Preventative Medicine/Herbal Supplements

Question 1

Breast CA screening guidelines

Answer 1

started at age > 50
Every 1-2 years
Stop at age 75

Question 2

When to do breast cancer screening in age 40-49?

Answer 2

2 first degree relatives w/ breast CA (1 before age 50)
1st degree relative w/ B/L breast CA
Male relatives w/ breast CA
≥ 3 1st or 2nd degree relatives w/ breast CA
1st or 2nd degree relative w/ breast and ovarian CA

Question 3

Which drugs can be used to decrease the risk of breast CA in asymptomatic pts w/ multiple 1st degree relatives w/ breast CA

Answer 3

Tamoxifen

Raloxifen

Question 4

Cervical CA screening guidelines

Answer 4

Pap smear at age 21
Stop at age 65
From age 21-29 = Pap only every 3 years
From age 30-65 = Pap only every 3 years OR Pap+HPV testing every 5 years

Question 5

HPV vaccine ages for male vs female

HPV CI

Answer 5

Male: 11-21
Female: 11-26

HPV CI in pregnant pts and those w/ severe hypersensitivity rxn to yeast

Question 6

Colon CA screening guidelines

Answer 6

Begin at age 50
Colonoscopy every 10 yrs

If have family member w/ disease – > start at age 40 or 10 yrs earlier than family member was dx (whichever is earlier), every 3-5 yrs

HNPCC (3 family members, 2 generations, 1 family member before age 50) –> start at age 25, every 1-2 yrs
- associated w/ ovarian and endometrial CA

FAP –> start at age 12, every 1-2 yrs

• increased risk of gastric and duodenal CA so do endoscopy
• develop colon CA by age 45 if don’t get colectomy

Question 7

Intervals for F/U Colonoscopy After Colectomy

Answer 7

Small, rectal hyperplastic polyps –> 10 yrs
1 or 2 small (<1 cm) tubular adenomas –> 5 yrs
3-10 adenomas, any adenoma >1cm, high grade dysplasia, villous adenoma –> 3 yrs
>10 adenomas –> <3 yrs

Large (>2cm) sessile polyp removed by piecemeal excision –> 2-6 months
Polyp w/ adenoCA (must have minimal invasion and ≥2mm margin) –> 2-3 months

Question 8

Recommendations of Screening w/ Previous Hx of Colon CA

Answer 8

Colonoscopy at year 1 after resection, then at 3 yrs, then every 5 yrs
CT abd/pelvis/chest yearly
CEA every 3 months for 3 yrs

Question 9

Pneumococcal vaccine schedule

Answer 9

See pneumococcal vaccine schedule

Question 10

Diabetes Diagnostic Criteria for Sugar/ HgA1C

Answer 10

HgA1C ≥ 6.5%
2 fasting glucose levels ≥ 126
random glucose level ≥ 200 + sxs
2 hr post-load glucose level ≥ 200

***Screen for DM in pts w/ HTN

Question 11

Hyperlipidemia Screening Guidelines

Answer 11

Men > 35, Women > 45 (screen earlier if pt has additional CV RFs eg. HTN)
Screen every 5 yrs

Question 12

Tests in HTN Pts

Answer 12

U/A --> proteinuria 
Fasting glucose --> DM
Electrolytes, Cr --> CKD 
ECG --> LVH
Fasting lipid panel --> hyperlipidemia

Question 13

Tetanus vaccine guidelines

Answer 13

Td booster every 10 yrs (replace one dose w/ Tdap)

If never got vaccine before, give tetanus vaccine today, repeat in 1 month and again in 12 months

Question 14

Tetanus PPX

Answer 14

≥ 3 tetanus toxoid doses + clean wound
= tetanus toxoid vaccine ONLY if last dose was ≥ 10 yrs ago
≥ 3 tetanus toxoid doses + dirty wound
= tetanus toxoid vaccine ONLY if last dose was ≥ 5 yrs ago
Unimmunized, uncertain or <3 tetanus toxoid doses + clean wound
= tetanus toxoid vaccine ONLY
Unimmunized, uncertain or <3 tetanus toxoid doses + dirty wound
= tetanus toxoid vaccine + TIG

Question 15

Herbal Supplements w/ SE of bleeding risk

Answer 15

Black Cohosh (post-menopausal sxs) 
Ginkgo biloba (memory)
Ginseng (mental performance) 
Garlic (hypercholesterolemia) 
Horse chestnut (venous insufficiency) 
Saw palmetto (BPH)

Question 16

Herbal Supplements w/ SE of hepatic damage

Answer 16

Black Cohosh

Kava (anxiety, insomnia)

Question 17

Use and SE of St.John’s Wort

Answer 17

Use –> depression, insomnia

SE –> drug interactions, serotonin syndrome, decreased efficacy of OCPs, decreased INR, hypertensive crisis

Question 18

Herbal Supplements w/ SE of HTN

Answer 18

Licorice (stomach ulcers, bronchitis)

Ephedra (tx of cold, flu, weight loss, improved athletic performance)

Question 19

Use and SEs of Licorice (prevents conversion of cortisol to cortisone)

Answer 19

Use –> stomach ulcers, bronchitis

SEs:
HTN
Hypokalemia
Metabolic acidosis

Question 20

Use and SE of Echinacea

Answer 20

Use –> tx and prevention of cold and flu

SE:
Anaphylaxis

Question 21

Use and SE of Ephedra

Answer 21

Use –> tx of cold and flu; w. loss and improved athletic performance

SEs: 
HTN
Arrhythmia/ MI/ sudden death 
Stroke 
Seizure 

NOTE: Ephedra banned in USA

Question 22

Herbal Supplements for tx of cold and flu

Answer 22

Echinacea

Ephedra