Secondary Prevention: Detecting preclinical disease Flashcards
What is secondary prevention
early findings of asymptomatic disease using screening tests
Principles of secondary prevention
prevalence sufficient to justify screening
health problem has effect on life
target disease has long asymptomatic period
acceptable screening test available
Most accurate information about alcohol use
pos response to CAGE questions
CAGE questions
C: cut down on drinking?
A: annoyed by criticizing drinking?
G: ever felt guilty about drinking?
E: eye opener
Findings in a man with 10 year hx of alcohol abuse
elevated AST and ALT (3x normal)
mild macrocytosis (elevated MCV) without anemia (>3drinks/day women and >5/day men)
isolated hypertriglyceridemia
AST and ALT resolvent with sobriety
1-3 months
Macrocytosis resolvement with sobriety
2-3 months
Hypertriglyceridemia resolvement with sobriety
1-2 months
1 drink defined as
12 oz beer
5 oz wine
1.5 oz liquor
Legal alcohol limit for motor vehicle operation
0.08g/dL blood alcohol concentration
Is chest x-ray a screening for lung cancer?
NO
Hgb electrophoresis looks for?
sickel cell diease
Calculating pack year history
number of packs per day times number of years smoked
Highest risk for suicide
elderly males
Best statements to use when asking a pt something
“I” statements
I noticed the bruises are in the shape of a hand
Who is the author of the stages of change?
Prochaska and DiClemente
Stages of change
precontemplation contemplation preparation action maintenance/relapse
precontemplation stage of change
pt may not be ready to change or aware of change that needs to occur
contemplation stage of change
pt is considering change and looking at the pos and neg.
may report being “stuck” with the problem
preparation stage of change
pt exhibits some change of behaviors or thoughts
may need assistance in tools to success
action stage of change
the pt is ready to go forth with change
can be inconsistent with carry through
maintnance/relapse of change
pt learns to continue change and has adopted and embraced healthy habit
positive reinforcement
5 A’s with tobacco use
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
Top leading causes of death in US
Heart disease
cancers
respiratory disease
cerebrovascular diseases
Top cancer causes
Men: prostate, lung, colon, urinary
Women: breast, lung, colon, uterine
Top cancer deaths
Men: lung, prostate, colon, pancreas
Women: lung, breast, colon, pancreas
When guidelines have conflicting information
focus on the commonalities vs the differences
Screening for breast cancer should begin at
age 20 with BSE and clinical breast exam
mammo starting at 40
MRI if younger
Screening for colorectal cancer
begin at 50
colonoscopy every 10
fecal occult blood testing every year
procedure for fecal occult blood testing
collect 2 samples from 3 consecutive specimens
digital rectal exam not adequate
Screening for prostate cancer
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
High risk for prostate cancer
African American
first degree relative dx earlier than 65
Screening for endometrial cancer
women who are menopausal
any postmenopausal bleeding evaluated
those with colon cancer should be screened
Screening for lung cancer
low dose CT
those 55-74 with >30pack year hx, current smoker or quit less than 15 years ago
Screening for cervical cancer
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
Sensitivity defined
likelihood of true pos results with the disease
“neg helps to rule out”
Specificity defined
likelihood of a true neg result in those who are healthy
“pos helps to rule in diease”
Prevalence defined
proportion of sampled individuals possessing the condition at a given time
Incidence defined
proportion of individuals to developed a condition over a defied period of time
