Primary Care

Question 1

Health

Answer 1

A human condition with physical, social, and psychological dimensions, each characterized in a continuum with positive and negative poles.

Question 2

Primary prevention

Answer 2

Delivery of healthcare services focused on preventing disease from occurring (e.g. immunizations, health promotion counseling/education)

Question 3

Secondary prevention

Answer 3

Delivery of healthcare services focused in early detection of disease states as well as interventions that limit severity and morbidity (e.g. identification of risk factors, screening tests, counseling/education)

Question 4

Tertiary prevention

Answer 4

Delivery of healthcare services focused in restoring optimal function, improving health status, and limiting long-term disability following the diagnosis of disease (e.g. treatment of the disease, counseling/education)

Question 5

Health screening

Answer 5

Laboratory or other tests conducted in asymptomatic individuals for early detection of health problems (secondary prevention)

Question 6

Behavioral counseling interventions

Answer 6

Education and counseling focused on assisting individuals to maintain healthy behaviors, change existing behaviors, or adopt new behaviors with the goal of improving health status and health outcomes

Question 7

Resources for health screening, education, and counseling recommendations

Answer 7

US preventive services task force (USPSTF)
American cancer society (ACS)
American college of obstetricians and gynecologists (ACOG)
American Diabetes Association (ADA)
American heart association (AHA)
CDC

Question 8

Breast cancer screening

Answer 8

American cancer society
- does not recommend CBE
- yearly mammogram starting at 45 for average risk; 55 yo + can switch to biannual, no cut off age
- eduction on BSE 20 years +

ACOG
-CBE every 1-3 years for women 25-39 then annually over 40; informed decision making
- mammogram yearly at 40 or every other year , no cut off age
- BSA 20 years +

USPSTF
- CBE not sufficient data
- biennial from 50-74

Question 9

Breast cancer screening for transgender males

Answer 9

Same as cos gendered females

Question 10

Cervical cancer screening

Answer 10

ACS
- <21 screening not recommended
- 21-29 cytology alone q3 years
- 30-65 cytology with cotesting of HPV q5years or cytology alone q3 years
- 65+ stop screening if adequate prior negatives - 3 consecutive cytology negatives or 2 contests within 10 years with more recent test within last 5
- any age with total hysterectomy - no screening necessary unless hx of CIN2, CIN3, adenocarcinoma in with, or cervical cancer in past 20 years

ACOG
- same as ACS except if pt has HIV, begin screening 1 year after sexual activity begins or 1 year of HIV dx if already sexually active

USPSTF
- same as ACS except 30-65 option of just HPV testing alone q5years

Question 11

Cervical cancer screening for trans males

Answer 11

Same as cis gendered females

Question 12

Colorectal cancer screening ACS

Answer 12

• 45 yo + regular screening with either high-sensitivity stool-based test or structural (visual) exam
• more frequent testing and starting at younger age for those with high risk (IBD, personal or fam hx of colonic polyps or colon CA, known or suspected presence of launch syndrome [hereditary nonpolyposis colon cancer])
• all positive non-colonoscopy screening tests should be followed up with timely colonoscopy
• continue screening with adults in good health and life expectancy > 10 years through age 75

Question 13

Colorectal cancer screening stool based tests

Answer 13

Guaiac fecal occult blood test: multiple-stool sample, at-home test detects hidden blood in stool; yearly screening

Stool DNA test: single-sample, at-home test detects DNA from cancer or polyp cells as well as blood; screening every 3 years

Fecal immunochemical test (FIT): yearly screening

Question 14

Colon cancer screening - structural (visual) screening

Answer 14

• Colonoscopy every 10 years
• Flexible sigmoidoscopy every 5 years
• CT colonography (virtual colonoscopy) every 5 years

Question 15

Lung Cancer Screening
USPSTF, ACS

Answer 15

• screen individuals 55-74 (USPSTF upper limit 80) in fairly good health who have risk factors for lung cancer
• risk factors: 30 pack/year smoking hx and still smoking or quit within last 15 years
• low-dose CT every year

Question 16

Testicular cancer screening

Answer 16

USPSTF and ACS do not recommend clinical or self-testicular examination for testicular cancer screening

Question 17

Prostate Cancer screening

Answer 17

USPSTF: for men 55-69 years, decision to undergo periodic PSA based screening should be based on client-clinician discussion of benefits and harms based on family hx, race/ethnicity, other medical conditions and client values. Recommends against PSA testing for 70+

ACS: recommends client-clinician discussion about screening uncertainties, risks and potential benefits beginning at age 50 years and earlier for African American men and men with fam hx of prostate cancer before 65

Question 18

Diabetes Screening - ADA

Answer 18

• every 3 yrs starting at age 45
• more frequent and starting at younger age with BMI >25 and 1 or more risk factors
• risk factors: obesity, HTN, DLD, CVD, physical inactivity, PCOS, diabetes in 1st degree relative, African American, Hispanic, Native American, Pacific Islander, hx of gestational diabetes or baby weighing more than 9 lbs at birth
• individuals diagnosed with gestational diabetes should have lifelong screening at least every 3 years
• use HbA1c fasting or 2 hr 75g glucose tolerance test

Question 19

CVD risk factors for women

Answer 19

55 +, fam hx of premature CHD (male relative <55, female<65), cigarette smoking, HTN, HDL-C < 40 mg/dL, diabetes Melitus

Question 20

Prevention of CVD

Answer 20

Behavioral counseling to decrease modifiable risk factors and treatment of conditions the individual at high risk

Question 21

Blood pressure screening USPSTF

Answer 21

• screen adults aged 18-39 with normal BP (<130/85) who have no other sick factors every 3-5 years