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Intro to Clinical Medicine > Preventative medicine > Flashcards

Preventative medicine Flashcards

1
Q

Preventive medicine or disease prevention refers to what?

Why was it developed?

A

measures taken to prevent diseases (or injuries).

Developed to control medical costs as well as to improve the value, quality and outcomes of healthcare.

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2
Q

Barrieres to preventative health?

7

A
  1. Time
  2. Provider training meh
  3. Reimbursement
  4. Lack of office resources for tracking, promoting and performing preventive care
  5. Provider’s professional satisfaction
  6. Patient interest
  7. Lack of support and resources for patients
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3
Q

Primary preventiion?

Example?

A

Intend to avoid the development of disease.
Aspirin to prevent MI to patient without heart disease

Men age:50
Woman for stroke moreso than MI

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4
Q

Seconday prevention?

Example?

A

Attempt to diagnose and treat an existing disease in its early stages and possibly cure it.
Aspirin to someone who has had an MI

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5
Q

Tertiary prevention?

Example?

A

These treatments aim to slow down the disease progression and prevent complications.
-give medications that help to decrease the worsing of the pump funciton on the heart

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6
Q

Two things involved in disease prevention?

A

Focus on risk factors
Testing for early detection of disease
-Different from health promotion

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7
Q

What is health promotion?

A

Empowering people to take control over their own health to improve their life

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8
Q

Top 10 causes of death in the US

A
  1. Heart Disease 611, 105
  2. Cancer 584, 881
  3. Chronic Lower Respiratory Disease (COPD)
    149, 205
  4. Unintentional Injuries 130, 557
  5. Cerebrovascular disease (stroke) 128,978
  6. Alzheimer’s Disease 84,767
  7. Diabetes Mellitus 75,578
  8. Influenza and Pneumonia 56,979
  9. Renal disease 47,112
  10. Suicide 41,149
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9
Q

What does the yearly exam focus on?

A
  1. Past medical, social and family history
  2. Complete physical exam and review of body systems
  3. Review of medications
  4. Immunizations
  5. Counseling/anticipatory guidance/risk factor reduction/interventions
  6. Review of age/gender appropriate screening tests
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10
Q

What is the yearly exam focused on?

A

prevention NOT problem focused

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11
Q

RISE for preventative medicine visits?

A

R Risk assessment (heart disease, cancer, HIV, depression, etc)
I Immunizations
S Screening tests
E Education/counseling

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12
Q

What is involved with education and couseling during a preventative health exam?

A 
dental health, nutrition, exercise
weight management, injury prevention
tobacco use, substance use
HIV prevention, contraception
menopause, mental health
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13
Q

Education?

A

Breast, Testicular Exam
Limiting sun exposure
Use of seat belts
Weight management

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14
Q

Screening?

A 
Blood Pressure
Cholesterol
Diabetes
Osteoporosis
Breast CA
Colon CA
Prostate CA
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15
Q

Risk factors for disease?

3

A

Genes, environment, and behaviors interact with each other to cause disease.

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16
Q

What do environment risk factors include?

A

Environmental risk factors include exposures to harmful agents in food, water and air.

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17
Q

Main risk factors for disease regarding behavior?

2

A

Exercise
Only 25% of adults engage in physical activity as recommended

ETOH and other substance abuse

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18
Q

Exercise recommendations for children?

A

60 min a day

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19
Q

Exercise recommendations for adults?

2

A
  • 150 min a week of moderate intensity aerobic activity OR 75 min/week of vigorous activity
  • PLUS twice weekly muscle strengthening to include major muscle groups
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20
Q

HOw many servings of fruits/veggies per day?

A

5-9

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21
Q

Entire medical history?

A

Past Medical and Surgical History

Family History is CRITICAL

Social History

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22
Q

This we want to know for past medical history?

8

A 
Any medical diagnosis
Any hospitalizations
Surgeries
Injuries/Accidents
Medications – Including OTC & herbal
Allergies – medications (WITH REACTIONS LISTED) and environmental
Immunizations
OB/GYN - Females
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23
Q

Purpose of a medical history?

A

A family medical history can identify people with a higher-than-usual chance of developing common medical disorders

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24
Q

Common medical disorders in family history?

6

A 
Heart disease
Hypertension
Diabetes
Cancer
Coagulation disorders
Mental health disorders
Health of first degree family members
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25
Q

The more people with disease in the family =

A

The higher the prevalence/higher chance for that patient to have it

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26
Q

Definition of diabetes

A

Metabolic disorder that results in defects in the secretion of insulin, its action or both.

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27
Q

Type 1 diabetes

A

No production of insulin
Autoimmune disease
About 5% of diabetics

Not always juvenile onset. Its an autoimmune disease so it can develop later in life

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28
Q

Type 2 diabetes

4

A

Deficient production or improper utilization of insulin

Generally initiates after 30 years of age

Some type 2 diabetes is happening in teens

Can have a strong genetic component (even though they are doing the right things they might get it)

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29
Q

Diabetes screening is veru important why?

5

A 
If we can find it early decrease risk of
4-fold more likely to have a MI
8-fold more likely to die from first MI
Leading cause of blindness ages 20-74
Most common cause of kidney disease
#2 cause of amputations
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30
Q

The higher the BMI =

A

More people that have the disease

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31
Q

Risk factors for DM?

A 
Family History
(BMI > 25)
Race/Ethnicity (African-American, Hispanic-American, Native Americans, Asian Americans, Pacific Islanders)
Age > 45
Hypertension (> 140/90) - poor vascular health that goes along with diabetes
HDL Cholesterol  250 high
History of GDM (gestational diabetes)
History of Macrosomia (Given birth to a baby over ten lbs)
Polycystic Ovarian Disease
Previous Abnormal Screening
Physically Inactive
Vascular Disease
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32
Q

DM screening recommendations for adults

A

BMI ≥ 25 + one or more risk factors

Test every one to three years

33
Q

When do we screen without risk factors?

A

ithout risk factors screen at 45 years old and older

Test evrey one to 3 years

34
Q

What does the A1c tell us?

A

want to be around 7

35
Q

How long does the A1C tell us our glucose levels for?

A

for three months that how long a RBC lasts

36
Q

Who needs to be screened more often?

A

prediabetics
A1C at 5.7 or up
FFG at 100 or up
OGTT at 140 or up

37
Q

Retesting: If results are normal and no risk factors

A

Then retest in 3 years

38
Q

How do we confirm diabetes?

A

have two of the three tests above the limit

39
Q

Restesting: If results are normal + risk factors?

A

retest in a year

40
Q

If results indicate prediabetes how often do we retest?

A

yearly

41
Q

Heart disease risk factors?

A 
Atherosclerosis
Diabetes
Chronic kidney disease
Hyperlipidemia
Hypertension
Smoking
Overweight
Excessive alcohol intake
Sedentary lifestyle
Advancing age
Family history
Diet high in saturated fat,    sugars and low in fruits and vegetables
Abdominal obesity
42
Q

Who should take aspirin primary prevention for a heart attack and how much?

A

Men age 45-79

Daily aspirin with dose 75-100mg

43
Q

Who should take aspirin for primary prevention of ischemic stroke?

A

Women age 55-79
Dose 75-100mg

For the average healthy person taking an aspirin for 20 years would be harmful

44
Q

What type of risk factors would go into this decision making?
5

A
  1. Bleedingdisorder/hemorrhagic stroke
  2. Aspirin allergy
  3. GI bleeding
  4. Cant clot from liver disease
  5. People who are too old-higher risk for GI bleed, falls causing bleeding
45
Q

Hypertension leads to what?

4

A

Premature death
Heart attack
Stroke
Chronic kidney disease

46
Q

Hypertension guidleines?

A

Systolic BP > 150 mmHg
Diastolic BP > 90 mmHg
2 or more readings at least a week apart

Either can be high individually to diagnose hypertension. This is hard to treat though - more likely to have dizziness, light headedness, falls

47
Q

What is the leadiing reason for office visits?

A

hypertension

48
Q

Leading contributor to death through what?

A

MI
Stroke
Vascular disease

Vessels take a toll

49
Q

What can you do without taking medication?

7

A

Decrease sodium intake, decrease ETOH,
increase potassium, increase physical activity, weight loss,
stress management, treatment of sleep apnea

50
Q

Things that could be causing hypertension?

5

A 
stress
obesity
sleep apnea
undiagnosed diabetes
kidney disease- not getting enough perfusion
51
Q

Screening recommendations for lipid disorders?

5

A
  1. Routinely screen (healthy) men 35 and women 45 y.o. for lipid disorders and treat if at increased risk for CHD
  2. Routinely screen men age 20-35 and women age 20-45 if other risk factors present (obesity etc)
  3. Screen with total cholesterol and high density lipoprotein levels
  4. Insufficient evidence for or against triglyceride screening
  5. Interval (5 years?) and upper age limit (65?) not specified. This is usually much more frequently. If youre going to have it you should have it diagnosed by then
52
Q

Purpose for social history taking?

A
  1. Facilitates you getting to know and remember the patient
  2. Helps to assess risk factors for certain diseases
  3. Important aspect of caring for patients
  4. Includes marital status, employment status, habits (exercise and substance use), sexual history, hobbies, travel history, military history etc
53
Q

What is the leading cause of preventable and premature death?

A

tobacco use

Make sure to ask about tobacco use not just smoking- chew

54
Q

How often do you document tobacco use?

A

Tobacco use status needs to be documented for every visit (ACA)

55
Q

What do we record about tobacco use? specifics

4

A
  1. List the number of years smoked or chewed
  2. Packs per day/cans per week
  3. Calculate pack years (#ppX#years smoked)
    (1 pack per day for 30 years = 30 pack year)
  4. Number of years quit
56
Q

Types of tobacco cessation treatment?

5

A
  1. Gradual and scheduled decrease
  2. Nicotine replacement
  3. Medications
  4. Cessation programs, support groups
  5. Hypnosis, acupuncture, individual counseling
57
Q

Steps in process for tobacco counseling?

6

A 
Assess readiness to quit
Set a target date
Barriers to success in the past
What has/hasn’t worked in the past
What support do they have
What method do they think will work
58
Q

Where do you document marijunana use?

A

Medications and social history. Make sure you ask how much they use

59
Q

What to ask about alcohol use?

A

Frequency, amount, perception of problem, problems with alcohol in the past

60
Q

What is asked in the CAGE questionnaire?

A
  1. Have you ever felt you should Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt bad or Guilty about your drinking?
  4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

Cut down
Annoyed
Guilty
Eye-opener

61
Q

If you have a score of 2 and over on Cage what does that tell you?

A 
Score of ≥ 2
Identification of excessive drinking
Specificity 76%
Sensitivity 93%
Identification of alcoholism
Specificity 77%
Sensitivity 91%
62
Q

Have they used street drugs or prescrition drugs poorly?

what to ask

A
  1. Pursue if evidence suggests a problem
  2. Early intervention needed for success
  3. Greatest success is with cessation as well as intense counseling
  4. If theyve had a drug abuse histiry they may not want you to prescribe narcotics
63
Q

There are two main categories of sexual history taking:

A

1) A risk assessment of acquisition of a sexually transmitted infection including:
GC, Chlamydia, Syphilis, HIV, HSV, Condyloma

2) An assessment of sexual dysfunction

64
Q

Top 6 reasons for taking a sexual history

A
  1. To identify need for screening for infection.
  2. To assess risk of patient’s acquisition of infection.
  3. To assess risk of transmission of infection.
  4. To assess risk of pregnancy.
  5. To educate about the patient’s sexual health.
  6. To identify which clinical specimens need to be obtained.
65
Q

How do we address sexual partners?

A

Are you sexually active?

  1. It is important to establish if there have been other partners.
  2. “ When did you last have a partner other than the one you are currently with?” It covers all eventualities without implying any assumptions
  3. How many partners have you had in the last three months.
  4. Then establish the gender of the other partner, condom use and method of birth control
66
Q

What are the immunizations you need as a child?

Don’t need to know all for this talk but good to go over

A 
Hepatitis B
DTaP, DT, Td, Tdap
Polio
HPV
Varicella
MMR
Influenza (TTV, LAIV)
Rotavirus
Hib- influenza
Pneumococcal (PCV,PPV)
Hepatitis A
Gardasil
Meningococcal (MCV4, MPSV4)
67
Q

What are the immunizations you need as an adult?

Don’t need to know all for this talk but good to go over

A 
Tetanus, diphtheria, pertussis (Td/Tdap)
Human papillomavirus (HPV)
Measles, mumps, rubella (MMR)
Influenza
Pneumococcal 
Hepatitis A
Hepatitis B
Meningococcal
Varicella
Gardasil- dependant on risk factors (age, type of sexual relationship)
68
Q

When should self breast exams start and how often?

What is a BSE and CBE?

A

monthly and at age 20

Self breast exam
clinician breast exam

69
Q

When should self testicular exams start and how often?

A

monthly and at age 15

70
Q

What are the three categories of skin cancer?

A

Basal cell
Squamous cell
Melanoma

71
Q

Risk factors for osteoporosis?

5

A

female,
age,
Caucasian,
low body weight, & bilateral oophorectomy

72
Q

When should we screen people for osteoporosis?

A

Screen women aged ≥ 65 and men ≥ 70

Screen at a younger age if risk factors

73
Q

60 year old African American female presents for a wellness visit
Both of Shirley’s parents had developed Type 2 DM by the time they were 60.
Should she be concerned about her family history of diabetes?

A

Race plays factor
Parents health plays a factor
should she be concerned: yes

74
Q

shirley has a BMI of 32. She is 5’4” and weighs 180 lbs.

Should her family history of diabetes combined with her weight concern her?

A

High BMI
combination should be concerning

At least three risk factors combined

75
Q

What are your recommendations for Shirly?

A
  1. screening for diabetes test = A1C or FPG
  2. Lipid panel
  3. Breast Exam= BSE, CBE, mammo
  4. Colonoscopy
  5. When did you go through menopause and have you have bleeding
  6. doesnt smoke
  7. pap smear and pelvic exam
  8. Nutritional counseling
  9. not active- exercise counseling
  10. check blood pressure
  11. Should reccommend a daily aspirin
76
Q

Signs of endometrium cancer?

A

period like bleeding after women have been thorugh menopause

77
Q

What should you do for prostate screening?

A

Talk to your patient about the risk factors and have a discussion about screening and what it could cause. Very slow growing cancer

78
Q

Main cause of melanoma

A

too much UV exposure

79
Q

What else do we want to know about swirly?

A 
diet
tobacco and alcohol use
cholesterol
exercise
hypertension
previous screenings
(preventative health)
high blood glucose
Want to know everything about her!!!!

Intro to Clinical Medicine (12 decks)

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