Preventstive Screen

Question 1

Cervical screening guidelines

Answer 1

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

Question 2

Osteoporosis / when to do BMD

Answer 2

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

Question 3

AAA screening

Answer 3

One time screening for men 65-80

-women not needed
-not needed after 80

Question 4

Colorectal screening

Answer 4

FIT >50 q2years

If completed colonoscopy not needed FIT,

If family history of colon cancer screen with colorectal Q10 years

Question 5

Breast cancer

Answer 5

Mammogram q2 years >50years - 74 years

Maybe recalled in 1 year if:

Question 6

30-69 high risk breast cancer screening for who?

Answer 6

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.

Question 7

Ottawa ankle rule - who should get an xray

Answer 7

Question 8

Is Ottawa ankle rule validated in pt <18 ?

Answer 8

No

Question 9

Ottawa knee rule

Question 10

When to stop screening for cervical cancer screens

Answer 10

70 if you’ve had 3 normal in the previous 10 years.

Question 11

Ascus cells on pap what’s next?

Answer 11

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

Question 12

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

Question 13

HSIL what next?

Answer 13

Colposcopy

Question 14

LSIL what next?

Answer 14

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

Question 15

atypical endocervical cells?

Answer 15

Colposcopy and or endometrial sampling

Question 16

Atypical squamous cells cannot exclude HSIL

Answer 16

Colposcopy

Question 17

Squamous carcinoma, adenocarcinoma ?

Answer 17

Colposcopy

Question 18

Unsatisfactory for evaluation what next

Answer 18

Repeat cytology in 3 months

Question 19

Satisfactory for evaluation, no transformation zone present what next

Answer 19

Routine screening in 3 years

Question 20

Benign endometrial cells on Pap test

Answer 20

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

Question 21

Benign endometrial cells on Pap test

Answer 21

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

Question 22

Question 23

When should you screen for diabetes

Answer 23

> 40 or high risk Q3 years

Question 24

Who is high risk for diabetes

Answer 24

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

Question 25

What is diagnostic of diabetes

Answer 25

FBG >7 mmol/L
A1C > 6.5%

Question 26

When to add statin therapy to diabetes

Answer 26

Age >40
Age >30 and diabetes >15 years

Question 27

Which meds should be held if you are sick

Answer 27

S- SU
a- ACEI
D- diuretics
M-metformin
A- ARB
N-NSAID
S- SGLT2i

Question 28

Diabetes BP target

Answer 28

<130/80

Question 29

Cholesterol targets if you have DM

Answer 29

LDL <2.0 or >50% reduction from baseline

Question 30

Drugs for CVD risk protection

Answer 30

ACEI/ ARB
Statin
ASA (if CVD)
SGLT2i

Question 31

What screening should you do with diabetes (cardiac, foot, eyes)

Answer 31

Cardiac: ECG q3-5 years of age >40 OR DM complication

Foot: monofilament yearly

Kidney: test eGFR and ACR yearly

Retinopathy: yearly

Question 32

Diagnosis of diabetes if symptomatic

Answer 32

With only one test in the diabetes range confirms diagnosis

Question 33

Diagnosis of diabetes if asymptomatic

Answer 33

2 different test results in the DM range on another day

Question 34

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 34

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

Question 35

PSA screen

Answer 35

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

Question 36

Who is at high risk of prostate cancer

Answer 36

African Americans
Obesity
first degree relatives with prostate cancer

Question 37

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 37

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.