoride
Substance abuse: Tobacco (A), Alcohol (B), Illicit drugs (l)

-Diet and physical activity to prevent CVD- for adults at increased risk (B)
-Women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid (A)
Screening all adults for obesity (B)

24
Q

Smoking

A

single largest preventable cause of disease and premature death in the US

Black males: 20% higher risk than white men
Black women: 10% lower risk than white women
Smokers have twice the risk of fatal heart disease
Smokers have increased risk for other cancers
Smokers have higher incidence of stroke
Smokers have increased risk for bone fractures

25
Q

ATP III (Adult Treatment Panel) classifications for LDL

A

LDL < 100: Optimal
160-189: high
>190: very high

26
Q

ATP III (Adult Treatment Panel) classifications for HDL

A

HDL < 40 low; > 60 high

27
Q

ATP III (Adult Treatment Panel) classifications for total cholesterol

A

Total cholesterol < 200 desirable
200-239: borderline high
> 240: high

28
Q

Four Major Groups that Benefit from Statin Therapy

– Should receive MAX dose

A
  1. Pt w/ history and clinical evidence of ASCVD
  2. Pt 21+ with LDL > 190 mg/dl
  3. Pt w/ DM, ages 40-75 with LDL 70-189 mg/dl and without clin ASCVD
  4. Pt’s ages 40-75, with LDL 70-189 and estimated 10 year risk of ASCVD of 7.5% or greater
29
Q

Alcoholism

A

Screening to detect problem drinking is recommended for all adults > 18 and adolescent patients
CAGE test is sensitive and specific for chronic alcoholism
Have you ever felt the need to Cut down on drinking?
Have you ever felt Annoyed by criticism of you drinking?
Have you ever felt Guilty about your drinking?
Have you ever taken a morning Eye opener?
Two “yes” answers indicates a problem with alcohol

30
Q

Skin Cancer USPSTF

A
  • USPSTF recommends counseling patients aged 10-24 who have fair skin about minimizing their exposure to UV radiation to reduce the risk of skin CA (B)
  • USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of counseling adults >24 about minimizing risks to prevent skin CA (l)
31
Q

Colorectal Cancer Screening

A

Fecal occult blood testing (FOBT):
Guaiac - based test of 3 consecutive bowel movements
avoid NSAID’s, vitamin C, citrus juices, red meat 3 days prior to test
Fecal immunochemical test (FIT): like FOBT but does not require special dietary restrictions
Flexible sigmoidoscopy- direct visualization of rectum and lower portion of colon (sigmoid colon)
Double contrast barium enema–an x-ray image of the entire colon.
Colonoscopy-able to visualize entire rectum and colon, take tissue samples and remove polyps.

32
Q

Colorectal Cancer Screening USPSTF

A

Ages 50-75: screen with FOBT, sigmoidoscopy, colonoscopy
Ages 76-85: do not screen routinely
Ages 85 and over: do not screen

33
Q

Cervical cancer Tx USPSTF

A

Usually occurs in mid-life; most patients are under the age of 50
FDA approved a vaccination against HPV types 6, 11, 16 and 18 (Gardasil®) and one that protects against types 16 and 18 (Cervarix®).
Recommended for girls aged 11-12, but FDA approved for females aged 9-26.
Given as a series of three shots over 6 months.

34
Q

Cervical Cancer screening USPSTF

A

Women 21-65: Pap every 3 years
Women 30-65: Pap plus HPV screening every 5 years
No screening in women 65 if had adequate prior screening and are not high risk
No screening in women who have had hysterectomy with removal of cervix and who did not have a history of high-grade precancerous lesion (CIN grade 2 or 3) or cervical CA
Against screening with HPV testing alone, or in combination with cytology in women <30

35
Q

ACOG Cervical Cancer Screening Recommendations

A

Begin screening at age 21
Women 30 and older: conventional or liquid Pap test every two years
Women 30 and older who have had three consecutive negative tests: can then be screened once every three years
Women with HIV or weakened immune system: screen every year
Stop screening around age 65-70 if woman has had three negative tests in the last ten years
Women who had a hysterectomy for benign reasons do not need to be screened

36
Q

BREAST CANCER

USPSTF Recommendations:

A
  • In women with a family Hx of deleterious mutations in BRCA1 or BRCA2 genes: refer for genetic counseling and evaluate for BRCA gene testing.
  • Biennial (every other year/ every 2 years) screening mammography for women aged 50 to 74 years (B)
  • Insufficient evidence to continue screening women 75 years or older (I)
  • Recommends against teaching breast self-examination (BSE) (D)
  • insufficient evidence for clinical breast examination (CBE) beyond screening mammography in women 40 years or older (I)
  • evidence is insufficient for using either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer (I)
37
Q

BREAST CANCER

ACOG Recommendations

A

Screening mammography every year for women aged 40 years or older
Breast self-examination – for high-risk persons
Clinical breast examination - every 1-3 years for women aged 20-39; annually in persons age 40 years and older

38
Q

USPSTF recs for Hepatitis B screening for people at high risk:

A

High risk individuals should be screened for Hep B-Grade B rec.
High-risk people: Those born in countries and regions with high prevalence of HBV infection; US-born persons not vaccinated as infants whose parents were born in countries and regions with a high prevalence of HBV infection; HIV-positive people, injection drug uses, men who have sex with men, and those living with or having sex with someone with HBV infection; or patients with weakened immune systems or undergoing treatment for kidney failure (hemodialysis).

39
Q

USPSTF HTN screening

A

screen all adults; hypertension commonly diagnosed at 140/90. Must have 2 or more elevated readings, obtained on at least 2 visits over a period of one to several weeks.
Per JNC7: If BP <120/80, screen every 2 years
If systolic BP 120-139 and/or diastolic BP 80-90, screen at least yearly

40
Q

Lipid disorders

A

Screen men > 35, women > 45 who are at risk for CHD
Screen men 20-35, women 20-45 who are at risk for CHD
No rec for or against screening in men 20-35 and women over 20 who are at no risk

41
Q

Prostate cancer: USPSTF

A

USPSTF does not rec screening with PSA; American Urologic Association recommends screening men with average risk, >50, with PSA and DRE

42
Q

Skin cancer USPSTF:

A

counsel fair-skinned patients aged 10-24 about minimizing their exposure to UV radiation to reduce the risk of skin cancer; at-risk patients for melanoma are those who are fair-skinned men and women >65; patients with atypical moles or >50 moles.

43
Q

Chemical dependency USPSTF

A

Grade B recs for screening adults > 18 for alcohol misuse and providing individuals engaged in risky or hazardous drinking with brief behavioral counseling to reduce alcohol misuse, AND providing interventions, including education or brief counseling, to prevent the initiation of tobacco use in school-aged children and adolescents.

44
Q

Breast Cancer screening and preventions USPSTF -risk factors

A
  • Grade B recs for screening women who have family members with breast, ovarian, tubal, or peritoneal cancer (by any of several methods/tools) for BRCA1 and BRCA2 genes. Those who have positive screening results should be referred for genetic counseling and if indicated after counseling, BRCA testing.
  • Women at increased risk for breast cancer and low risk for adverse medication effects should be offered risk-reducing medications (tamoxifen or raloxifene). Grade B
45
Q

Gestation DM

A

Screen for gestational diabetes in asymptomatic pregnant women after 24 weeks gestation. Grade B

46
Q

USPS HTN Tx

A

Hypertension treatment: in non-blacks with HTN: can use thiazide-type diuretic, CCB, ACE or ARB first-line; in blacks (including those with DM): thiazide or CCB as first-line
– In all patients, if goal is not reached within one month of treatment, increase dose of initial drug or add a 2nd; if goal cannot be reached with 2 drugs, add a 3rd. If goal cannot be reached with 3 drugs, can add a 4th from the “alternative” list; consider consulting a hypertension specialist.

Clin Med I (5 decks)

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