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Family Med > Well Visits and Prevention > Flashcards

Well Visits and Prevention Flashcards

1
Q

5 A’s of Smoking Cessation

A 
Ask - ask about use at ea visit
Advise - give specific risks to that pt
Assess - willingness to quit
Assist - counseling, pharmacology, use MI 
Arrange - follow up visit
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2
Q

5 R’s of Motivational Interviewing

A 
Relevant 
Risks of cont use
Rewards of quitting
Roadblocks - discuss to troubleshoot
Repetition - readdress at each visit
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3
Q

Smoking Cessation in Preg

A

Nicotine replacement = category D

Buproprion and Varencline = category C

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4
Q

Meds for Smoking Cessation (side effects and considerations)

A

Nicotine Replacement (can use in combo w/ bupropion or ea other)

  • Gum - chew then park in mouth
  • Cartridge, nasal inhaler, lozenge - do not use w/in 15 min caffeine
  • Inhaler has highest nicotine level - most dependence
  • Patch - 24 hr Nicoderm or 16 hr Nicotrol
  • E cigs have no carcinogens or tar

Buproprion- blocks uptake of NE and dopamine

  • Side effects - insomnia, dry mouth, cardiotoxicity
  • Contraindications - eating disorder, seizure disorder, on MAOi

Varenicline - partial nicotinic agonist to dec cravings, withdrawal and binding of nicotine if used

  • Dec dose if renal problems
  • Side effects - agitation, depression, suicide, nausea, dreams, inc cardiac events
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5
Q

Adult Male Immunization

A

Tdap if no booster in 10 yrs or no vaccine as an adult

Annual flu in anyone > 6 mo

PPSV23 & PCV13 if 65+ or risk like immune comp or COPD

Hep A if high risk (travel, chronic liver disease, IV drugs, MSM)

Hep B if high risk (HD, DM, healthcare workers, IV drugs, sexual hx)

Varicella if no immune hx or seronegative

Mening - dorms/military, asplenia or complement def

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6
Q

Adult Male Cancer Screening

A

Colon 50 yo male or female

  • Annual FOBT
  • Sigmoidoscopy 2-3 yrs
  • Colonscopy 10 yrs

NO SCREEN for prostate, testicular or pancreatic

Lung Cancer - annual low dose CT in smokers 50-80 yo w/ 30+ pack year who quit < 15 yrs ago

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7
Q

Adult Male CVD Screening

A

No CAD or PVD

HTN - meas BP if 18+

Lipid panel - men > 35 & women > 45

AAA US in men 65-75 yo who have smoked

ASA in men 45-79 if no risk GI hemorrhage

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8
Q

Pediatric Growth Monitoring

A
  • Meas head circumference until 3 yo
  • Meas BP once 3 yo
  • BMI once 2 yo (percentile)

Obese >95th
Overweight 85-95th
Normal 5-85th
Underweight < 5th

-Failure to thrive - deceleration in growth OR < 3-5th percentile

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9
Q

Pediatric Screens

A

Newborn - PKU and hypothyroid in all states

Lead - screen at 12 and 24 mo OR 36 and 72 mo, if move to US, esp if high risk (buildings b/f 1950, certain industrial sites)

Prev task force does not recommend screening for asymptomatic iron def anemia

Hearing if high risk infant - family hx, craniofacial abnormalities, syndrome like neurofibromatosis, infections like bacterial meningitis

Asymmetric light reflex - strabismus, then do cover-uncover test (if uncovered eye must deviate to focus then positive)

Use Snellen after age 3

HLD

  • All kids 1X b/n 9-11 and again at 17-21
  • Done at 2 if family hx, obese, overweight, HTN, smoking
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10
Q

Peds Safety Recs

A

Car seats - rear for 2 yrs, booster once 40 lbs, can sit w/o seat if 4’9” and 8-12 yo w/ back square

Sleep on back to prevent SIDS

Water < 120 degrees in home

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11
Q

Peds Nutrition and Dental Recs

A

Nutrition

  • Formula or breast milk until 1
  • Intro foods at 4-6 mo
  • Cows milk at 1 until at least 2 (then can do reduced fat)

Dental

  • Topical or systemic fluoride by 6 mo
  • First visit to dentist at 12 mo
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12
Q

Pediatric Immunization Schedule (9 shots)

A

Hep B - birth, 1-2 mo, 6-18 mo

Rotavirus - 2, 4, 6 mo

Dtap - 2, 4, 6 mo + 18 mo + 4-6 yrs

IPV - 2, 4, 6 - 18 mo + 4-6 yrs

Hib & Pneumococcal (PCV13) - 2, 4, 6, 12-15 mo

MMR, Varicella and Hep A - not until 1 yr

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13
Q

Adult Female CVD Screening

A

Lipid screen at 45 yo unless specifically at risk

BP meas 18 +

Discourage long term use hormone therapy due to CVD risk

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14
Q

Adult Female Cancer Screening

A

Colonoscopy rec same as men - 50 yo

Breast - no rec for clinical or self breast exam, mammography at age 50 (prev task force) q every 2 yrs

Cervical - pap at 21 yo q 3 yrs then once 30 can do co-test for HPV every 5 yrs; vaccinate b/n 11 and 26; can stop at 65 yo if 2 neg tests in last 10 yrs

  • Still receive pap if vaccinated
  • If hysterectomy for non - cervical reason that removes cervix then can stop but can’t if cervix still in place
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15
Q

Osteoporosis Risks and Prevention

A

Risks - smoking, low wt, family hx, sedentary, poor diet, Asian or Caucasian, steroid use

DXA at 65 yo - do not repeat if normal

  • T score < or = -2.5 - osteoporosis
  • T score -1.0 to -2.5 - osteopenia

Suggest dec alcohol, smoking cessation and wt bearing exercise in post-menopausal women; only give supplemental Vit D and Ca if high risk fracture or diagnosed officially w/ osteoporosis

Once diagnosed - fall prevention (check vision, hearing and med list)

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16
Q

Domestic Violence Risks and Prevention

A
  • screen 14-46 w/ questionairre
  • Risks - low income, divorced or separated, young age, hx child abuse, mental illness or substance abuse by either partner, pregnancy
17
Q

IADLs v ADLs

A

ADLs - bathing, dressing, eating, transfers, continence, toileting, grooming

IADLs - (instrumental) transportation, shopping, cooking, phone, managing money, cleaning, taking meds, laundry

18
Q

Vision and Hearing in Elderly

A

ONLY SCREEN IF SYMPTOMATIC

Vision

  • Presbyopia - prob w/ near sight
  • AMD - central vision loss b/c atrophy (give photocoagulation or injections of VEGF)
  • Glaucoma - screen if inc ICP, black, family hx
  • Cataracts - pacification –> leading cause blindness worldwide (surgery)
  • Diabetic retinopathy

Hearing (HHIE-S)

  • Presbycusis - sensorineural, loss high frequency and prob w/ speech discrimination
  • Cerumen impaction
  • Otosclerosis - see bones on PE; auto dominant
  • Central auditory processing disorder - no problem hearing noise but problem understanding
  • Noise-induced
19
Q

Other Geriatric Screening (7)

A

Falls - ask about hx falls and balance issues; suggest Vit D and PT to prevent

Cog - clock drawing and 3 item recall
Incontinence

Depression
1- Have you felt down in last 2 wk?
2- Have you felt little interest in doing things?

Nutrition - serial weights and ask about appetite

HTN screen - give HCTZ

DEXA at 65 yo or earlier if risk factors

Cancer - stop colon and breast screening at 75; stop Pap smear at 65

20
Q

Geriatric Immunizations

A

pneumococcal at 65, flu, Herpes Zoster at 60, Tdap booster

21
Q

Contraindications to Combo Birth Control Use

A

prior DVT, smoker > 35, CVD or coronary occlusion, impaired liver function, known breast cancer or cong hyperlipidemia

22
Q

IUDs (3 types + contraindications)

A
  • Copper (Paraguard) - lasts 10 yrs, can cause heavy periods, cannot use if Wilson’s disease
  • Mirene - lasts 5 yrs, prog only, can cause lighter periods
  • Skyla - lasts 3 yrs, also prog only
  • Contraindications - PID, infected abortion in last 3 mo, distorted anatomy, malignancy, unexplained bleeding
    • Wait 3 mo after resolution of any STD infection
23
Q

Emergency Contraception Options (5)

A
  • Yuzpe method - high dose combo pill, can use up to 5 days after sex but better if w/in 72 hrs, give anti-emetic due to likely N&V (not as effective as Plan B)
  • Plan B - .75 mg prog X 2 w/ 12 hrs between pills, can use up to 5 days after
  • Sngl dose mifepristone (prog antagonist)
  • Ulipristal acetate (Ella) - sunglasses dose program receptor modulator
  • Insert copper IUD
24
Q

HEADSSS

A

Home, educ/eating, activity, drug use, sexuality, suicide/dep, safety (violence, abuse, accidents)

25
Q

Teen Sports Physical

A

R/o HCM

  • Hx - syncope, chest pain w/ exertion, dyspnea, murmurs, family hx of sudden cardiac death
  • PE - systolic murmur that gets louder w/ anything that dec preload (Valsalva or standing)

R/o Marfan
-PE - arachnodactyly, thin/tall, lens subluxation, high arched palate, arm span > ht

Refer to cardiology if …

  • Marfan signs
  • HCM murmur
  • Systolic murmur at 3/6 or greater
  • ANY diastolic murmur

Also screen for asthma, ortho injuries, heat disorders, eating disorders

Family Med (8 decks)

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