Preventive medicine

Question 1

HTN screening

Answer 1

USPSTF guideline:
screen adults for HTN
there is no particular interval

JNC7: check BP once at least every 2 years beginning at age 18

Question 2

Cholesterol screening

Answer 2

Men- age 35
Women- age 45
Screen every 5 years

Question 3

Smoking cessation

Answer 3

Counseling to quit at every encounter:

• ask, assess, advise, assist, arrange
• set a precise quit date while in clinic- instruct patient to throw away all smoking paraphernalia including ash trays and lighters
• offer American Cancer Society quitline: 1-800-ACS-235
• Offer prescription therapies to help them quit

Nicotine replacement doubles the quit rate

• much higher efficacy when used with buproprion
• available as patch, gum, inhaler, nasal spray, lozenge

Prescription therapies help people quit smoking

• Varenicline: side effects include nausea, suicidal thoughts, bizarre dreams
• Buproprion, more effective if used with nicotine replacementl side effects include dry mouth, weight loss, contrasindications include seizure disorder, pregnancy, eating disorders

Question 4

Preventive medicine for ages 50-65

Answer 4

History and counseling:

• ask about smoking and alcohol use
• remind about exercise, high fiber, sunscreen (SPF15), seat belts, high-risk behavior
• ask about depression, assault/abuse, advance directive/will
• dental exam/cleaning q6 months- 1 year
• daily MVI, calcium 1200 mg/day, and vitamin D > 600 IU/day
• flu shot annually
• tetanus-diphtheria booster (Td or Tdap) q 10 years. Use Tdap instead of Td if no previous Tdap
• Zostavax once after age 60, regardless of shingles history
• Consider ASA 81mg qD (to help prevent MI, stroke, colon CA)
• proven benefit if 10 year MI risk is >10%, or annual MI risk is >1%
• women who take ASA had a 25% decrease in deaths from all causes

Labs/studies:

• FOBT q1yr
• Colonoscopy q10yrs or flex sig/BE q3-5 years
• TSH q5yrs
• consider glaucoma screening q1-5 years (esp blacks)
• consider EKG q5yrs
• consider regular chem14, UA, and CBC (q1-5 yrs)
• Consider regular Chem 14, US, and CBC (q1-5 yrs)
• HIV test (ages 15-65; no frequency given)

Question 5

WOmen>50yo

Answer 5

mammogram
USPSTF-every 2 years
other organizations recommend annual screening

no cut-off

Question 6

increased RBC fragility

Answer 6

Vitamin E deficiency

Question 7

Dermatitis, cheilosis, glossitis

Answer 7

Vitamin B2, B3, B9-folate, B12 deficiency

Question 8

peripheral neuropathy, angular cheilosis, glossitis

Answer 8

Vitamin B12 deficiency

Question 9

Hemorrhagic disease

Answer 9

Vitamin K deficiency

Question 10

NTD

Answer 10

B9 (folate) deficiency

Question 11

Dermatitis, diarrhea, dementia

Answer 11

niacin (B3) deficiency

Question 12

megaloblastic anemia

Answer 12

B12, folate (B9) deficiency

Question 13

Pernicious anemia

Answer 13

B12 deficiency

Question 14

Bitot’s spots, keratomalaxia, xerophthalmia

Answer 14

VitA deficiency

Question 15

Osteomalacia

Answer 15

vit D deficiency

Question 16

rickets

Answer 16

vit D deficiency

Question 17

When to start screening for high cholesterol in otherwise healthy patients

Answer 17

men-age 35

women- age 45

Question 18

when to start screening for HTN in normotensive patient

Answer 18

every 2 years, starting at age 18

Question 19

which smoking cessation med has a side effect of suicidality?

Answer 19

Varenicline

Question 20

what topical vitamins can treat psoriasis?

Answer 20

topical vit D analogs

vitamin A