Preventstive Screen Flashcards
Cervical screening guidelines
25 and up WHO EVER HAVE BEEN SEXUALLY ACTIVE
If immunocompromised then start at 21
Q3 years
Eligible people need to get cervical screened if they:
- feel healthy and have no symptoms
-are no longer sexually active
-only had 1 sex partner
-are in the same sex relationship
-have been through menopause
-have no family history of cervical cancer
-have received the HPV vaccine
Those with hysterectomy should talk to their doctor about whether they need more screening
Osteoporosis / when to do BMD
Post menopausal age >50
50-64
- if has 2 risk factors or previous fracture
65-69
-if 1 risk factor
Age >70
-no risk factors
AAA screening
One time screening for men 65-80
-women not needed
-not needed after 80
Colorectal screening
FIT >50 q2years
If completed colonoscopy not needed FIT,
If family history of colon cancer screen with colorectal Q10 years
Breast cancer
Mammogram q2 years >50years - 74 years
Maybe recalled in 1 year if:
30-69 high risk breast cancer screening for who?
Personal or family history of breast cancer
Have had radiation to the chest
Known carrier of the pathogenic gene variant
High risk Breast cancer screening will continue to see you until age 74 if already in the program. They do not accept participants over the age of 70.
Ottawa ankle rule - who should get an xray
Is Ottawa ankle rule validated in pt <18 ?
No
Ottawa knee rule
When to stop screening for cervical cancer screens
70 if you’ve had 3 normal in the previous 10 years.
Ascus cells on pap what’s next?
Repeat cytology in 12 months
If results are AScus again then refer for colposcopy
If results are normal then return to routine screening Q3 years
Currently HPV testing is not an insured test in Ontario but you can pay for it. HPV testing for someone with a first time ascus or LSIL is not required. Anyone can do it
People with cervix who tested positive can be referred directly to colposcopy
People with a cervix who are HPV non 16-18 positive should repeat their cytology in 12 months
People with a cervix who are HPV negative can return to normal screening Q3 years
HSIL what next?
Colposcopy
LSIL what next?
Repeat cytology in 12 months
If greater or equal to ascus > colposcopy
If normal repeat cytology again in 12 months, if the result is:
-normal, return to routine screening in 3 years
-greater than or equal to ascus > refer to colposcopy
atypical endocervical cells?
Colposcopy and or endometrial sampling
Atypical squamous cells cannot exclude HSIL
Colposcopy
Squamous carcinoma, adenocarcinoma ?
Colposcopy
Unsatisfactory for evaluation what next
Repeat cytology in 3 months
Satisfactory for evaluation, no transformation zone present what next
Routine screening in 3 years
Benign endometrial cells on Pap test
Pre-menopausal women who are asymptomatic require no action - continue to follow usual screening guidelines
Post menopausal women require investigations, including adequate endometrial tissue sampling
Any women with abnormal vaginal bleeding requires investigations, which should include adequate endometrial tissue sampling
Benign endometrial cells on Pap test
Pre-menopausal women who are asymptomatic require no action - continue to follow usual screening guidelines
Post menopausal women require investigations, including adequate endometrial tissue sampling
Any women with abnormal vaginal bleeding requires investigations, which should include adequate endometrial tissue sampling
When should you screen for diabetes
> 40 or high risk Q3 years
Who is high risk for diabetes
First degree family history
Non white low socioeconomic status
History of GDM/ pre diabetes
Cardiovascular risk factors
Presence of end organ damage associated with diabetes
What is diagnostic of diabetes
FBG >7 mmol/L
A1C > 6.5%
When to add statin therapy to diabetes
Age >40
Age >30 and diabetes >15 years
Which meds should be held if you are sick
S- SU
a- ACEI
D- diuretics
M-metformin
A- ARB
N-NSAID
S- SGLT2i
Diabetes BP target
<130/80
Cholesterol targets if you have DM
LDL <2.0 or >50% reduction from baseline
Drugs for CVD risk protection
ACEI/ ARB
Statin
ASA (if CVD)
SGLT2i
What screening should you do with diabetes (cardiac, foot, eyes)
Cardiac: ECG q3-5 years of age >40 OR DM complication
Foot: monofilament yearly
Kidney: test eGFR and ACR yearly
Retinopathy: yearly
Diagnosis of diabetes if symptomatic
With only one test in the diabetes range confirms diagnosis
Diagnosis of diabetes if asymptomatic
2 different test results in the DM range on another day
A patient presents to the clinic after a hand laceration. The patient was chopping wood and accidentally pierced through the palmar surface of their hand. After the nurse practitioner cleans and sutures the wound, they advise the patient to return for suture removal in how many days?
A. 5
B.10 to 14
C.3
D.21 to 28
Answer: B. 10 to 14
The timing of suture removal varies according to anatomic site. Suture removal for the digits, palms, and soles should occur in about 10 to 14 days.
The face and neck require suture removal in 5 days, replace with steri strips
scalp and trunk 7 to 10 days,
Joints 14 days
Arms and legs 10-14 days
PSA screen
55-69
Cancer screening should be an individualized decision
Otherwise screening is not recommended
If they want to be tested, order PSA with DRE
Cancer = PSA >4
Who is at high risk of prostate cancer
African Americans
Obesity
first degree relatives with prostate cancer
Which of the following is the current recommendation for screening of prostate cancer?
A.All men age 55 to 69 years should engage in shared decision-making regarding screening.
B.All men 50 years or older should be screened with a prostate-specific antigen (PSA) test and digital rectal examination.
C.All men age 55 to 69 years should undergo a digital rectal examination.
D.All men older than 70 years should be screened due to increased risk of advanced disease.
Answer: A. All men age 55 to 69 years should engage in shared decision-making regarding screening.
In 2018, the U.S. Preventive Services Task Force (USPSTF) made the following recommendations: Men who are 55 to 69 years old should engage in shared decision-making about whether they choose to be screened. A deciding factor involves individual patient preferences and health history; the potential benefits must be balanced against the potential harms, including the risks of false-positive tests, prostate biopsy, anxiety, over-diagnosis, and treatment complications. Screening involves a PSA blood test. A digital rectal examination is not recommended as a screening test due to its low sensitivity and specificity for detecting prostate cancer. The USPSTF does not recommend PSA-based screening for prostate cancer in men 70 years and older.
