Red Book/Prevention

Question 1

FHx screening questionnaire (ages)
-Heart disease
-Bowel Ca
-Prostate Ca
-Breast Ca

Answer 1

-Heart disease <60 y.o
-Bowel Ca <55 y.o
-Prostate Ca <60 y.o
-Breast Ca <50 y.o

Question 2

Falls risk screening - history questions (incl. contributing factors) [10]

Answer 2

-Details of falls - frequency, location
-Polypharmacy
-Impaired gait/balance/mobility
-Home hazards
-Foot deformities/unsafe footwear
-Impaired vision
-Incontinence
-Recent hospital discharge
-Chronic illness - stroke, PD, MS, dementia
-Vit D Deficiency

Risk reduction strategies - home/community-based exercise program, deprescribe, balance exercises

Question 3

When to start measuring CVS risk and how often?
When to start for ATSI population?

Answer 3

• At least every 2 years >45 y.o

-Begin CVS risk assessment for ATSi at age 35

If moderate CVS risk PLUS BP persistently >160/100, FHx of premature CVD or South Asian/Maori/Pacific Islander/Middle Eastern b/g –> treat BP and lipids immediately

If moderate CVS risk - review again in 6-12 months

Question 4

Indications for ambulatory BP monitoring (6)

Answer 4

• Unusual variations between readings at clininc
  
  • Suspected white coat HTN
  • HTN resistant to meds
  • Suspected hypotensive episodes (elderly, diabetic pts)
  • Suspected nocturnal hypertension (e.g OSA)
  • Masked HTN

Question 5

Lipids monitoring frequency
-Low risk
-Mod risk
-High risk
*Caveat

Answer 5

Low risk - 5 yearly
Mod risk - 2 yearly
high risk - annually
measure annually in anyone with Diabetes, CVS disease, stroke, HTN, CKD

Question 6

Type 2 Diabetes - when to start AUSDRISK and how often
What to do if high AUSDRISK

Answer 6

Every 3 years in daults >40 y.o, or ATSI >18 y.o
Fasting glucose or HbA1c every 3 years if high risk

Question 7

Colorectal cancer recommendations:
Average risk
Moderate risk
High risk

Answer 7

-Average - iFOBT every 2 years from 50-74, aspirin 100mg at least 2.5 years between 50-70
-Moderate - iFOBT every 2 years from 40-49, colonoscopy 5 yearly from 50-74, aspirin 100mg at least 2.5 years between 50-70
-High - iFOBT every 2 years from 35-44, colonoscopy every 5 years from 45. Refer familial cancer clinic - genetic risk assesment

Question 8

Colorectal cancer red flag system:
? = 4 red flags
? = 2 red flags
? = 1 red flag

Need 4 red flags to be in moderate risk - anything below is average risk

Answer 8

1st deg rel dx <55 y.o = 4 red flags
1st deg rel dx >55 y.o = 2 red flags
2nd deg rel dx any age = 1 red flag

Need 4 red flags to be in moderate risk - anything below is average risk

Question 9

Breast cancer recommendations
-Average risk
-Moderate risk
-High risk

Answer 9

-Average risk - mammogram every 2 years from 50-74
-Moderate risk - mammogram at least every 2 years from 50-74 +/- annual mammogram from age 40
-High risk - individualised, refer to cancer specialist/family cancer clinic

Question 10

Breast cancer red flag system
! = ?
! = ?
! = ?

!-one flag = average risk
!!-two flags = moderate risk

Answer 10

! = no. of relatives 2 or more
! = degree - 1st degree
! = age dx. <50

!-one flag = average risk
!!-two flags = moderate risk

Question 11

Follow-up intervals post-polypectomy:
-Small, pale, distal hyperplasic polyps only
-1-2 small tubular adenomas
-Multiple adenomas (>5)
-High-risk adenomas

Answer 11

-Small, pale, distal hyperplasic polyps only - no f/u required
-1-2 small tubular adenomas - repeat colonoscopy at 5 years
-Multiple adenomas (>5) - 12 monthly
-High-risk adenomas - every 3 years

Question 12

Skin cancer - ?high risk criteria (2)
-Recommended screening process/interval

Answer 12

1. PHx of melanoma
2. > 5 atypical (dysplastic) naevi

Self-exam 3 monthly, clinical exam 6 monthly

Question 13

Follow-up of HSIL treatment (recommendation)

Answer 13

Co-test 12 months post-treatment, & annually until 2 negative results –> return to normal screening interval

Question 14

Glaucoma- increased risk factors (2)- & suggestion
-higher increased risk factors (6) & suggestion

Answer 14

1. Fhx of glaucoma (1st deg. rel)
2. Age >50 y.o
   Refer for optom 5-10 yrs earlier than age of onset in affected relative
3. Diabetes
4. Myopia
5. HTN
6. Migraine
7. Long-term steroid use
8. Hx. of eye trauma
   Refer optom - indirect opthalmoscopy w/ slit lamp

Question 15

Osteoporosis risk factors (many!)

Answer 15

○ FHx of minimal trauma fracture
○ Smoking
○ Excessive eTOH
○ Vit D deficiency
○ Low BMI
○ Sedentary lifestyle/immobility
○ Recurrent falls
○ Medical conditions; Endocrine (Cushing syndrome, hyperparathyroidism, hyperthyroidism)
○ Premature menopause
○ Rheum arthritis
○ CKD/liver disease
○ Malabsorption (e.g coeliac)
○ Multiple myeloma
○ Diabetes
-Medications (long-term steroids, androgen deprivation therapy)

Question 16

Colorectal Ca non-pharm prevention (6)

Answer 16

-Cease smoking
-Limit eTOH
-Healthy BMI
-Healthy diet (high fat and fibre)
-Limit amount of proccessed meats, lean red meat 100g/day
-Low dose aspirin 100mg 2.5 years total

Question 17

ATSI specific immunisations (4)

Answer 17

-Annual flu vax (eligible NIP) from 6 mths
-Hep A (WA/NT/SA/QLD) 18mth & 4 years
-Meningoccocal B (Bexsero) - 2, 4, 6, 12 mths (first four)
-Pneumococcal - prevnera13 at 6 mths (WA/NT/SA/QLD), pneumovax23 at 4y.o (if at risk conditions)

Question 18

Breast Cancer risk factors (5)

Answer 18

○ Ashkenazi Jewish ancestry - ↑risk of carrying pathogenic variant of BRCA1/2
○ Early age menarche, later age of 1st live birth
○ Later age at menopause
○ High BMI
○ High breast density

BRCA2 associations - breast, ovarian, prostate, pancreatic cancers

Question 19

Populations who need referral to colposcopy after 2nd HPV+ve test (any type) (3)

Answer 19

-Overdue by 2 or more years for screening at time of initial screen
-ATSI women
-Women aged 50-69

Question 20

Falls risk screening questions (3)

Answer 20

-2 or more falls in the last 12 mths?
-Are you presenting following a fall?
-Are you having difficulty with walking or balance?

Question 21

Adult ATSI pneumoccocal vaccine schedule

Answer 21

1 dose 13prevenar from age 50
1 dose 23pneumovax 12 mths after
2nd dose 23 pneumovax at least 5 years after