Screening

Question 1

Describe screening for kids with obesity concerns

Answer 1

if BMI over 85% with risk factors or over 95, screen for diabetes
if BMI over 85%, screen for hyperlipidemia (treat to get below total below 170)
if over 95%, screen for steatosis

Question 2

What are the screening recommendations for osteoporosis?

Answer 2

women over 65

Question 3

What are the screening recommendations for colon cancer?

Answer 3

Fecal occult blood testing (FOBT), collected at home annually, Colonoscopy every ten years, Flexible sigmoidoscopy every five years with FOBT every three years

Question 4

How should you screen for depression?

Answer 4

Over the past 2 weeks, have you ever felt down, depressed, or hopeless?
Over the past 2 weeks, have you felt little interest or pleasure in doing things?

Question 5

What are the features of a good screening test?

Answer 5

can be treated (A) and have a latent phase of a disease (B) enabling early detection and more timely treatment, impacting the outcome of the disease.
The screening test should be acceptable to patients (D) at reasonable cost

Question 6

When is lung cancer screening indicated?

Answer 6

does recommend screening for lung cancer in patients 55-65 years old with 30-pack-history of smoking by low-dose CT scan

Question 7

Is screening for COPD recommended in all patients?

Answer 7

not if asymptomatic

Question 8

When are mammogram screenings initiated?

Answer 8

Biennial screening mammography for women aged 50-74 years

Question 9

What are the screening guidelines for diabetes according to the USTSPF?

Answer 9

screen anyone with BP > 135/80

Question 10

Describe screening for colorectal cancer in a patient who has an affected first degree relative

Answer 10

take the first degree relative’s age, subtract ten. that’s when you start screening

Question 11

What age do you start screening a woman with a first degree relative with breast cancer/

Answer 11

35

Question 12

Name whom to screen for a AAA

Answer 12

male smokers 65 - 75

Question 13

What are the CAGE questions for alcohol abuse screening?

Answer 13

1. felt the need to Cut down your drinking?
2. felt Annoyed by criticism of your drinking?
3. had Guilty feelings about drinking?
4. taken a morning Eye opener?

Question 14

Who

Are the patients that should be screened with Low res CT

Answer 14

30
Year pack year history,
Age
Between 55 and 74

Question 15

Who should be screened for lipid disorders?

Answer 15

women over 45 with risk factors

men over 35

Question 16

Who should be screened for chlamydia?

Answer 16

All sexually active non-pregnant women 24 and younger, non pregnant women older than 25 at increaed risk, all pregnant women 24 and younger

Question 17

What screenng should be conducted for women looking to become pregnant?

Answer 17

Folic acid supplement, Carrier screening, HIV
Syphilis, Recommend regular moderate exercise
Avoid hyperthermia (hot tubs, overheating)
Caution against obesity and being underweight
Screen for domestic violence
Assess risk of nutritional deficiencies (vegan, pica, milk intolerance, calcium or iron deficiency)
Avoid overuse of Vitamin A (recommendations are to 750 mcg (2500 IU per day) with daily upper intake limit of 3,000 mcg (10,000 IU))
Avoid overuse of Vitamin D (recommendations are 600 IU per day, tolerable upper intake is 4000 IU)
Caffeine (limit to the equivalent of two cups of coffee or six glasses of soda per day)
Note: the sugar intake in six glasses of soda is not recommended.

Hepatitis B immunization, Occupational exposures: Material Safety Data Sheets from employer, Diabetes: optimize control, folic acid, 1 mg per day, off ACE-inhibitors
Hypertension: avoid ACE inhibitors, angiotensin II receptor antagonists, thiazide diuretics
Epilepsy: optimize control; folic acid, 1 mg per day
DVT: switch from warfarin (Coumadin) to heparin
Depression/anxiety: avoid benzodiazepines

Household chemicals: avoid paint thinners and strippers, other solvents, pesticides
Smoking cessation: bupropion (Zyban), nicotine patches (Nicoderm)
Screen for alcoholism and use of illegal drugs

Preconception immunizations (rubella, varicella)
Toxoplasmosis-avoid cat litter, garden soil, raw meat
Cytomegalovirus, parvovirus B19 (fifth disease)-frequent hand washing, universal precautions for child care and health care

Question 18

What are good questions to ask adolescent patients?

Answer 18

Home
Education / Employment
Eating
Activities
Drugs
Sexuality
Suicide / Depression
Safety / Violence

Question 19

When should patients be vaccinated for HPV?

Answer 19

ages 11-18, no evidence for 19-26

Question 20

What are the routine immunizations we give to people over 65?

Answer 20

shingles, DTAP, flu, pneumovax

Question 21

What are the required immunizations for most school students?

Answer 21

Hep B - 4
DTAP - 5
Polio - 4
MMR - 2
Varicella - 2

Question 22

Who should be screened for chlamydia?

Answer 22

all sexually active women aged 24 and older

NO MEN

Question 23

What are some of the predisposing factors for testicular torsion?

Answer 23

congenital abnormality, undescended testis, exercise, trauma

Question 24

What are the risk factors for testicular cancer?

Answer 24

Genetics, Family history, Cryptorchidism, Environment, Prior testicular cancer

Question 25

Describe the epidemiology of grave’s disease (who gets it, what triggers it)

Answer 25

Women are five to ten times more likely than men to get it.
Peak incidence is between ages 40-60.
Often occurs with family history of thyroid disease; can also be associated with other autoimmune diseases.
Triggers include stressful life events, high iodine intake, or a recent pregnancy.

Question 26

What are the key components of a diabetic foot exam?

Answer 26

testing for loss of protective sensation
assessment of pedil pulses
inspection for wounds and breaks in the skin

Question 27

What cancers are at higher risk if you have an elevated BMI?

Answer 27

non hodkins lymphoma, multiple myeloma,

Question 28

What are the risk factors for CHD?

Answer 28

Cigarette smoking
Hypertension (BP ≥ 140/90 or on antihypertensive medication)
Low HDL cholesterol (<65 years of age)
Age (men ≥45 years, women ≥55 years)

Question 29

What are the risk factors for childhood obesity?

Answer 29

high birth weight (B) and maternal diabetes. obese parent ,

Question 30

What can be used to screen for secondary hypertension in kids?

Answer 30

Umbilical Arterial or Venous Access
Placement of an umbilical arterial or venous line during the perinatal period may predispose to renal vascular disease.

Urinary Tract Infection
Although less common in boys, UTIs in childhood are one of the leading causes of hypertension and renal insufficiency later in life. This is due to renal scarring following the infection.

Catecholamine Excess
Although some children with catecholamine excess, e.g., pheochromocytoma or neuroblastoma, may not have symptoms such as flushing or sweating or palpitations, a positive response to a screening question in a hypertensive child would merit urine catecholamine testing.

Family History of Renal Disease
Ask about family history for hypertension and kidney disease. Inquiring whether a family member has needed dialysis is a good screening question for severe kidney disease.

Coarctation of the Aorta
Some children with coarctation of the aorta may go undetected until presenting with hypertension at a school-age visit. On exam, pay special attention to the femoral pulses and consider documenting BP measurement in a lower extremity.