Preventative Medicine - MTB Flashcards
Cancer screening test that lowers the most mortality
Mammogram
- mortality benefit greatest > 50 years old
- test should be stated in all women > 50
Clinical breast examination
has no proven benefit
Cervical cancer screening
Pap smear lowers mortality
Pap smear
- cervical cancer screening
- should start at 21 REGARDLESS OF SEXUAL ACTIVITY ONSET
- should be done at least every 3 years until 65
Colonoscopy
- at age 50 years, then every 10 years
Cervical cancer
- Pap smear at age 21, then every 2-3 years
- stop at age 65 unless no previous screening
HPV testing
- right for ASCUS
- If ASCUS is HPV-positive, do colposcopy
Colon cancer screening if family member had the disease
Screening should begin at 40 or 10 years earlier than the family member was diagnosed, whichever is earlier
Hereditary nonpolyposis colon cancer syndrome (HNPCC)
- aka Lynch syndrome
- defined as colon cancer in 3 family members in 2 generations having the disease with 1 having it prematurely (before 50)
- screening should begin at 25 and be done every 1-2 years
Prostate Cancer Screening
- no recommendation to screen patients routinely for prostate cancer either w/ PSA or DRE
- recommendation AGAINST men > 75 on disadvantages of treatment
Indications for influenza vaccination and pneumococcal pneumonia vaccination
- Pts with chronic lung, heart, liver, kidney and cancer
- HIV-positive patients
- Patients on steroids
- Patients with diabetes
Influenza vaccine is recommended yearly in general population. Has greatest benefit following persons:
- Everyone > 50
- Pregnant women
- Health care workers
Pneumococcal vaccine is different from influenza vaccine in that:
- Indicated for patients > 65
- Administered as single injection
Meningococcal vaccination
- is now routine at age 11
- children especially at high risk, who be vaccinated even early
- are those functional or anatomic asplenia
- those with terminal complement deficiency
HPV vaccination
- quadrivalent vaccine that should be administered to ALL FEMALES BTWN 13 and 16
- acceptable in boys
Varicella-Zoster Vaccine
- against the reactivation of varicella zoster (shingles) should be performed in everyone above 60 years
- vaccine is higher-dose form of varicella vaccine given to children
Smoking Cessation
- should be screened for tobacco use and advised against it
- effective method is use oral meds (BUPROPION and VARENICLINE)
- less effective therapies are nicotine patches and gums
Osteoporosis
- should screened with bone densitometry at age 65
Abdominal Aortic Aneurysm
- all men about age 65 who were ever smokers should be screened once with an ultrasound
Diabetes Screening
- routine only in those with hypertension
Hypertension
- all patients above age 18 should have their blood pressure checked at every office visit
Hyperlipidemia
- Men > 35 and women > 45 should be screened for hyperlipidemia
Mammography
- should be done starting at age 40 - 50 every 2 years
- reduction in mortality greatest above 50
- screening can stop at age 75
Who is most likely to benefit an asymptomatic patient with multiple first-degree relatives with breast cancer?
Tamoxifen or raloxifene – result in 50% to 66% reduction in breast cancer
BRCA Testing
- not necessarily beneficial screening test
- positive test means an increased risk of cancer
Cervical Cancer Screening
- Pap smear is done from 21 to 65 years (every 3 yars)
Combined Pap and HPV testing
- starts at ages 30 to 65 stretches the interval to 5 years
Chlamydia screening
- screen women 15 - 25 years old
Capsule endoscopy
- detects small bowel bleeding
- it is not a screening method
Digital rectal exam
- not proven to lower mortality in any disease
- always a wrong choice
Lung Cancer Screening
- no test to lower mortality from lung cancer
- CXR detects many lesions that can be insignificant
Lipid Screening
- recommended for all patients with diabetes, HTN, CAD, or CAD equivalents: carotid disease, peripheral vascular disease, aortic disease
Cholesterol and LDL measurement is recommended for healthy patients when:
- Men > 35
- Women > 45
Hypetension
- indicated for all patients above age 18 at every visit
- screening adults should be done every 2 years
Diabetes Mellitus
- screening for diabetes with fasting blood glucose (2 measurements > 125 mg/dL or HgA1C > 6.5%) is done when patients has:
- hypertension, hyperlipidemia
Two most beneficial vaccine for adults
- Influenza (either inactivated or live attenuated vaccine)
- Pneumococcus
Live attenuated vaccine
- should NOT be used in patients> age 50
Both influenxa and pneumococcal vaccine are recommended for all patients:
- Chronic heart, liver, lung and kidney disease including asthma
- HIV/AIDS
- Steroid users
- Immunocompromised pts such as cancer or functional or anatomic splenia
- Diabetes mellitus
Pneumococcal vaccine indications
- everyone above age 65
- cochlear impant
- CSF leaks
- Alcoholics
- One vaccine ABOVE 65 ONLY
- Single revaccination after 5 yrs if patient is immunocompromised or if first injection is before 65
Influenza vaccine
- everyone yearly
- healthcare workers
- pregnant patients
Herpes (Varicella) Zoster Vaccine
- routinely indicated in all children
- higher dose version of varicella vaccine indicated in all patients above age 60 (prevents post-herpetic neuralgia)
Hepatitis A and B vaccines most benefit in which patients
- Chronic liver disease
Hep A and B vaccines combined indication
- Chronic liver disease
- Men who have sex with men and multiple sex partners
- Household contacts w/ Hep A and B
- Injection drug users
Hep A specific indications
- Travelers to countries of high endemicity
Hep B specific indications
- End stage renal disease (dialysis)
- Healthcare workers
- Diabetes
Tetanus Vaccine
- Td (toxoid) every 10 years
- One Tdap (tetanus w/ acellular pertussis) as one of boosters
- Tetanus immune globulin in those never vaccinated
Meningococcal Vaccine
- routinely indicated at age 11 visit
Also indicated for adults w/ following circumstances - Asplenia
- Terminal complement deficiency
- Military recruits
- Residents of college dorms
- Travelers to Mecca or Medina in S. Arabia for Hajj (pilmrimage)
Strongest indication for meningococcal vaccination
Asplenia
- presents person at high risk for disseminated meningococcal injection
Tetanus immunization for person never vaccinated
Immune globulin
Tetanus immunization in person with dirty wound
Booster after 5 years
Tetanus immunization in clean wound
Booster after 10 years
Osteoporosis
- should be screened with bone densitometry at age 65 with DEXA scan
- Hip fracture in elderly pt carries an extremely high risk
- preventing fracture with bisphosphonates
Abdominal Aortic Aneurysm
- all men above age 65 w/ smoking hx should be screened at least once to exclude aneurysm
- AAA should be repaired if it is wider than 5 cm
- Also screen 65 - 75 w/ family hx of AAA
Domestic Violence
- all pts should be asked about possibility of intimate partner violence
- cannot report injury w/o consent of patient
Alcohol Dependence
- self-diagnosed disease
- ask CAGE
- Feel need to CUT DOWN on drinking?
- Do you get ANGRY when people ask about drinking?
- Do they feel GUILTY about amount drinking?
- Do you feel you need for morning EYE-OPENER?
