TBL Nov 29 part 2

Question 1

What is PPV?

Answer 1

Proportion of pt’s w/ positive test who actually have the disease (so true positives divided by all positives)

Question 2

What does PPV increase with?

Answer 2

Increasing prevalence

Question 3

What is NPV?

Answer 3

Proportion of pt’s w/ negative test who are actually free of the disease (so true neg’s divided by all negatives)

Question 4

What does NPV increase with?

Answer 4

Decreasing prevalence

Question 5

What does likelihood ratio > 1 mean?

Answer 5

Increased likelihood of disease
If > 5, greater likelihood of detecting the presence of the disease
> 10 is strong evidence to rule in

Question 6

What must a good screening test have?

Answer 6

A high sensitivity

- able to find true positives

Question 7

What is RISE mnemonic?

Answer 7

Risks (of this patient)
Immunizations
Screening
Education/counseling

Question 8

Lead time bias

Answer 8

Diagnosed by screening so found disease earlier than would have if waited for symptoms

Question 9

Length time bias

Answer 9

Screening tests catch indolent cases of disease (slow growing cancers) but not severe disease (rapid growing cancers) — so people screened have “better prognosis”

Question 10

TdaP indications:

Answer 10

18-65 - TdaP
- booster every 10 years; wound and > 5 yrs
65+ Td

Question 11

MMR

Answer 11

can’t give to preggers

want women of childbearing age to get to prevent devo problems

Question 12

When avoid varicella vaccine?

Answer 12

Active TB
Immunosuppressed
Preggers
Recent immune globulin

Question 13

Polio

• OPV
• IPV

Answer 13

Oral (live) not recommended in US

Only give IPV if risk (traveler, health care)

Question 14

When not give influenza vaccine?

Answer 14

Acute febrile illness

Question 15

Pneumoccal vaccine

Answer 15

One dose for 65 years +
Consider 5-year booster if high risk
Give 2 wks before elective splenectomy
Nursing home residents

Question 16

When give Zoster?

Answer 16

Adults 60 and older once

Question 17

HPV

Answer 17

Females 11-16 (may start at 9)

If prior abnormal pap, positive HPV still give

Question 18

1-3 leading behaviors linked w/ death

Answer 18

1. Tobacco
2. Poor diet + physical inactivity
3. Alcohol consumption

Question 19

Level C vs. D evidence

Level I

Answer 19

C - consider based on individual pt
D - NOT used as harms > benefits

I - insufficient evidence so make decision based on clinical considerations

Question 20

Who screen for Syphilis?

HIV?

Answer 20

High-risk adults

All pregnant women

Question 21

What is new screening for breast cancer?

Answer 21

50-74 years old
Mammography
+/- clinical breast exam
EVERY 2 YEARS (unless limited life expectancy)

Question 22

When screen cervical cancer?

Answer 22

Start at age 21
Every 3 years
Discontinue at 65 or after hysterectomy for benign reasons

Question 23

What is best predictor hip fracture?

Answer 23

DEXA scan femoral neck

Question 24

Osteoporosis screening?

Answer 24

Age 65, at least 2 years between, longer ok

takes 2 years to measure change in BMD

Question 25

When screen prostate cancer?

Answer 25

1st degree relative
High risk
African American

Question 26

For which of these do we screen?

• pancreatic CA
• Ovarian CA
• Testicular CA

Answer 26

None

Question 27

SAFE screen for domestic violence?

Answer 27

Stress/safety: do you feel safe
Afraid/abused: threatened, abused?
Friends/family: would they know, would they help?
Emergency plan