Secondary Prevention: Detecting preclinical disease

Question 1

What is secondary prevention

Answer 1

early findings of asymptomatic disease using screening tests

Question 2

Principles of secondary prevention

Answer 2

prevalence sufficient to justify screening
health problem has effect on life
target disease has long asymptomatic period
acceptable screening test available

Question 3

Most accurate information about alcohol use

Answer 3

pos response to CAGE questions

Question 4

CAGE questions

Answer 4

C: cut down on drinking?
A: annoyed by criticizing drinking?
G: ever felt guilty about drinking?
E: eye opener

Question 5

Findings in a man with 10 year hx of alcohol abuse

Answer 5

elevated AST and ALT (3x normal)
mild macrocytosis (elevated MCV) without anemia (>3drinks/day women and >5/day men)
isolated hypertriglyceridemia

Question 6

AST and ALT resolvent with sobriety

Answer 6

1-3 months

Question 7

Macrocytosis resolvement with sobriety

Answer 7

2-3 months

Question 8

Hypertriglyceridemia resolvement with sobriety

Answer 8

1-2 months

Question 9

1 drink defined as

Answer 9

12 oz beer
5 oz wine
1.5 oz liquor

Question 10

Legal alcohol limit for motor vehicle operation

Answer 10

0.08g/dL blood alcohol concentration

Question 11

Is chest x-ray a screening for lung cancer?

Answer 11

NO

Question 12

Hgb electrophoresis looks for?

Answer 12

sickel cell diease

Question 13

Calculating pack year history

Answer 13

number of packs per day times number of years smoked

Question 14

Highest risk for suicide

Answer 14

elderly males

Question 15

Best statements to use when asking a pt something

Answer 15

“I” statements

I noticed the bruises are in the shape of a hand

Question 16

Who is the author of the stages of change?

Answer 16

Prochaska and DiClemente

Question 17

Stages of change

Answer 17

precontemplation
contemplation
preparation
action
maintenance/relapse

Question 18

precontemplation stage of change

Answer 18

pt may not be ready to change or aware of change that needs to occur

Question 19

contemplation stage of change

Answer 19

pt is considering change and looking at the pos and neg.

may report being “stuck” with the problem

Question 20

preparation stage of change

Answer 20

pt exhibits some change of behaviors or thoughts

may need assistance in tools to success

Question 21

action stage of change

Answer 21

the pt is ready to go forth with change

can be inconsistent with carry through

Question 22

maintnance/relapse of change

Answer 22

pt learns to continue change and has adopted and embraced healthy habit
positive reinforcement

Question 23

5 A’s with tobacco use

Answer 23

Ask: ask about tobacco use every visit
Advise: advise quitting every visit
Assess: are they willing to quit
Assist: help with plan
Arrange: follow up

Question 24

Top leading causes of death in US

Answer 24

Heart disease
cancers
respiratory disease
cerebrovascular diseases

Question 25

Top cancer causes

Answer 25

Men: prostate, lung, colon, urinary Women: breast, lung, colon, uterine

Question 26

Top cancer deaths

Answer 26

Men: lung, prostate, colon, pancreas Women: lung, breast, colon, pancreas

Question 27

When guidelines have conflicting information

Answer 27

focus on the commonalities vs the differences

Question 28

Screening for breast cancer should begin at

Answer 28

age 20 with BSE and clinical breast exam mammo starting at 40 MRI if younger

Question 29

Screening for colorectal cancer

Answer 29

begin at 50 colonoscopy every 10 fecal occult blood testing every year

Question 30

procedure for fecal occult blood testing

Answer 30

collect 2 samples from 3 consecutive specimens | digital rectal exam not adequate

Question 31

Screening for prostate cancer

Answer 31

``` start at 50 in those who are expected to live at least 10 more years start at 45 for those at high risk DRE and PSA PSA less than 2.5 retest every 2 PSA greater than 2.5 retest annual ```

Question 32

High risk for prostate cancer

Answer 32

African American | first degree relative dx earlier than 65

Question 33

Screening for endometrial cancer

Answer 33

women who are menopausal any postmenopausal bleeding evaluated those with colon cancer should be screened

Question 34

Screening for lung cancer

Answer 34

low dose CT | those 55-74 with >30pack year hx, current smoker or quit less than 15 years ago

Question 35

Screening for cervical cancer

Answer 35

start at 21 21-29 every year without HPV 30 every 3 years if three consecutive neg or every 5 if PAP with HPV 65 and older: no need for cytology

Question 36

Sensitivity defined

Answer 36

likelihood of true pos results with the disease | "neg helps to rule out"

Question 37

Specificity defined

Answer 37

likelihood of a true neg result in those who are healthy | "pos helps to rule in diease"

Question 38

Prevalence defined

Answer 38

proportion of sampled individuals possessing the condition at a given time

Question 39

Incidence defined

Answer 39

proportion of individuals to developed a condition over a defied period of time