Prevention in General Practice Flashcards
_________may be defined as the means of promoting
and maintaining health or averting illness
Prevention
It is concerned with removal or reduction of
risks; early diagnosis; early treatment; limitation of
complications, including those of iatrogenic origin;
and maximum adaptation to disability
Prevention
________includes action taken to avert the
occurrence of disease. As a result there is no disease.
Primary prevention
_________ includes actions taken to stop or
delay the progression of disease.
Secondary prevention
Secondary prevention applies measures for
the detection of disease at its earliest stage, i.e. in
the ___________ so that treatment can be
started before irreversible pathology is present
presymptomatic phase,
_______ includes the management of
established disease so as to minimise disability
Tertiary prevention
Conceptually, curative medicine falls within the
definitions of secondary and tertiary prevention
while _______ measures are mainly concerned
with primary prevention
public health
As GPs our role in prevention is twofold.
1 First, we can recognise the ________
that are involved in an illness process and
determine appropriate interventions.
2 Second, we can act to implement the _____
preventable factors
preventive
measure.
Conditions can be ranked in importance as causes of
premature death according to the ‘person-years of life
lost before 70 years’
- _________29%
- Neoplasms 19%
- ____________s 17%
- Perinatal conditions 10%
- ___________ 7%
Accidents, poisoning and violence
Circulatory disease
Congenital conditions
The Royal College of General Practitioners (UK)
has identified the seven most important opportunities
for prevention as:
1 family planning 2 antenatal care 3 immunisation 4 fostering the bonds between mother and child 5 discouragement of smoking 6 detection and management of raised blood pressure 7 helping the bereaved
The two most
common causes of death in Australia are ______ AND _________, each accounting for
approximately 29% of all deaths.
cancer
and cardiovascular disease
By comparison, the ten leading causes of death
in the world are (in order) ____, _______, ______, _______, _______ HIV/AIDS, cancer, diabetes
mellitus, road injury and prematurity
ischaemic heart disease,
stroke, lower respiratory tract infection, COPD,
diarrhoeal disease,
The World Health Organization (WHO) defines _________as ‘a state of dynamic harmony between the
body, mind and spirit of a person and the social
and cultural influences which make up his or her
environment
good
health
That environmental factors are involved in the
aetiology of _________ and other cancers is
indicated by wide variations in incidence between
different countries
colorectal cancer
Studies in the US indicate that at least 35% of all
cancer deaths are related to _______
diet
Obese individuals have an increased risk
1.
2.
3.
of colon, breast and uterine
cancers.
_______s are a risk factor for prostate,
breast and colon cancers
High-fat diet
Salt-cured, smoked and nitrate-cured foods increase the risk of ________
upper GIT cancers.
Overall, diet, smoking, alcohol and occupational
exposures (5%) appear to account for over _______of all
cancer mortality
73%
The development of a number of cancers appears to
be related to a depression of the individual’s___________particularly in relation to cellular immunity,
in a similar way (albeit on a different scale) to the
effect of HIV infection
immune
system,
a protective effect on the immune system may be provided by:
1
2
3
- food antioxidants
- tranquillity
- meditation
It is worth noting that the death rate from
coronary heart disease is about _______higher for
smokers than for non-smokers and for very heavy
smokers the risk is almost ________ higher.
70%
200%
GPs can estimate the absolute 5-year risks of
cardiovascular events in their patients by referring
to the New Zealand Guidelines Group Cardiovascular
Risk Charts ( www.nzgg.org.nz ).
The parameters used are:
1
2
3
4
5
- gender and age
- smoking status
- diabetes status
- blood pressure
- total cholesterol/HDL ratio
That environmental factors are involved in the
aetiology of ________ and other cancers is
indicated by wide variations in incidence between
different countries.
colorectal cancer
The development of a number of cancers appears to
be related to a depression of the individual’s immune
system, particularly in relation to _______
cellular immunity
The protective effect for asthma and COPD of
___________and other natural
antioxidants is highlighted by Sridhar.
vitamin C, fish oils, a low-salt diet
What are the 6 steps to asthma management
1 Establish the severity of the asthma.
2 Achieve __________.
3 Maintain best lung function—identify and avoid
_______
4 Maintain best lung function—follow an _____
5 Develop an action plan.
6 Educate and review regularly.
best lung function
trigger factors.
optimal
medication program.
In practice, _______ is not only to detect disease at
its earliest stage, but also to find individuals at risk or
those with established disease who are not receiving
adequate care
screening
3 levels of screening
- ________ with risk factors that predispose
to disease - _______ individuals with signs of early
disease or illnes
‘well’ individuals
asymptomatic
_______ individuals whose irreversible
abnormalities are unreported but the effects
can be controlled or assisted (
symptomatic
Important social history
1. 2 3 4 5 6 7 8
- Family history.
- Suicide and accidents.
- Substance abuse
- Exercise and nutrition
- Occupational health hazards
- Physical functioning, home conditions and social
supports. - Sexuality/contraception
- Osteoporosis.
Occupational Health Hazards:
- coal miners—
- gold, copper and tin miners—
- asbestos workers and builders—
- veterinarians, farmers, abattoir workers—
- aniline dye workers—
- health care providers—
• coal miners—pneumoconiosis • gold, copper and tin miners—silicosis • asbestos workers and builders—asbestosis, mesothelioma • veterinarians, farmers, abattoir workers— zoonoses • aniline dye workers—bladder cancer • health care providers—hepatitis B
Fractures of the_______
have a particularly poor prognosis, with up to a third
of these women dying within 6 months
femoral neck
Bone loss accelerates at the time of the menopause, and can be reduced by _______
hormone replacement therapy
Women at risk of osteoporosis are _____________; they drink coffee and alcohol, smoke,
eat a high-protein
short, slim,
Caucasian
________has been estimated to exist in up
to 15% of women aged 60 and above, and searching
for clues may elicit subtle symptoms and signs
previously attributed to ageing.
Hypothyroidism
Screening for children
Height/weight/head circumference:
- Record height from age ______ and weight at regular intervals to age 5 years
- Record head circumference at birth and then up to ________months.
3
6
Hips. Screen for congenital dislocation at birth,
_____weeks, ______ months and _____months
6–8
6–9
12–24
Screening for hip dislocation:
The flexed hips are abducted, checking for
movement and a ‘clunk’ of the femoral head forwards
(the test is most likely to be positive at _______weeks and
usually negative after _______ weeks)
_____ or ______is also abnormal.
3–6
8
Shortening or limited abduction
Strabismus should be sought in all infants and toddlers by ________ (not very sensitive), examining light reflexes and questioning parents, which must be taken very seriously
occlusion testing
_______ can be prevented by early recognition and
treatment of strabismus by occlusion and surgery.
Early referral is essential
Amblyopia
Visual acuity. At_______ and _____, eyes should be
inspected and examined with an ophthalmoscope with
a 3 + lens at a distance of 20–30 cm to detect cataracts
and red reflexes.
birth and 2 months
At 9 months gross vision should
be determined by assessing ability to see common
objects. Visual acuity should be formally assessed at
school entry using _______
Sheridan Gardiner charts
Hearing. Hearing should be tested by ______
at 9 months or earlier; also by _______
at 1000 and 4000 hertz when a child is 4 years
(preschool entry) and 12 years
distraction
pure tone audiometry
Oral health/d ental assessment/fluoride.
Advise daily ______ drops or tablets, if water supply is
not fluoridated
fluoride
Oral health/d ental assessment/fluoride.
Advice should be given on sugar
consumption, especially night-time bottles, and tooth
cleaning with fluoride toothpaste to prevent _____
plaque.
Scoliosis.
Screening of females by the________ test, which is carried out around 12 years
of age, is of questionable value because of poor
sensitivity and specificity
forward flexion
Congenital heart disease.
The heart should be
auscultated at birth, in the first few days, a_________and on school entry
t 6–8
weeks
Femoral pulses.
Testing for absence of femoral
pulses or delay between brachial/femoral pulses at
_______and _____will exclude coarctation of the
aorta.
birth and 8 weeks
Speech and language.
A child’s speech should be
intelligible to strangers by ________years. It is related to
hearing.
3
Screening for adults
Weight should be recorded at least every
few years._________ is a major reversible health risk
for adults, contributing to many diseases
Obesity
Abdominal obesity is a major risk factor for adults.
The ________ ratio is regarded as a
useful predictor of cardiac disease.
waist:hip circumference
Recommended
waist:hip ratios are:
• males _____
• females _______
<0.9
<0.8
Blood pressure. Blood pressure should be recorded
at least every _____ years on all people 16 years and over.
1–2
Cholesterol. All adults aged 45 and over should
have a _____estimation of serum cholesterol
5-yearly
The National Heart
Foundation recommends keeping cholesterol levels
below_______
4.0 mmol/L
Fasting blood glucose. Screen every 3 years for all
patients_______ years of age.
> 40
Women aged 18–70 who have
ever been sexually active should have a __________ every 2 years, or HPV testing according to recommended
national screening guidelines
Pap test
Those over _______ who
have never been screened should have two successive
tests before screening is ceased
70
Risk factors for cervical cancer
- all women who are or ever have been ____
- early age at first sexual intercourse
- multiple sexual partners
- ________ infection
- cigarette smoking
- use of combined oral contraception >5 years
- those with ____ and _____ on Pap tests
sexually active
genital wart virus
LSIL and HSIL
Breast cancer.
__________ should be performed
at least every 2 years on women aged 50–70 years
Mammography
Breast Cancer
It is not useful for screening prior to age 40 years
due to difficulty in discriminating malignant lesions
from _____.
dense tissue
________must not be used alone to exclude cancer if a lump is palpable.
Mammography
Such lesions require a complete appraisal
since, even in the best hands, mammography still has
a false-negative rate of at least_____
10%.
Colorectal cancer (CRC). A history should be taken,
with specific enquiry as to family history of adenomas
or colorectal cancer, past history of ______ and ______
inflammatory
bowel disease and rectal bleeding
Faecal
occult blood testing (FOBT) every 2 years is now
recommended for screening for people over ______
without symptoms and with average or slightly above
average risk.
50 years
Colorectal Cancer
Should a positive history be elicited, then the
following are recommended:
• past history of large bowel cancer or colonic
adenomas—
colonoscopy
Colorectal Cancer
Should a positive history be elicited, then the
following are recommended:
• past or present history of ulcerative colitis—
colonoscopy with biopsies
Colorectal Cancer
Should a positive history be elicited, then the
following are recommended:
• familial polyposis, Gardner syndrome—
sigmoidoscopy or colonoscopy
Apart from FOBT screening, the National Health
and Medical Research Council (NHMRC) currently
recommends ________colonoscopy for people from
25–30 years of age if there is a family history
2-yearly
Family history screening for colorectal CA
• ______ or more first or second degree relatives
with CRC at any age
• two or more first or second degree relatives
diagnosed as CRC _______of age
• a family member where____ studies identify a
high risk
three
<50 years
genetic
Skin cancer, which is increasing in incidence, is
common in Australia, particularly in more northern
areas. _______ and ____in
particular, may be lethal
Squamous cell carcinoma, and melanoma
Patients should be counselled
about cessation of smoking and alcohol consumption,
and dental hygiene should be taught. The oral cavity
should be inspected annually in patients over the age
of ______
40 years.
Although oral cancer has a relatively low incidence,
______ lesions may be detected by inspection
of the oral cavity
premalignant
NHMRC endorses_______ vaccine for all infants and pre-adolescents
(three doses)
hepatitis B
Do not postpone immunisation
for minor illnesses such as _____
Acellular______ vaccine, which reduces the risk of reactions, has become a standard component of triple antigen.
mild URTI.
pertussis
Age Immunisation
Birth: ____
2 months:
4 months DTP, Hib, hepatitis B, polio,
pneumococcus,_______
6 months DTP, polio, Hib, pneumococcus
and _____ and ___
Hepatitis B
DTP, Hib, hepatitis B, polio, pneumococcus, rotavirus
rotavirus
hepatitis B (or at 12 months), rotavirus
12 months:
18 months Varicella, pneumococcus (ATSIP),
measles, mumps, rubella (MMR)
4 years ______
School programs
10–15 years (contact state authorities)
_______
Measles/mumps/rubella (MMR), Hib, meningococcus C and hepatitis B (or at 6 months)
DTP, polio, MMR (if not given at 18 months)
HPV, varicella, DTP (adult), hepatitis B
Common adverse effects are _______,______._____and a local reaction to the injection
irritability, malaise,
fever
________is recommended for fever and local pain;
however, routine use at the time of or immediately
after vaccination is not recommended.
Paracetamol
Children with minor illness
(providing the temperature is______º C) may be
vaccinated safely. Otherwise it should be delayed
<38.0
A simple past _____ and ______ is not a contraindication to
pertussis vaccination
febrile convulsion or pre-existing
neurological disease
Absolute contraindications
include __________ within 7 days of a previous DTP
or an immediate severe or___________to DTP.
encephalopathy
anaphylactic reaction
_______ is
recommended on an annual basis for persons of all
ages with chronic debilitating diseases, especially
chronic cardiac, pulmonary, kidney and metabolic
diseases, persons over 65 years of age, Indigenous
Australian adults over 50 years of age and persons
receiving immunosuppressant therapy.
Influenza immunisation
This should be considered
for the same risk groups as influenza vaccine
Pneumococcal disease.
Those
at higher risk of fatal pneumococcal infection (e.g.
______ and _________), should
receive a booster every 5 years
post-splenectomy or Hodgkin lymphoma
Hepatitis A. Immunisation is recommended for:
• certain ________ at risk (e.g. health
workers, child care workers, sewage workers)
• non-immune __________men
occupational groups
homosexual
Hepatitis A. Immunisation is recommended for:
- those with chronic _____
- recipients of _______
- travellers to hepatitis A endemic areas
liver disease
blood products
Hepatitis B. Immunisation is recommended
routinely for all children at ____, ____,, ______ and ______, and for individuals of all
ages who, through work or lifestyle, may be exposed
to hepatitis B and have been shown to be susceptible
birth, 2 months, 4 months
and at either 6 or 12 months
Booster doses are not
recommended for immunocompetent people but are
recommended for ______ individuals
immunosuppressed
________is recommended for all children, especially those
in child care.
Hib immunisation
It is ideal to achieve immunity by the
age of _______months and preferably commencing at
2 months.
18
Risk factors for Hib disease include ___, _____, _______ and ____
day
care attendance, presence of ill siblings under 6 years
of age in the home and household crowding.
People at reasonable risk from ______
particularly abattoir workers, should be given this
vaccine, which is virtually 100% effective
Q fever,
Both females and males
should be immunised against measles, mumps and
rubella at the age of 12 months and 4–5 years using
the _____
trivalent vaccine.
_________This is available and one dose
is given at 18 months. Those over 12 years have a
course of two injections
Varicella vaccine.
Meningococcal disease
is caused by Neisseria meningitides, which has 13
serogroups of which A, B and C account for over 90%
of isolated cases, with _______ responsible for
most cases.
serogroup B
The main vaccine
that is available is a quadrivalent polysaccharide
vaccine against serogroups _______ for use in
individuals over 2 years as a single injection
A, C, Y and W125
Rotavirus. A course of three oral live attenuated
rotavirus vaccines is given to children to cover a common cause of______
childhood gastroenteritis.
Rotavirus.
Inform parents of the risk of ______ with the first dose
intussusception
Human papilloma virus. A course of three injections
is given to Year 7 (or equivalent) schoolgirls (and boys
in some states), although this is recommended for all
females from ___
9–26 years
