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CMN 571 > Unit 3 > Flashcards

Unit 3 Flashcards

1
Q

Influenza immunization

A

1 dose annually all ages

LAIV - 19-49y/o

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2
Q

Tdap or Td

A

all ages

a dose Tdap then Td booster every 10 years

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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

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4
Q

HPV immunization

A

female: 2 or 3 doses 19-26 y/o

Male: 2 or 3 doses 19-21 y/o

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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)

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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)

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7
Q

Varicella immunization

A

19-38 y/o

w/o evidence of immunity: 2 dose serious 4-8 weeks apart

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8
Q

Vaccines contraindicated in pregnany

A

(Vagina IZ A Hateful Monster)

Varicella

IPV
Zoster

Hep A

HPV

MMR

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9
Q

Tdap and pregnancy

A

every pregnancy between 27-36 weeks (passive pertussis antibody to infant)

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10
Q

influenza and pregnancy

A

inactivate recommended

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11
Q

Meningococcal and pregnancy

A

give if indicated

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12
Q

Hep A and B and pregnancy

A

safety not determined

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13
Q

cardiovascular disease: risks

A 
HTN
hyperlipidemia
age
family history
smoking
obesity
DM
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14
Q

cardiovascular disease: screening

A

Framingham Risk Calculator

ACC Risk Calculator

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15
Q

cardiovascular disease:

primary prevention

A 
changing modifiable risk factors
exercise
adequate sleep
reduce stress
ASA?
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16
Q

cardiovascular disease:

secondary prevention

A

ECG
stress test
cardiac cath
calcium score?

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17
Q

cardiovascular disease:

tertiary prevention

A

limiting impact of diagnoses disease

Pharm: ACE/BB

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18
Q

breast cancer: risks

A 
age
family history
ETOH
smoking
denser breast tissue
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19
Q

breast cancer: screening

A

GAIL calculator

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20
Q

breast cancer:

primary prevention

A

change modifiable risk factors

pharmacological therapy to lower risk

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21
Q

breast cancer:

secondary prevention

A

clinical breast exam
SBE
mammography

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22
Q

breast cancer:

tertiary prevention

A

pharm intervention to prevent reoccurrence past surgery

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23
Q

colorectal cancer:

primary prevention

A

changing modifiable risk factors

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24
Q

colorectal cancer:

secondary prevention

A

guaiac

colonoscopy

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25
Q

colorectal cancer:

tertiary prevention

A

limiting effect of treating CA

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26
Q

cervical cancer:

primary prevention

A

condoms
smoking cessation
limit partners
abstinence

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27
Q

cervical cancer:

secondary prevention

A

PAP

HPV testing

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28
Q

cervical cancer:

tertiary prevention

A

preventing reoccurrence

hysterectomy

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29
Q

colorectal cancer: risks

A 
certain diets
smoking
ETOH
obesity, lack of physical activity
hx of polyps or adenomas
family hx
hx of IBS
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30
Q

colorectal cancer: screening

A

Guaiac

Colonoscopy

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31
Q

cervical cancer: risks

A

multiple partners
HPV
smoking

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32
Q

cervical cancer: screening

A

PAP

HPV testing

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33
Q

lung caner: risks

A

smoking
environmental exposure
radon

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34
Q

lung cancer: screening

A

CXR

LDCT

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35
Q

lung cancer:

primary prevention

A

instruction of dangers before beginning smoking

smoking cessation program

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36
Q

lung cancer:

secondary prevention

A

CXR to detect masses

LDCT for at risk patients

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37
Q

lung cancer:

tertiary prevention

A

limit impact of disease

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38
Q

STIs: risk

A

increased number of sexual partners

inappropriate use of barriers

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39
Q

STIs: screening

A

STD blood, urine, cultures

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40
Q

STIs:

primary prevention

A 
condoms
limit partners
delay of sexual activity
immunizations
PEP
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41
Q

STIs:

secondary prevention

A

GC/Chl screening

HIV, Hep B and C, Syphillis screening

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42
Q

STIs:

tertiary prevention

A

limit impact of disease (sequelae of PID, chronic pelvic pain, infertility) with some STIs
prevent transmission of disease to others

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43
Q

Depression: risks

A 
isolation
chronic diseases
loss or grief, life changes
female
family history
substance abuse
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44
Q

Depression: screenings

A

PHQ
BECK
other validate instruments ≈

45
Q

Depression: primary prevention

A

avoid isolation
stay involved
talk w/ people about problems/thoughts/concerns
ETOH/drug avoidance

46
Q

Depression: secondary prevention

A

PHQ 2 or 9

BECK

47
Q

Depression: tertiary prevention

A

medications
CBT
intervention groups

48
Q

Intimate Partner Violence: risks

A 
young
female
pregnancy
single, divorced,separated
ETOH or drug use in partner
smoking
poverty
49
Q

Intimate Partner Violence: screenings

A

Question Matrix
HITS
recognizing physical or emotional S/S

50
Q

Intimate Partner Violence: primary prevention

A

change modifiable risk factors

51
Q

Intimate Partner Violence: secondary prevention

A

screenings at visits

counseling for victim to recognize

52
Q

Intimate Partner Violence: tertiary prevention

A

counseling to change behavior of perpetrator
social services to assist with legal
permanent plans/solutions to limit contact

53
Q

assessment of cardiovascular risk AGES

A

40-79 w/o known cardiovascular disease

54
Q

when to start statins

A

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
Q

Framingham rich calculator

A

used to estimate woman’s 10 year risk of Coronary Heart Disease based on age, smoking, BP, cholesterol
- includes races and DM

56
Q

how to improve adherence to treatment of HTN, DM, hyperlipidemia

A

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
Q

HTN: risks

A

HTN
DM
HLD
Obesity

58
Q

HTN: screenings

A

recommended for new onset or uncontrolled HTN

59
Q

HTN: primary prevention

A

promote lifestyle modifications to all for healthy lifestyles

diet, exercise, weight loss
DASH diet
Na reduction
dietary K
ETOH abstinence or in moderation
60
Q

HTN: secondary prevention

A

promote early detection of disease or precursor states

61
Q

HTN: tertiary prevention

A

aimed at limiting impact of established disease

62
Q

Diabetes: risks

A

HTN
obesity
HLD

63
Q

Diabetes: screenings

A

> 45 y/o, overweight/obese, every 3 years

64
Q

Diabetes: primary prevention

A

diet
exercise
prediabetes prescribe metformin (not an actual diagnosis)

65
Q

Diabetes: secondary prevention

A

metformin

66
Q

Diabetes: tertiary prevention

A

limit impact of established disease

67
Q

Hyperlipidemia: risks

A

HTN
DM
Obesity

68
Q

Hyperlipidemia: screenings

A

?

69
Q

Hyperlipidemia: primary prevention

A

risk calculator: BP, cholesterol, DM. smoker
lifestyle interventions
statin treatment
ASA in select patients

70
Q

Hyperlipidemia: secondary prevention

A

promote early detection of disease or precursor states

71
Q

Hyperlipidemia: tertiary prevention

A

aimed at limiting impact of established disease

72
Q

Obesity: risks

A 
behavior
genetics
dietary patterns
physical inactivity
medication use
other exposures
73
Q

obesity is associated with?

A 
HTN
DM
HLD
cancer
gallbladder disease
sleep apnea
OA
CV disease
74
Q

Obesity: contributing social factors

A

food and physical activity
education and skills
food marketing and promotion

75
Q

Obesity: primary prevention

A 
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
Q

Transtheoretical Model “Stages of Change”

A 
Pre contemplation
Contemplation
Planning
Actions
Maintenance
Relapse

-may not reach all in 1 visit, may need to start over after visiting success/failures

77
Q

Transtheoretical Model “Stages of Change”:

Pre-contemplation

A

(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
Q

Transtheoretical Model “Stages of Change”:

Contemplation

A

(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
Q

Transtheoretical Model “Stages of Change”:

Planning

A

(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
Q

Transtheoretical Model “Stages of Change”:

Actions

A

(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
Q

Transtheoretical Model “Stages of Change”:

Maintenance

A

(5: I have) patient achieves positive and concrete development with continuing support

has snagged for 6 months
continue to support, relapse prevention/ID

82
Q

Transtheoretical Model “Stages of Change”:

Relapse

A

(6) patient falls back into old patterns, actions, behaviors

83
Q

Motivational Interviewing

A

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
Q

5 principles of Motivational Interviewing

A

(1) roll with resistance
(2) express empathy
(3) avoid argumentation
(4) develop discrepancy
(5) support self-efficacy

85
Q

when?

dental screening

A

every 6 months

86
Q

when? BP screening

A

begin 18

2 separate readings on 2 occasions

87
Q

when? ETOH screening

A

begin 18

88
Q

ETOH screening

A

AUDIT tool: quantify ETOH consumption, dependency, related problems

89
Q

when? BMI screening

A

begin 18

each visit

90
Q

when? vision screening

A

20s - once
30s - once
40s - baseline exam

DM/preDM - annual
>65 - annual

91
Q

when? domestic violence screening

A

not pregnant: routine GYN visits

pregnant: 1st visit, every trimester, PP

92
Q

when? IPV screening

A

women of childbearing age

93
Q

when? ASCVD screening

A

begin 20

20-39: measure RF every 4-5 years

94
Q

when? blood glucose screening

A

begin 45, normal every 3 years

A1C >5.7 - annual

GDM - every 3 year

95
Q

when? colorectal cancer screening

A

45-75
sigmoidoscopyy q5y or colonoscopy q10y

75-85 if risk factors
>85 no more

96
Q

when? breast cancer screening

A

begin 40 annually

>55 every 2 yrs

97
Q

when? endometrial cancer screening

A

educate at menopause a/b risk, symptoms

98
Q

when? prostate cancer screening

A

begin 50

99
Q

when? testicular exam screening

A

begin 15

100
Q

when? cervical cancer screening

A

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
Q

Basal Cell

A

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
Q

Actinic Keratoses

A

start as this (pre-cancer) -> squamous cell carcinoma (rare)

usually small, rough or scaly flesh colored patches that begin on sun-exposed areas

103
Q

Bowens / Actinic Keratoses

A

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
Q

Squamous Cell Carcinoma

A

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
Q

Normal Mole

A

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
Q

Melanoma

A

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
Q

Seborrheic Keratoses

A

benign tumors/skin growths

tan/brown/black raised spots w/ wavy texture to rough surface

not contagious

108
Q

Wart

A

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)

CMN 571 (4 decks)

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