Preventative Medicine

Question 1

breast cancer screening

Answer 1

• mammography
• start at age 50
• stop at age 75

-self examination is NOT recommended

Question 2

tamoxifen

Answer 2

prophylaxis tx for asymptomatic women with multiple first-degree relatives

• inc DVT and PE and endometrial cancer risk
• dec risk of fractures

Question 3

trastuzumab

Answer 3

• tx for HER2/neu breast cancer

- not prophylactic

Question 4

Pap smear

Answer 4

• start at age 21
• every 3 years until age 30
• after age 30: combing e with HPV and test every 5 years
• stop at age 65

Question 5

colon cancer screening

Answer 5

• colonoscopy starting at age 50
• repeat every 10 years

-FHx: age 40 or ten years before relative’s px

Question 6

HNPCC

Answer 6

• 3 relatives, 2 generations, 1 premature

- colonoscopy starting at age 25, ever 1-2 years

Question 7

famililal adenomatous polyposis screening

Answer 7

sigmoidoscopy (since polyps are through ENTIRE colon)

-start at age 12 and then every year

Question 8

prostate cancer screening

Answer 8

NONE

• PSA tracks current disease, but does not reduce mortality
• DRE does not reduce mortality

Question 9

lung cancer screening

Answer 9

NONE

Question 10

osteoporosis screening

Answer 10

• DEXA scan
• 1 SD below average = osteopenia
• 2 SDs below average = osteoporosis

-women at age 65

Question 11

lipid screening

Answer 11

• men age 35

- women age 45

Question 12

lipid goals?

Answer 12

HDL > 40

LDL < 100 for CAD & equivalents
LDL < 70 for CAD + DB

Question 13

CAD equivalents

Answer 13

carotid disease
peripheral artery disease
DB
aortic disease

Question 14

DB screening

Answer 14

-fasting blood glucose > 126
-oral glucose tolerance test > 200
Hgb A1C > 6.5%

Question 15

abdominal aortic aneurysm screening

Answer 15

• all men 65-75

- any smoking history

Question 16

alcoholism screening

Answer 16

• self diagnosed

- CAGE questions: cut down, annoyed about questions, guilt

Question 17

influenza vaccine =

Answer 17

• influenza A and B
• strains from previous year
• inactived (killed) injection
• healthcare workers, pregnant, elders

Question 18

pneumococcal vaccine

Answer 18

-protects against Strep pneumonia

• splenectomy pts
• chronically ill (respiratory, heart, kidney, liver disease)
• 65+
• one revaccination after 5 years

Question 19

herpes zoster vaccine

Answer 19

• protects against shingles
• reduces incidence & severity
• to avoid post-shingles neuropathy
• 60+

Question 20

hepatitis A vaccine

Answer 20

given to those with chronic liver disease, MSM, IV drug users, infected close contacts, travelers

Question 21

hepatitis B vaccine

Answer 21

given to those with chronic liver disease, MSM, IV drug users, healthcare workers, dialysis patients, DIABETICS

Question 22

tetanus toxoid booster (Tdap)

Answer 22

• booster after 10 years
• 5 years after a dirty wound

-Ig is for unvaccinated patients who are exposed to dirt

Question 23

meningococcal vaccination

Answer 23

• children age 11
• splenectomy pts
• sickle cell pts
• military, college dormitories