unit 3: adulthood Flashcards
USPSTF reccs for screening for AAA for CVD PREVENTION
“selectively” for NONSMOKING men under 65-75
“routine = 1 time US for men 65-75 w HX of smoking
none for women
USPSTF low dose statin use for CVD PREVENTION recc’d for use in pts:
A) aged _______
B) have _______ risk factors for CVD
C) have a 10y CV risk of _____ or more
A) 40-75
B) one or more (lipids, DM, HTN, smoking)
C) 10%
USPSTF low dose ASA reccs for CVD AND COLORECTAL CA PREVENTION A) adults aged \_\_\_\_ B)\_\_\_\_\_% or greater 10y risk C) NOT at risk for \_\_\_\_\_\_ D) life expectancy of at least \_\_\_\_y E) pt willingness
A) 50-59 B) 10% C) bleeding D) 10y E) pt willingness MUST BE ALL OF THE ABOVE
USPSTF BP screening reccs for CVD PREVENTION:
everyone 18y and over. need to screen outside of office before initiating treatment.
USPSTF recs for counseling for CVD prevention
offer or refer adults who are overweight or obese AND have additional CVD risk factors to intensive behavioral counseling
USPSTF screening for DM for CVD prevention
A) all adults aged _____ & who are ______
A) 40-70 & overweight/obese
USPSTF screening for smoking for CVD prevention
ask ALL adults about tobacco use & encourage cessation. treat pharmacologically if needed.
smoking is linked to mutation of the _____ gene
p53
new antilipid meds (two of them) expensive, last resort, can lower LDL by 50-60%
evolocuman, alirocumab
_____ BP (sys/dia) is a better predictor of morbid events than _____ (sys/dia)
SYSTOLIC is a better predictor than DIASTOLIC
aspirin reduces risk of death from several cancers including:
colorectal, esophageal, gastric, breast, prostate, possibly lung
- potential risks outweigh benefits for those w >10% 10y risk
- antioxidant suppls do NOT reduce risk (vit E, C, beta-carotene)
primary prevention for osteoporosis
sufficient dietary calcium intake, Vitamin D supplementation, exercise
screening for osteoporosis recc’d for women ages:
65+
treatment for osteoporosis is: _______ which carry a risk of _______
biphosphonates.
femoral head fx, rare osteonecrosis of JAW
top two “contributing lifestyle FACTORS of preventable death”
tobacco & physical inactivity
5 A’s =
Ask Assess Advise Assist Arrange
metabolic syndrome is defined as presence of any three of 5 factors
1) waist msrmnt over ______
2) triglyceride levels _____+
3) HDL cholesterol less than _____/_____ (M/F)
4) BP over _____
5) fasting blood glucose over _____
1) 40 men, 35 women
2) 150
3) 40 men, 50 women
4) 130/85
5) 100
metabolic syndrome is defined as presence of 3+ of what 5 factors?
1) waist measurement >40 men, 35 women
2) triglyceride levels >150
3) HDL cholesterol <40 men, 50 women
4) BP >130/85
5) fasting blood glucose >100
lorcaserin is a pharmacologic intervention for:
weight loss in pts w BMI>30
OR
BMI >27 + one obesity-related condition (HTN, DM, HLD)
bariatric procedures reserved for pts w BMI >
40
OR
BMI 35-40 + one high-risk comorbid condition (OSA, pickwickian syndrome, cardiomyopathy, severe DM)
______ is the most common cause of injury-related deaths in older adults
accidental falls
all women ages _____ and up need to be screened for intimate partner violence and what is the question to ask?
childbearing age.
*at any time, has a partner ever hit you, kicked you or otherwise physically hurt you?” (per EB’s guide)
cues to mistreatment of older adults include:
ill-kempt appearance of pt, recurrent urgent-care visits, missed appts, suspicious physical findings, implausible explanations for injuries
what is the AUDIT tool?
Alcohol Use Disorder Identification Test: questions quantity & frequency of ETOH consumption, ETOH dependency symptoms, & ETOH-related problems
3 FDA approved drugs for ETOH dependence:
1) disulfiram
2) naltrexone
3) acamprosate
buprenorphine
decreases s/s of withdrawal from opioids and is effective in reducing concomitant cocaine + opioid abuse
*risk of OD is lower than methadone & preferred in pts at high risk of methadone toxicity
framingham risk calculator for women’s CVD risk? (LOOK UP)
look up
other breast cancer risk models:
the gail model, ontario family history risk assessment tool, the manchester scoring system, the referral screening tool, the pedigree assessment tool, the family history screen
PHARMACOLOGIC primary prevention for breast cancer in high risk pts
tamoxifen & raloxifene (weigh risks & benefits)
osteopenia is classified as BMD (bone mineral density) between ____ & ____ standard deviations below the mean for young adults
1-2.5
osteopenia is classified as BMD (bone mineral density) between ____ & ____ standard deviations below the mean for young adults
1-2.5 (T score of -1 to -2.5)
osteoporosis is classified as BMD over ___ standard deviations below the mean for young adults
2.5 (T score below -2.5)
severe osteoporosis is classified as BMD below _____ AND a ______
OR as a T score below _____
- 2.5, fracture
- 3.5
FRAX (fracture risk assessment tool) predicts?
a woman’s 10y risk of having any osteoporotic fractures & the 10y risk of a hip fracture.
risk factors for osteoporosis include:
age, gender, personal hx of fracture, parental history of hip fracture, low BMI, use of oral corticosteroids, secondary osteoporosis (?? drug related?), current smoking, alcohol intake of 3+ drinks/day
**HELPFUL when deciding which women would benefit from treatment.
STD primary prevention: postponing sexual _____
debut
STD primary prevention: limiting ______
sexual partners
STD primary prevention: regular _____ or ______ condom use
latex or polyurethane
STD preventions: immunizations
guardasil, hep B, hep A (if indicated), what else?
consistent use of ______ by _______ sex partners is one of the most effective methods of preventing STDs
latex or polyurethane condoms by male sex partners
consistent condom use has shown to reduce risk of transmission of _______ by 80-95%
HIV
consistent condom use can prevent transmission of _____, _______, & ______
gonorrhea, chlamydia, trichomonas
condom use decreases risk of ______ infection
HPV
____ based lubricants can weaken latex, so ______ based lubricants should be used with latex condoms
oil, water
STD secondary prevention: screen for
Gonorrhea, Chlamydia, HIV, HEP B & C, syphilis
GCHBCS (go cardinals! home base for carlos syphil!)
STD tertiary prevention: limit ____ of disease, prevent _____
- impact of disease: sequalae of PID, chronic pelvic pain, infertility
- prevent transmission
quadravalent HPV vaccine:
protects against HPV types 6,11,16,18
bivalent HPV vaccine:
protects against HPV types 16,18
nine-valent HPV vaccine:
protects against HPV types 6,11,16,18,31,45,52,58
HPV routine vaccination:
girls 9-12
boys 11-12
adolescents <15 = 2 doses
HPV catch up:
after age 15 considered catch up
girls :up to age 26
boys: up to age 21
HPV vaccine prevents against:
genital warts, persistent HPV infections, and cervical intraepithelial neoplasia
**protection not proven for strains not included in virus or previously acquired by host
Hep B vaccine for STD prevention: routine schedule
given routinely to people ages 0-18. time btwn doses depends on which type of vaccine being given
Hep B vaccine for STD prevention: catch up sched indications
2-3 doses depending on type of vaccine.
adults without vaccination history, those at risk for sexual or blood-borne transmission, DM
Hep B rates are higher in _______ pts
DM. outbreaks AW blood glucose monitoring
hep A catch up for adults
2-3 doses depending on type of vaccine
*for adults requesting it (travelers, HCW, HIV+, homeless, IVDU, MSM, lab workers or those who may be exposed on the job)
HIV prevention
pre- exposure prophylaxis for those at high risk
post exposure prophylaxis can decrease risk
HSV prevention
acyclovir daily for those infected to reduce transmission
condoms
victims of sexual assault STI treatment
empiric =
*G&C = ceftriaxone 250mg IM
*trichomoniasis = azithro 1g PO AND metro or tinidazole 2g PO
*Hep B vaccine x3 = now, 1m, 6m
*HIV = post-exposure prophylaxis
HPV x2 = for age eligible pts not previously vax’d
IF A WOMAN DECLINES EMPIRIC TX THEN TEST FOR:
- G&C, trich, blood test for syphillis/hep B/HIV
- ideally w/i 72h s/p assault
USPSTF depression screening
only screen if you have HELP readily available to ensure accurate dx, tx, and f/u.
*if these supports are not in place DO NOT SCREEN
SECONDARY prevention: depression
PHQ2, PHQ9, Beck
TERTIARY prevention: depression
pharm, CBT, intervention groups
IPV primary prevention & risk factors
change modifiable risk factors
*<35yo, female, pregnancy, single/divorced/separated, ETOH or drug use in either partner, smoking, poverty
secondary prevention IPV
appropriate screening @ visits
counseling
tertiary prevention IPV
counseling to change behavior of perpetrator (no evidence to support),
social services to assist w legal issues,
permanent plans/solutions to limit contact
USPSTF recs screening for IPV
all women of childbearing age. provide or refer to intervention services
interventions for IPV
- encourage woman to leave when safe,
- ensure that she has a safe place to go
- counsel her to assess risks/create safety plan
- victim referal to social services & national domestic abuse hotline (1-800-799-SAFE)
do clinicians have a duty to report suspected or confirmed IPV?
No, it varies by state but if the woman is COMPETENT it is not req’d in MOST states
screening tools for IPV:
- HITS (hurt, insult, threaten, scream)
- WAST (women abuse screening tool)
- PVS (partner violence screen)
- AAS (abuse assessment screen)
- WEB (women’s experience w battering) scale
inclusion of WHAT specific question when taken w the MEDICAL HISTORY is proven to increase identification of IPV?
“have you ever been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?”
clues that suggest abuse:
injury/explanation mismatch, frequent visits to ED, somatic complaints (chronic HA, abd pain, fatigue), may be vague about s/s, may avoid eye contact, abusing partner may answer questions for the pt or refuse to leave the room
it is imperative the pt have the opportunity to?
speak with the clinician ALONE
it is imperative the clinician document what?
- the pts description of the event (for legal purposes)
- all physical findings to reveal injuries usually on central areas of body, forearms if defending, bruises in VARIOUS STAGES OF HEALING
- PTSD, depression, anxiety, ETOH/substance may develop in victims
DASH diet: choose foods low in ______ & _____and rich in _____, _____, ______, ______, _______
saturated/trans fats, sodium
potassium, calcium, magnesium, fiber, protein
recc’d daily servings GRAINS
6-8
recc’d daily servings meats/poultry/fish
6 or less
recc’d daily servings veggies
4-5
recc’d daily servings fruits
4-5
low fat/fat free dairy
2-3
fats & oils
2-3
sodium
2300mg
WEEKLY recc’d servings nuts/seeds/dry beans/peas
4-5
WEEKLY recc’d servings sweets
5 or less
caloric needs for women ages 19-30
sedentary: 2000
mod active: 2000-2200
active: 2400
caloric needs for women ages 31-50
sedentary: 1800
mod active: 2000
active: 2200
caloric needs for women ages 51+
sedentary: 1600
mod active: 1800
active: 2000-2200
caloric needs for men ages 19-30
sedentary: 2400
mod active: 2600-2800
active: 3000
caloric needs for men ages 31-50
sedentary: 2200
mod active, 2400-2600
active: 2800-3000
caloric needs for men ages 51+
sedentary: 2000
mod active: 2200-2400
active: 2400-2800
benefits of DASH
lower BP & LDL
beneficial popn of DASH + reducing sodium
HTN, HLD, obesity
daily target potassium to enhance effects of reducing sodium on BP
4700mg
foods high in potassium:
POTATOES, yogurt, OJ, apricots, pintos, pork, lentils, lima, soy, banana, fish, tomato sauce, prunes, skim milk, kidney beans, split peas, almonds
health and exercise recommendations prevents chronic diseases like:
CVD, DM2, some cancers
regular moderate-vigorous physical activity reduces feelings of ________ and improves _______
anxiety & depression
sleep & QOL
refer to opthamalogist:
- abnormal findings on exam (myopia, hyperopia, presbyopia, astigmatism, abn funduscopic exam)
- risk factors for vision disease
- DM for annual exams
risk factors for vision issues:
older age, AA race, fam hx of glaucoma
normal vision development:
- eye/vision system devel complete by early 20’s
- remains steady thru 30’s (women may experience fluctuations during pregnancy
- *lasik surgery should be performed in this stage
- glasses/contacts rx vary slightly if at all in this stage
vision screening recomendations <40y
if healthy w good vision: once in 20’s & twice in 30’s
*OPTHO urgently for: infection, injury, pain, unusual flashes/patterns of light
optho annually: contact lenses
*refer DM or fam hx of eye disease
tips for digital eye strain
- 20-20 rule: every 20m looking at screen, look 20 feet way for a full 20s
- look up and out windows every 2 chapters
vision related recc’s adults <40
- wear protective eyewear
- eat properly & exercise
- if at risk for glaucoma, see OPTHO early
- dont smoke
- adequate sleep
- avoid eye STDs
risk factors for glaucoma
AA, DM, AI, STIs, some cancers
illness detected in eyes:
potential stroke, DM, HTN, AI diseases, STIs, some cancers
adults age 40-60 normal vision development
come back to
_____ BP better predictor of MORBID events than ________ BP
SYSTOLIC is better than diastolic
high risk popns for HTN:
fam hx, AA, physical inactivity, excessive consumption of salt, ETOH, calories, and deficient intake of K+
PRIMARY PREVENTION of HTN
- reduce sodium & ETOH
- weight loss, regular excercise
- diet high in fruits & veggies, low in fat/red meats/SSBs
______ monitoring correlates BETTER with target end organ damage than ______ monitoring
HOME is better than clinical
recommendations for most adults newly diagnosed w STAGE 1 HTN (130-139/80-89):
LIFESTYLE MODIFICATIONS ONLY unless pt has existing CVD or increased risk then add pharm
nonpharm interventions for adults w elevated BP or HTN
- weight loss
- heart healthy diet to reduce BP
- sodium restriction
- K+ suppl (pref by diet)
- increased phys. activity w structured exercise program
- abstain from or practice moderation w alcohol (women <1/d, men <2/d)
antihypertensives as secondary intervention for a pt w CVD & an avg BP over
130+/80+
antihypertensives as primary intervention for a pt w estimated _____year ASCVD risk >_____% & an average BP over
10 year 10% ASCVD risk
130+/80+
antihypertensive meds for PRIMARY prevention of CVD n adults WITHOUT CVD and estimated _____year ASCVD risk > _____%
10, 10%
what is the current “goal BP” for adults?
<130/80
meds that may interfere with antiHTN therapy:
NSAIDS, stimulants, oral contraceptives
OSA increases risk for:
CVD diseases: HTN, CAD, cerebrovascular
treating OSA helps reduce BP in _____ HTN
resistant
def of primary prevention:
- REDUCE OR REMOVE RISK FACTORS
- intervening BEFORE health effects occur, measures such as VAX, altering risky behaviors, banning substances AW disease
- ex: giving up or not staring smoking
- **MOST COST EFFECTIVE
def of secondary prevention:
- promote early detection of disease or precursor states
- screening to ID disease in the earliest stages
- minimize impact
- ex: routine cervical pap to detect CA or dysplasia of cervix
def of tertiary prevention:
- aimed at limiting impact of established disease
- mgmt of disease s/p dx to slow or stop progression
- minimize impact of cost
- ex: partial mastectomy, radiation, chemo, rehab, screen for complications
CVD risk factors:
HTN, HLD, age, fam hx, smoking, obesity, DM
CVD screening tools:
- framingham risk calculator
- ACC risk calculator
- I’m unable to really find the diff btwn the two- they both calculate 10 year ASCVD risk
CVD primary prevention:
change modifiable risk factors:
- exercise
- adequate sleep
- reduce stress
- aspirin in certain circumstances?
CVD secondary prevention:
detection:
- ECG
- Stress test
- cardiac cath
- calcium score is controversial
CVD tertiary prevention:
after an event:
- pharmacological recommendations (ACE & BB)
- I’m assuming coronary interventions & CABG as well?
BREAST CA primary prevention:
- change modifiable risk factors (age, fam hx, ETOH, smoking, dense breast tissue)
- pharm therapy for high risk pts (selective estrogen receptor modifiers (SERMS) tamoxifen & raloxifene for high risk pts)
- preventative mastectomy (if high risk/have BRCA gene)
BREAST CA secondary prevention:
clinical breast exam, mammography, self breast exam
BREAST CA tertiary prevention:
- mastectomy
* pharm interventions to prevent recurrence
BREAST CA risk factors:
age, fam hx, ETOH, smoking, denser breast tissue
BREAST CA screening tool?
*GAIL calculator (breast cancer risk assessment)
SERMS stands for? and what are the two we care about?
selective estrogen receptor modifiers (SERMS)
*tamoxifen & raloxifene
COLORECTAL CA risk factors:
certain diets (fill in if you know), smoking, ETOH, obesity, lack of physical exercise, hx of polyps/adenomas or fam hx, hx of IBS
colorectal CA screening tools:
guiaic, colonoscopy
colorectal CA primary prevention:
change modifiable rf:
diet, exercise, no smoking, no ETOH
colorectal CA secondary prevention:
detection: guiaic, colonoscopy
colorectal CA tertiary prevention:
chemo, surgery, surveillance
cervical CA risk factors:
multiple partners, HPV, infection, smoking
cervical CA screening:
PAP, HPV testing
cervical CA primary prevention:
- change modifiable RF: no smoking
* prevent transmission: limit partners, abstinence, condoms
lung CA risk factors:
smoking, environmental exposure (asbestos/radon)
lung CA screen:
CXR, low dose CT scan
lung CA primary prevention:
- change modifiable risk factors: NO smoking
* minimize environmental exposure (radon leaks into basement
lung CA secondary prevention:
CXR, low dose CT scan
lung CA tertiary prevention:
chemo/radiation/surgery
osteoporosis risk factors:
age, female, ETOH 3+/d, personal hx of fracture, fam hx of hip fx, low BMI, use of oral corticosteroids, smoking
osteoporosis screening tools:
FRAX, BMD, determining adult functional history?
osteoporosis tertiary prevention:
- prevent falls w mobility aids
* meds: biphosphonates
osteoporosis primary prevention:
change modifiable RF: reduce ETOH, no smoking, weight train 2x/week, dietary CA++ and Vitamin D (check levels), get off glucocorticoids if possible
osteoporosis secondary prevention:
BMD (T Score)
what does the FRAX tool assess? results are in terms of?
*a woman’s 10-yr risk of osteoporotic fracture AND
10yr risk HIP fracture
*results are T-score
*PRO: good at determining women in osteopenia range that may benefit from treatment
_____ & ______ fractures are associated with premature mortality
hip & vertebral
osteopenia is defined as a T-score of:
-1 to -2.5
osteoporosis is defined as a T-score of:
< -2.5
severe osteoporosis is defined as a T-score of _____ OR _______
below -3.5 OR below -2.5 WITH A FRACTURE
normal T score is?
-1 to 1
must the FRAX tool be used with or without BMD score?
FRAX does NOT required BMD for assessment
treatment for osteoporosis begins when ____+ 10yHIPfx risk OR _____+ 10yOPfx
3%, 20%
true or false? calcium supplements helped reduce fx risk in healthy postmenopausal women
FALSE
recommended calcium intake for women < 50?
> 50?
1000mg/d <50
1200mg/d for 51+
dietary calcium is the preferred route but calcium may be supplemented in what way?
- calcium citrate OR calcium bicarbonate
* should be combined w vitamin D
USPSTF recc’s vitamin D suppl to prevent _____ in community-dwelling older women at high risk for ______
falls
Vitamin D dose for fall prevention: women <71
600iu/day
vitamin D dose for fall prevention: women 71+
800 iu/day
vitamin D deficiency is defined as level less than
20
main risk factor for developing osteoporosis =
increasing age
USPSTF screening reccs for OP =
- women 65+
* women UNDER 65 ONLY if their risk is = to or > the risk of a 65yo white lady w no additional risk factors
TREATMENT for OP is recc’d for WHO &/or when?
- T score < -2.5 W FRAX HX
* T score -1 to -2.5 AT HIGH RF FRAX
true or false? calcium & vitamin D supplementation are recc’d for PREVENTION of FRAX?
FALSE. no evidence in men or premenopausal women
Vitamin D/calcium supplement dose for noninstututionalized postmenopausal women
1000mgCA++/400iuD PER DAY. no more no less.
USPSTF rec’s regular assessment of global CVD risk in adults aged ________
40-79 even without known CVD
USPSTF screening recs for AAA
- MEN aged 65-75 WITHOUT smoking history: selective
- MEN 65-75yo WITH smoking history: 1 time US
- women dont’ get screened
USPSTF serum lipid screening reccs:
ALL MEN 35+ AND men 20-35 at increased risk
WOMEN 20+ only at increased risk (eye roll)
USPSTF recs statin use for CVD prevention: pts must meet what 3 criteria?
- 40-75yo
- 1+ CVD rf (lipids, DM, HTN, smoking)
- 10%+ 10yr risk CV event
most important prevalent cause of morbidity and mortality? cause 1 in every ___ deaths?
cigarette smoking, 1 in 5
smoking increases risk for:
premature death, fatal heart disease, lung CA, other cancers (mouth/throat/esoph/pancreas/kidneys/bladder/cervix), CVA, PUD, Hip/wrist/vertebrae frax, cataracts, AAA
