Preventive Medicine

Question 1

Which cancer screening method lowers mortality the most?

Answer 1

Mammography above age 50

• On average, you will detect 10 cases of breast cancer by screening 1000 women above age 50, but only 2 between ages 40-49*
• Statistically more beneficial than colonoscopy or pap smear*

Question 2

What is most likely to benefit an asymptomatic patient with multiple first-degree relatives with breast cancer?

Answer 2

Tamoxifen or raloxifene

Both SERMs result in a 50-66% reduction in breast cancer when compared with placebo

Question 3

True/False

All BRCA positive patients should be offered a prophylactic bilateral mastectomy

Answer 3

False

Management of BRCA positive patients is not universal

Clear benefit in preventing primary tumors by doing a mastectomy, but it will not prevent recurrence in patients who already have cancer

Question 4

Cervical Cancer Screening

Answer 4

Pap smear every 3 years ages 21-30

Combined Pap and HPV every 5 years ages 30-65

Question 5

Is there a mortality benefit in screening prostate cancer with PSA

Answer 5

No

It is only the answer when the patient in the vignette requests it

Question 6

Lung cancer screening

Answer 6

Chest CT annually starting at age 55 in long-term smokers (30 pack-years or more)

Question 7

Lipid screening

Answer 7

Measure cholesterol and LDL in;

men > 35

women > 45

Screen any patient with DM, HTN, or CAD (and its equivalents)

Question 8

Screening for diabetes is done when…

Answer 8

The patient has HTN and/or Hyperlipidemia

Screen with fasting blood glucose (2 measurements over 125 or HbA1c > 6.5%)

Question 9

For adults, the 2 most beneficial vaccines are:

Answer 9

Influenza

Pneumococcus

Question 10

True/False

Egg allergy is a contraindication to the flu vaccine

Answer 10

• False*
• The only vaccine that is contraindicated in patients with an egg allergy is Yellow Fever*

Question 11

Who gets the pneumococcal vaccine

Answer 11

Everyone above age 65

Cochlear implant

CSF leaks

Alcoholics

Tobacco smokers

Question 12

Difference in indication for Hep A and Hep B vaccine

Answer 12

Hep A: travelers to countries of high endemicity

Hep B: ESRD (dialysis), Healthcare workers, Diabetes

Question 13

Tetanus Vaccine

Answer 13

Td (toxoid) every 10 years

One Tdap (tetanus with acellular pertussis) as one of the boosters

Tdap = adult

DTaP = kid

Question 14

What type of patient has the strongest indication for meningococcal vaccination?

Answer 14

Asplenic patients (highest risk for disseminated meningococcal infection)

Question 15

Screening for AAA

Answer 15

All men above the age of 65 with a smoking history should be screened once with an ultrasound

Also screen 65-75 with FHx of AAA

Repair if > 5 cm

Question 16

Managing a dirty vs clean wound

Answer 16

If < 3 lifetime doses of tetanus vaccine

Clean = Tdap

Dirty = Tdap + TIG

If > 3 lifetime doses of tetanus vaccine

Clean = Tdap if > 10 years since last dose, otherwise go home

Dirty = Tdap if > 5 years since last dose, otherwise go home

Question 17

When is the rotavirus vaccine contraindicated?

Answer 17

In patient’s with a history of intussusception