risk assessment Flashcards
How often does a 20 yo. F need to receive a clinical breast exam?
every 3 years
total cholesterol & HDL: when to start checking? how often to check?
start at 20
repeat every 5 years unless chol above 200 mg/dL
How do you manage high lipid panel results?
LDL: statin
HDL: changing lifestyle
When are mammography indicated and how often should they be repeated?
start at 40 and repeat every 2 - 3 years
from 40 - 74, repeat annually (or as long as in good health)
When is an EKG indicated during a health screening? How often should it be repeated?
at 40 to provide baseline
repeat every 2 years if cardiac risk factors present
How often should a male receive a fecal occult blood test to assess for colorectal cancer?
annually starting at age 50
When is it appropriate to discontinue PAP smear and cytology screening in women?
when older than 65 - 70
discontinue after 3 consecutive normal cytology tests and no abnormal tests in past 10 years
Women and men over 60 years old should have a complete physical exam how often?
Every 2 years
What is the leading cause of death of African-American M lt35 yo?
Homicide
pneumonia and influenza in elderly adults
top killer, often requires hospitalization in this population
Top 4 killers of adults in the United States
- heart disease (CAD)
- cancer
- lower respiratory disease (asthma, COPD)
- CVA
What syndrome is associated with cardioembolic events (CAD & CVA)?
metabolic syndrome
Which cancer has the highest mortality in both adult men and women in the United States?
LUNG
Leading GYN cancer mortality in women?
OVARIAN
How do you screen for ovarian cancer?
Siiiike! THERE IS NONE!
Other than skin cancer, cancer with highest incidence in women?
BREAST
What is the mortality rate associated with breast cancer in women?
Low. 95% survival rate.
What is the second most common cancer mortality in men?
PROSTATE
What is the second leading cancer mortality in men and women combined?
COLORECTAL
immunizations and vaccinations are an example of what kind of prevention?
primary
What is secondary prevention?
Early identification AND treatment of existing problems
pap smear is what kind of prevention?
Secondary
Screening = Secondary
Tertiary Prevention
Rehabilitation and restoration of health
Cardiac rehabilitation s/p acute MI is what kind of prevention?
Tertiary
Skilled Nursing Facility is what kind of prevention?
Tertiary: restoration & rehabilitation of health.
Side effect of St. John’s Wort
↑ risk of clotting
St. John’s Wort is contraindicated in combination with?
SSRI - Serotonin Syndrome
beware, SJW is often used for depression!
Which herbal therapies are associated with increased risk of bleeding?
G whiz, you’re bleeding!
Ginger
Ginseng
Garlic
Gingko Bilboa
Which herbal therapy should be used cautiously in DM patients and why?
Evening Primrose (risk for hyperglycemia)
Which of the following is a contraindication to receiving the influenza vaccination?
a. PCN allergy
b. Being pregnant
c. Being immunocompromised
d. Allergic to eggs
D. Influenza is contraindicated in egg allergy
Can a pregnant woman receive an influenza vaccination?
Yes
When individuals are immunized with a vaccine, the type of immunity is called:
a. natural immunity
b. artificially acquired immunity
c. passive immunity
d. none of the above
B. artificially acquired immunity
Elevated homocystine levels are associated with:
a. ARF
b. PNA
c. premature CAD
d. GERD
C. thombosis and premature CAD cause elevated homocystine levels
Which of the following is an example of primary prevention:
a. mammogram
b. pneumococcal vaccine
c. pap smear
d. controlling HTN
b
What is the best way to detect breast cancer?
Mammogram
The leading cause of death in adolescents
MVC
CEA is most useful for the monitoring the activity of:
a. breast cancer
b. melanoma
c. thyroid cancer
d. colorectal cancer
Colorectal cancer
Screening is defined as:
detection of a disease process before occurrence of symptoms
Sensitivity of a test is defined as the:
Probability that a test will be positive if the disease is positive
Which of the following patients should be treated with a cholesterol-lowering agent?
a. 40 M LDL cholesterol of 100
b. 55 yo. post-menopausal F with LDL 170 despite diet and exercise
c. 60 M with HDL 35
d. 25 yo. M with family hx of CAD
B
How often should a 68 yo. F have a pap smear?
There is no need for her to have a PAP smear if the three previous tests were negative
Varicella is an example of what type of vaccine?
Attenuated vaccine
Pneumococcal vaccine contraindications
Hodgkins lymphoma
active disease
pregnancy
Which of the following vaccines are contraindicated during pregnancy:
a. influenza
b. varicella
c. hep b
d. none of the above
varicella (live)
In which age range can HPV vaccine series be given?
How is the series administered?
give between 10 - 25; three shot series
Gardasil: 0, 2mo, 6 mo
Cervarix: 0, 1mo, 6mo
How often is TDAP given?
every 10 years
pneumococcal vaccine: given to these 5 populations
smokers/asthmatics 19 - 64 immunocompromised chronic disease nursing home or LTCF 65+
At what age should complete physicals occur, and how often should they be done?
20, every 5 - 6 years
at age 60, every 2 years
At what age should conventional paps start and how often should they be repeated?
21, repeat every 3 years if no abnormalities
At what age should HPV co-test paps start and how often should they be repeated?
30, every 5 years if no abnormalities
no for women any younger!
At what age should clinical breast exams start? How often should they be repeated?
age 21 (same for self exams) and repeat every 3 years
at age 40, switch to annually
How often should men perform self breast and testicular exams? At what age should they begin?
start at adolescence, perform monthly
BP: When to start monitoring, normal range, how often to repeat?
start at 20
normal 120/80
repeat with every visit or every 2 years
Zostavax should be given when? What is it for?
give at 50 once - for herpes zoster
What are the two prostate screening exams? At what age should they begin and how often should they be repeated?
digital rectal exam (DRE) & prostate surface antigen (PSA)
- DRE & PSA should be done annually from 50
UNLESS: family hx of prostate cancer or black
- perform annually from age 40
what are the three colorectal cancer screening tests?
at what age should colorectal cancer screening begin and how often should they be repeated?
begin screening at 50
- fecal occult blood test (FOBT): repeat annually
- flexible sigmoidoscopy: repeat every 5 years
- colonoscopy
- total colon exam: repeat every 10 years
- double contrast barium enema: repeat every 5 - 10 years
What is glaucoma screening and its normal range, when should it begin, how often should it be done?
tonometry (normal 10 - 20 mmHg)
begin at 40 - 59 and repeat annually
Ratio of adults who get shingles?
1 in 3
Pneumococcal vaccine should be given at what age?
65+
3x max per CDC
What kind of prevention are screening tests?
secondary
S = secondary = screening
incidence vs prevalence
FREQUENCY at which disease appears in population during specific time + RATE at which new cases occur during specific time
VS
PROPORTION of population affected by disease during specific time
What is the leading killer of black men and women under 40?
AIDS (HIV contracted in teens)
top 3 causes of death in young adults (20 - 39)
MVC
homicide
suicide
top 3 causes of death in middle aged adults (40 - 59)
heart disease
accidents
lung cancer
top 3 causes of death in elderly adults (60+)
heart disease
CVA
COPD
Other than skin cancer, what is the second most common cancer in men?
PROSTATE
it is also the second leading cancer mortality
Recommended intake of carbs, fats, protein?
carbs: 50 - 60% total calories
fats: under 30% total calories + saturated fat under 10% total calories
proteins: 0.8 - 1.0 g/kg/day
5 benefits of exercise
↓ LDL, stress, signs of aging
↑ BMR, cardiovascular fitness
American Heart Association reccomendations for exercise x2
- exercise at least 30+ min most days of week
- target heart rate should be sustained for 30 minutes (improves conditioning)
35+ who have never exercised regularly should do what first? x3
complete history
physical exam
exercise stress test
typhoid immunization is what kind of immunity?
ACTIVE - ab stimulated with specific antigen
gamma globulin is what kind of immunity?
PASSIVE
maternal immunity transferred to fetus is what kind of immunity?
PASSIVE
vaccination is what kind of immunity?
ACTIVE ACQUIRED
comorbs warranting pneumococcal vaccine admin
- lung, heart, liver, kidney disease
- chronic diseases like DM, cirrhosis, sickle cell, alcoholism, etc
Consider Hep A vaccine if…
military, travel to endemic area, MSM
Consider Hep B vaccine if…
all health care workers, high risk pts (includes sexually active),
which hepatitis is a risk factor for fulminant liver failure?
Hep B
meningococcal vaccine is approved for what ages? recommended as routine for what ages? catch up for what ages?
approved for 2 - 55
routine for 11 - 12
catch up for college, military, immunecompromised, travellers to Africa
SJW may potentiate what important drug class?
NARCOTICS
herbal therapies used for lady problems
black cohosh
evening primrose
kava kava + alcohol
alcohol increases toxic effects!
evening primrose + DM
may elevate blood glucose so beware!
