Unit 3 Flashcards
1
Q
Influenza immunization
A
1 dose annually all ages
LAIV - 19-49y/o
2
Q
Tdap or Td
A
all ages
a dose Tdap then Td booster every 10 years
3
Q
Zoster immunization
A
> 50 y/o
Recombinant: 2 doses (2-6 months apart, minimum 4 weeks apart)
Live:
1 dose if not previously vaccinated
4
Q
HPV immunization
A
female: 2 or 3 doses 19-26 y/o
Male: 2 or 3 doses 19-21 y/o
5
Q
MMR immunization
A
healthcare born 1957 or later w/o evidence of immunity: 2 dose series 4 weeks apart (measles/mumps) or 1 dose (rubella)
born before 1957: 2 dose series 4 weeks apart (measles/mumps) or 1 dose (rubella)
6
Q
MMR immunization
A
19-60 y/o
healthcare born 1957 or later w/o evidence of immunity: 2 dose series 4 weeks apart (measles/mumps) or 1 dose (rubella)
born before 1957: 2 dose series 4 weeks apart (measles/mumps) or 1 dose (rubella)
7
Q
Varicella immunization
A
19-38 y/o
w/o evidence of immunity: 2 dose serious 4-8 weeks apart
8
Q
Vaccines contraindicated in pregnany
A
(Vagina IZ A Hateful Monster)
Varicella
IPV
Zoster
Hep A
HPV
MMR
9
Q
Tdap and pregnancy
A
every pregnancy between 27-36 weeks (passive pertussis antibody to infant)
10
Q
influenza and pregnancy
A
inactivate recommended
11
Q
Meningococcal and pregnancy
A
give if indicated
12
Q
Hep A and B and pregnancy
A
safety not determined
13
Q
cardiovascular disease: risks
A
HTN hyperlipidemia age family history smoking obesity DM
14
Q
cardiovascular disease: screening
A
Framingham Risk Calculator
ACC Risk Calculator
15
Q
cardiovascular disease:
primary prevention
A
changing modifiable risk factors exercise adequate sleep reduce stress ASA?
16
Q
cardiovascular disease:
secondary prevention
A
ECG
stress test
cardiac cath
calcium score?
17
Q
cardiovascular disease:
tertiary prevention
A
limiting impact of diagnoses disease
Pharm: ACE/BB
18
Q
breast cancer: risks
A
age family history ETOH smoking denser breast tissue
19
Q
breast cancer: screening
A
GAIL calculator
20
Q
breast cancer:
primary prevention
A
change modifiable risk factors
pharmacological therapy to lower risk
21
Q
breast cancer:
secondary prevention
A
clinical breast exam
SBE
mammography
22
Q
breast cancer:
tertiary prevention
A
pharm intervention to prevent reoccurrence past surgery
23
Q
colorectal cancer:
primary prevention
A
changing modifiable risk factors
24
Q
colorectal cancer:
secondary prevention
A
guaiac
colonoscopy
25
colorectal cancer:
| tertiary prevention
limiting effect of treating CA
26
cervical cancer:
| primary prevention
condoms
smoking cessation
limit partners
abstinence
27
cervical cancer:
| secondary prevention
PAP
| HPV testing
28
cervical cancer:
| tertiary prevention
preventing reoccurrence
| hysterectomy
29
colorectal cancer: risks
```
certain diets
smoking
ETOH
obesity, lack of physical activity
hx of polyps or adenomas
family hx
hx of IBS
```
30
colorectal cancer: screening
Guaiac
| Colonoscopy
31
cervical cancer: risks
multiple partners
HPV
smoking
32
cervical cancer: screening
PAP
| HPV testing
33
lung caner: risks
smoking
environmental exposure
radon
34
lung cancer: screening
CXR
| LDCT
35
lung cancer:
| primary prevention
instruction of dangers before beginning smoking
| smoking cessation program
36
lung cancer:
| secondary prevention
CXR to detect masses
| LDCT for at risk patients
37
lung cancer:
| tertiary prevention
limit impact of disease
38
STIs: risk
increased number of sexual partners
| inappropriate use of barriers
39
STIs: screening
STD blood, urine, cultures
40
STIs:
| primary prevention
```
condoms
limit partners
delay of sexual activity
immunizations
PEP
```
41
STIs:
| secondary prevention
GC/Chl screening
| HIV, Hep B and C, Syphillis screening
42
STIs:
| tertiary prevention
limit impact of disease (sequelae of PID, chronic pelvic pain, infertility) with some STIs
prevent transmission of disease to others
43
Depression: risks
```
isolation
chronic diseases
loss or grief, life changes
female
family history
substance abuse
```
44
Depression: screenings
PHQ
BECK
other validate instruments ≈
45
Depression: primary prevention
avoid isolation
stay involved
talk w/ people about problems/thoughts/concerns
ETOH/drug avoidance
46
Depression: secondary prevention
PHQ 2 or 9
| BECK
47
Depression: tertiary prevention
medications
CBT
intervention groups
48
Intimate Partner Violence: risks
```
young
female
pregnancy
single, divorced,separated
ETOH or drug use in partner
smoking
poverty
```
49
Intimate Partner Violence: screenings
Question Matrix
HITS
recognizing physical or emotional S/S
50
Intimate Partner Violence: primary prevention
change modifiable risk factors
51
Intimate Partner Violence: secondary prevention
screenings at visits
| counseling for victim to recognize
52
Intimate Partner Violence: tertiary prevention
counseling to change behavior of perpetrator
social services to assist with legal
permanent plans/solutions to limit contact
53
assessment of cardiovascular risk AGES
40-79 w/o known cardiovascular disease
54
when to start statins
10 year atherosclerotic CV risk >10%
20-75 y/o w/ LDL > 190
40-70 y/o w/ LDL 70-190 w/o DM use risk estimator
w/ DM 40-75 y/o
>75 y/o clinical assessment/risk discussion
55
Framingham rich calculator
used to estimate woman's 10 year risk of Coronary Heart Disease based on age, smoking, BP, cholesterol
- includes races and DM
56
how to improve adherence to treatment of HTN, DM, hyperlipidemia
evidence based care plan developed w/ patient (use motivational interviewing)
chose meds easy for adherence (once daily dosing, 1 pill, no SE)
contact w/ patient by clinic: reminders by EHRs, telehealth, emails/texts
57
HTN: risks
HTN
DM
HLD
Obesity
58
HTN: screenings
recommended for new onset or uncontrolled HTN
59
HTN: primary prevention
promote lifestyle modifications to all for healthy lifestyles
```
diet, exercise, weight loss
DASH diet
Na reduction
dietary K
ETOH abstinence or in moderation
```
60
HTN: secondary prevention
promote early detection of disease or precursor states
61
HTN: tertiary prevention
aimed at limiting impact of established disease
62
Diabetes: risks
HTN
obesity
HLD
63
Diabetes: screenings
>45 y/o, overweight/obese, every 3 years
64
Diabetes: primary prevention
diet
exercise
prediabetes prescribe metformin (not an actual diagnosis)
65
Diabetes: secondary prevention
metformin
66
Diabetes: tertiary prevention
limit impact of established disease
67
Hyperlipidemia: risks
HTN
DM
Obesity
68
Hyperlipidemia: screenings
?
69
Hyperlipidemia: primary prevention
risk calculator: BP, cholesterol, DM. smoker
lifestyle interventions
statin treatment
ASA in select patients
70
Hyperlipidemia: secondary prevention
promote early detection of disease or precursor states
71
Hyperlipidemia: tertiary prevention
aimed at limiting impact of established disease
72
Obesity: risks
```
behavior
genetics
dietary patterns
physical inactivity
medication use
other exposures
```
73
obesity is associated with?
```
HTN
DM
HLD
cancer
gallbladder disease
sleep apnea
OA
CV disease
```
74
Obesity: contributing social factors
food and physical activity
education and skills
food marketing and promotion
75
Obesity: primary prevention
```
healthy eating:
DASH diet
smaller plates
no second helpings
no sugary drinks/desserts
```
portion control:
tip of index finger = 1 tsp (butter, oil,mayo)
tip of thumb = 1 tbsp (dressing, cream cheese, PB)
fist = 1 cup (fruit, cereal, soup, casserole)
plam = 3 oz (meat)
cupped hand = snacks (ice cream, pretzels, pasta, ships, crackers)
exercise: begin a routine, step up ineffective.inconsistent routine, recognize unplanned exercise
76
Transtheoretical Model "Stages of Change"
```
Pre contemplation
Contemplation
Planning
Actions
Maintenance
Relapse
```
-may not reach all in 1 visit, may need to start over after visiting success/failures
77
Transtheoretical Model "Stages of Change":
| Pre-contemplation
(1: I won't) patient has not thought about or has rejected change
unaware, unwilling, too discouraged
won't change w/in next 6 months
worst strategy: persuasion
best strategy: listening, empathy, ID barriers
78
Transtheoretical Model "Stages of Change":
| Contemplation
(2: I might) patient is thinking and talking about change, seeks support
open to info, thinking about trying in next 6 months
good for info, emotional support
79
Transtheoretical Model "Stages of Change":
| Planning
(3: I will) patient plans what it would take to make change happen
ready to try in next 30 days
best strategies: goal setting, praise readiness, enlist support
80
Transtheoretical Model "Stages of Change":
| Actions
(4: I am) patient takes positive steps by putting plan into practice
taking steps, needs will power, habituating behaviors
need stimulus control, reinforcement, emotional support
*supporting self-efficiency is critical*
81
Transtheoretical Model "Stages of Change":
| Maintenance
(5: I have) patient achieves positive and concrete development with continuing support
has snagged for 6 months
continue to support, relapse prevention/ID
82
Transtheoretical Model "Stages of Change":
| Relapse
(6) patient falls back into old patterns, actions, behaviors
83
Motivational Interviewing
person centered
directive
method of communication for enhancing intrinsic motivation to change by exploring and resolving ambivalence
*developed to ID stage of readiness in pt*
create a favorable climate for change
use specific skills/strategies to move people forward
*addresses ambivalence and resistance*
takes 3-5 minutes
84
5 principles of Motivational Interviewing
(1) roll with resistance
(2) express empathy
(3) avoid argumentation
(4) develop discrepancy
(5) support self-efficacy
85
when?
| dental screening
every 6 months
86
when? BP screening
begin 18
| 2 separate readings on 2 occasions
87
when? ETOH screening
begin 18
88
ETOH screening
AUDIT tool: quantify ETOH consumption, dependency, related problems
89
when? BMI screening
begin 18
| each visit
90
when? vision screening
20s - once
30s - once
40s - baseline exam
DM/preDM - annual
>65 - annual
91
when? domestic violence screening
not pregnant: routine GYN visits
pregnant: 1st visit, every trimester, PP
92
when? IPV screening
women of childbearing age
93
when? ASCVD screening
begin 20
| 20-39: measure RF every 4-5 years
94
when? blood glucose screening
begin 45, normal every 3 years
A1C >5.7 - annual
GDM - every 3 year
95
when? colorectal cancer screening
45-75
sigmoidoscopyy q5y or colonoscopy q10y
75-85 if risk factors
>85 no more
96
when? breast cancer screening
begin 40 annually
| >55 every 2 yrs
97
when? endometrial cancer screening
educate at menopause a/b risk, symptoms
98
when? prostate cancer screening
begin 50
99
when? testicular exam screening
begin 15
100
when? cervical cancer screening
begin 25-65 every 3 yrs
>65 no screenings in normal last 10 years if hx precancerous test for 25 years after dx
PAP q3y
101
Basal Cell
develop on areas exposed to sun (head / neck)
flat, pale, or pink areas OR raised, red or pink,
translucent, shiny, pearly bumps that may bleed after sx; lower area in the center & blue / brown / black areas; larger
= oozing, crusted areas; grow slowly;
rare for it to spread to other parts of the body; however, left untreated à
invade bone or other tissues beneath the skin;
likely to occur in elderly; men more likely than women
fragile and BLEED EASILY
can progress to
102
Actinic Keratoses
start as this (pre-cancer) -> squamous cell carcinoma (rare)
| usually small, rough or scaly flesh colored patches that begin on sun-exposed areas
103
Bowens / Actinic Keratoses
squamous cell carcinoma in situ = BOWEN DISEASE
earliest form of SCC
rough patches in sun exposed areas (sometimes in anal/genital area)
larger, redder, scalier than AKs
doctors recommend treating this
104
Squamous Cell Carcinoma
flat, reddish or brownish patches in the skin; rough, scaly, or crusted surface; grow
slowly & occur on sun-exposed areas (face, neck, ears, lips, back of hands); can develop scares or skin sores; likely
to grow in deeper layers of skin à spread to other parts of the body; almost ALWAYS CAN BE CURED IF
FOUND EARLY!
105
Normal Mole
most are harmless; evenly colored brown/tan or black spot, can be flat or raised, round or oval; if
there’s an abnormal shape/larger mole/abnormal color à turn into melanoma
106
Melanoma
less common
most dangerous type
different colors, jagged border
occur anywhere on skin (women: neck. face; men: chest, back)
\may grow quickly and spread to surrounding skin
not common in darker skin
107
Seborrheic Keratoses
benign tumors/skin growths
tan/brown/black raised spots w/ wavy texture to rough surface
not contagious
108
Wart
benign growths caused by infection with HPV; lumps / bumps with a rough surface; CAN SPREAD
THROUGH CONTACT; more common in areas of broken skin (fingernails); if on bottom of feet = PLANTAR
WART (hard to treat due to growing inward)
