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.
2
Q
Barrieres to preventative health?
7
A
- Time
- Provider training meh
- Reimbursement
- Lack of office resources for tracking, promoting and performing preventive care
- Provider’s professional satisfaction
- Patient interest
- Lack of support and resources for patients
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
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
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
6
Q
Two things involved in disease prevention?
A
Focus on risk factors
Testing for early detection of disease
-Different from health promotion
7
Q
What is health promotion?
A
Empowering people to take control over their own health to improve their life
8
Q
Top 10 causes of death in the US
A
- Heart Disease 611, 105
- Cancer 584, 881
- Chronic Lower Respiratory Disease (COPD)
149, 205 - Unintentional Injuries 130, 557
- Cerebrovascular disease (stroke) 128,978
- Alzheimer’s Disease 84,767
- Diabetes Mellitus 75,578
- Influenza and Pneumonia 56,979
- Renal disease 47,112
- Suicide 41,149
9
Q
What does the yearly exam focus on?
A
- Past medical, social and family history
- Complete physical exam and review of body systems
- Review of medications
- Immunizations
- Counseling/anticipatory guidance/risk factor reduction/interventions
- Review of age/gender appropriate screening tests
10
Q
What is the yearly exam focused on?
A
prevention NOT problem focused
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
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
13
Q
Education?
A
Breast, Testicular Exam
Limiting sun exposure
Use of seat belts
Weight management
14
Q
Screening?
A
Blood Pressure Cholesterol Diabetes Osteoporosis Breast CA Colon CA Prostate CA
15
Q
Risk factors for disease?
3
A
Genes, environment, and behaviors interact with each other to cause disease.
16
Q
What do environment risk factors include?
A
Environmental risk factors include exposures to harmful agents in food, water and air.
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
18
Q
Exercise recommendations for children?
A
60 min a day
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
20
Q
HOw many servings of fruits/veggies per day?
A
5-9
21
Q
Entire medical history?
A
Past Medical and Surgical History
Family History is CRITICAL
Social History
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
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
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
25
The more people with disease in the family =
The higher the prevalence/higher chance for that patient to have it
26
Definition of diabetes
Metabolic disorder that results in defects in the secretion of insulin, its action or both.
27
Type 1 diabetes
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
28
Type 2 diabetes
| 4
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)
29
Diabetes screening is veru important why?
| 5
```
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
```
30
The higher the BMI =
More people that have the disease
31
Risk factors for DM?
```
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
```
32
DM screening recommendations for adults
BMI ≥ 25 + one or more risk factors
Test every one to three years
33
When do we screen without risk factors?
ithout risk factors screen at 45 years old and older
Test evrey one to 3 years
34
What does the A1c tell us?
want to be around 7
35
How long does the A1C tell us our glucose levels for?
for three months that how long a RBC lasts
36
Who needs to be screened more often?
prediabetics
A1C at 5.7 or up
FFG at 100 or up
OGTT at 140 or up
37
Retesting: If results are normal and no risk factors
Then retest in 3 years
38
How do we confirm diabetes?
have two of the three tests above the limit
39
Restesting: If results are normal + risk factors?
retest in a year
40
If results indicate prediabetes how often do we retest?
yearly
41
Heart disease risk factors?
```
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
Who should take aspirin primary prevention for a heart attack and how much?
Men age 45-79
| Daily aspirin with dose 75-100mg
43
Who should take aspirin for primary prevention of ischemic stroke?
Women age 55-79
Dose 75-100mg
For the average healthy person taking an aspirin for 20 years would be harmful
44
What type of risk factors would go into this decision making?
5
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
Hypertension leads to what?
| 4
Premature death
Heart attack
Stroke
Chronic kidney disease
46
Hypertension guidleines?
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
What is the leadiing reason for office visits?
hypertension
48
Leading contributor to death through what?
MI
Stroke
Vascular disease
Vessels take a toll
49
What can you do without taking medication?
| 7
Decrease sodium intake, decrease ETOH,
increase potassium, increase physical activity, weight loss,
stress management, treatment of sleep apnea
50
Things that could be causing hypertension?
| 5
```
stress
obesity
sleep apnea
undiagnosed diabetes
kidney disease- not getting enough perfusion
```
51
Screening recommendations for lipid disorders?
| 5
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
Purpose for social history taking?
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
What is the leading cause of preventable and premature death?
tobacco use
| Make sure to ask about tobacco use not just smoking- chew
54
How often do you document tobacco use?
Tobacco use status needs to be documented for every visit (ACA)
55
What do we record about tobacco use? specifics
| 4
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
Types of tobacco cessation treatment?
| 5
1. Gradual and scheduled decrease
2. Nicotine replacement
3. Medications
4. Cessation programs, support groups
5. Hypnosis, acupuncture, individual counseling
57
Steps in process for tobacco counseling?
| 6
```
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
Where do you document marijunana use?
Medications and social history. Make sure you ask how much they use
59
What to ask about alcohol use?
Frequency, amount, perception of problem, problems with alcohol in the past
60
What is asked in the CAGE questionnaire?
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
If you have a score of 2 and over on Cage what does that tell you?
```
Score of ≥ 2
Identification of excessive drinking
Specificity 76%
Sensitivity 93%
Identification of alcoholism
Specificity 77%
Sensitivity 91%
```
62
Have they used street drugs or prescrition drugs poorly?
| what to ask
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
There are two main categories of sexual history taking:
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
Top 6 reasons for taking a sexual history
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
How do we address sexual partners?
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
What are the immunizations you need as a child?
Don't need to know all for this talk but good to go over
```
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
What are the immunizations you need as an adult?
Don't need to know all for this talk but good to go over
```
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
When should self breast exams start and how often?
What is a BSE and CBE?
monthly and at age 20
Self breast exam
clinician breast exam
69
When should self testicular exams start and how often?
monthly and at age 15
70
What are the three categories of skin cancer?
Basal cell
Squamous cell
Melanoma
71
Risk factors for osteoporosis?
| 5
female,
age,
Caucasian,
low body weight, & bilateral oophorectomy
72
When should we screen people for osteoporosis?
Screen women aged ≥ 65 and men ≥ 70
| Screen at a younger age if risk factors
73
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?
Race plays factor
Parents health plays a factor
should she be concerned: yes
74
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?
High BMI
combination should be concerning
At least three risk factors combined
75
What are your recommendations for Shirly?
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
Signs of endometrium cancer?
period like bleeding after women have been thorugh menopause
77
What should you do for prostate screening?
Talk to your patient about the risk factors and have a discussion about screening and what it could cause. Very slow growing cancer
78
Main cause of melanoma
too much UV exposure
79
What else do we want to know about swirly?
```
diet
tobacco and alcohol use
cholesterol
exercise
hypertension
previous screenings
(preventative health)
high blood glucose
Want to know everything about her!!!!
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