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NURP 501 - Ex 1 > 1: Screening and Health Maintenance > Flashcards

1: Screening and Health Maintenance Flashcards

1
Q

Name the 3 prongs of the USPST mission.

A
  • Evaluate benefits and harms of preventive services in healthy populations based on age, gender, and risk factors for disease.
  • Make recommendations about which preventive services should be incorporated routinely into primary care practice.
  • Assess quality of evidence and magnitude of net benefit.
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2
Q

Why screen those born between 1945-1965 for hep c?

A

Predates universal screening of blood donations, which began in 1992.

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3
Q

What are the risk factors for hep c?

A
  • Born between 1945-1965.
  • IV or intranasal drug use.
  • Long-term hemodialysis.
  • Incarceration.
  • Being born to an infected mother.
  • Getting a tattoo at an unregulated establishment.
  • Other exposure through percutaneous means.
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4
Q

What is the MOST significant risk factor for chlamydia/gonorrhea?

A

Age (through 24 yo)

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5
Q

An attribute or exposure that is causally associated with an increased probability of a disease or injury.

A

Risk factor

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6
Q

What is an additional screening recommendation for overweight or obese adults age 40-70?

A

DMT2

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7
Q

How long do you test at risk patients for lung cancer?

A

Yearly until 15 years after smoking cessation, then discontinue.

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8
Q

Name the 10 Grade A/B recommended screenings.

A
  1. Alcohol misuse
  2. Cervical cx
  3. Chalmydia/gonorrhea
  4. Depression
  5. Height/Weight
  6. HTN
  7. HIV
  8. Intimate partner violence
  9. Rubella immunity
  10. Tobacco use
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9
Q

What quantity puts women at risk for alcohol misuse

A

Alcohol consumption greater than 7 drinks/week or greater than 3 drinks/day.

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10
Q

What screening tests are used for BRCA-related cx?

A

Genetic counseling and testing for BRCA mutations.

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11
Q

What test is used for cervical cx and how frequently?

A
  • Papanicolaou (PAP) q 3 years OR
  • PAP + HPV DNA test q 5 years for those 30-65 yo.
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12
Q

What test is used for chlamydia/gonorrhea?

A

Nucleic Acid Amplification Tests (NAATs)

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13
Q

What are recommendations to prevent/treat DMT2?

A

Promote physical activity and a healthy diet.

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14
Q

What items are included in the essential health benefits package?

A

Essential Health Benefits Package includes coverage of all preventive health services that receive an A or B rating from the USPSTF at no cost to the individual. It is up to providers to be aware of which items are covered.

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15
Q

What screening test is used for osteoporosis?

A

Fracture Risk Assessment (FRAX)

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16
Q

What are rubella recommendations?

A

They are inactive, but in-line with CDC. Test all women of childbearing age.

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17
Q

What is the optimal screening interval for lipid disorders?

A

Not determined. Every 5 years for general population. More frequently for those with high levels and less frequently for those with repeatedly low levels.

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18
Q

What are the 5 risk factors for osteoporosis?

A
  1. Low body weight
  2. Cigarette smoking
  3. Family hx
  4. Increased alcohol intake
  5. White race
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19
Q

When was the USPST created?

A

Created by the U.S. Public Health Service in 1984.

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20
Q

What is the best predictor of hip fracture?

A

Bone density using dual-energy x-ray absorptiometry (DXA) of hip and lumbar spine.

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21
Q

What is the risk factor for lung cancer?

A

Smoking

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22
Q

What is the most effective approach to screening?

A

Combine evidence with individual needs of the patient.

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23
Q

What is the test for BP?

A

Recommended screening is blood pressure measurement in provider’s office using sphygmomanometer.

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24
Q

T/F When no risk factors are found for a dx a woman can still be at risk for the dx.

A

False. When no risk factors are found for a disease, a woman is not at risk for that disease. However, a woman’s risk factors can change.

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25
Q

What is an obese BMI?

A

30+

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26
Q

When does cervical cx screening begin?

A

21 yo OR within 3 years of onset of sexual activity.

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27
Q

What are the risk factors for colorectal cx?

A
  • First-degree relative at a younger age
  • Multiple first-degree relatives
  • Rare genetic disorders (familial adenomatous polyposis or hereditary nonpolyposis colorectal cx)
  • Inflammatory bowel dx (NOT IBS but IBD).
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28
Q

T/F Comprehensive patient hx is one of the most valuable tools available to clinicians.

A

True

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29
Q

What 3 tests are used for colorectal cx screening?

A
  1. Yearly high-sensitivity fecal occult testing (FOBT)
  2. Flexible sigmoidoscopy q 5 years in combination with FOBT q 3 years.
  3. Colonoscopy q 10 years.
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30
Q

What 3 tests are used to screen for intimate partner violence (IPV)?

A

All are 3-4 questions and can be self-administered:

  1. Hurt, Insult, Threaten, Scream (HITS).
  2. Humiliation, Afraid, Rape, Kick (HARK).
  3. Slapped, Threatened, and Throw (StaT).
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31
Q

What is the test for lung cancer?

A

Low-dose computed tomography (CT)

32
Q

What is the screening test for hepatitis c?

A

Anti-HCV antibody testing and confirmation with polymerase chain reation (PCR).

33
Q

What is goal BP for adults?

A
  • < 150/90: Adults 60+ without kidney disease or DM.
  • <140/90: All other adults, regardless of age or disease.
34
Q

How do you deal with IPV?

A

Document and treat injuries, give counseling referral, and inform about community resources.

35
Q

What is the optimal screening for depression?

A

Optimal frequency not determined. Screen all who have never been screened and rescreen based on clinical judgment and existence of risk factors.

36
Q

What is an additional screening recommendation for women who smoke?

A

Lung cx

37
Q

Why is it so important to screen women for depression?

A

Women are 70% more likely than men to develop clinical depression.

38
Q

What are 4 risk factors for syphilis?

A
  1. Commercial sex worker
  2. Exchanging sex for drugs
  3. Correctional facility inmate
  4. High-risk sex behaviors
39
Q

What can excess weight lead to?

A

Increased morbidity and mortality.

40
Q

What is the intent of the USPST?

A

To provide clinicians with a framework for decision making about the provision of preventive health services that is based on extensive reviews on existing evidence.

41
Q

Why is alcohol misuse in women so important?

A

Smaller quantities cause more severe damage in women.

42
Q

What is the initial step in secondary prevention?

A

Assessment: hx, physical exam, lab tests.

43
Q

What is an issue with changes in bone density?

A

It may take up to 2 years to identify changes in bone density and longer to improve fracture risk prediction.

44
Q

What are the risk factors for lipid disorders?

A
  1. DM
  2. Personal hx of CHD or noncoronary atherosclerosis
  3. Family hx of cardiovascular dx
  4. Tobacco use
  5. HTN
  6. Obesity
45
Q

How do you calculate BMI?

A

Divide weight (kg) by height (meters squared).

46
Q

What is an additional screening recommendation for women with familial risk factors for breast cx?

A

BRCA-related cx

47
Q

T/F Breast self-examination is a recommended tool for patients.

A

False. Task Force recommends against teaching it (Grade D). Some evidence actually suggests that clinical breast exams and breast self-exams may increase the likelihood of further testing and biopsy without improving outcomes.

48
Q

What are the 7 risk factors for Hep B?

A
  1. Birth in a country with high HBV rates
  2. Lack of HBV vaccine
  3. HIV-positive
  4. Household contacts or sex partner infected with HBV
  5. IV drug user
  6. Hemodialysis
  7. Cytotoxic/immunosuppressive therapy
49
Q

When were initial findings of USPST published and what was the name?

A

1989 Guide to Clinical Preventive Services

50
Q

What is done for a woman who is not immune to rubella?

A

Vaccinate all nonpregnant women. Vaccinate pregnant women immediately postpartum.

51
Q

What is the screening test for Hepatitis B?

A

Hep B surface antigen (HBsAg) with confirmation of initially reactive tests.

52
Q

What test is used for breast cx?

A

Mammography q 2 years.

53
Q

What is the optimal interval for nonpregnant women and Hep B screening?

A

Insufficient evidence. Use clinical judgment.

54
Q

What is the screening test for lipid disorders?

A

Serum measurement of total cholesterol, LDL, and HDL.

55
Q

How do you limit healthcare costs in secondary prevention?

A

Use only tests and treatments with proven benefits.

56
Q

What are 2 STI screening recommendations for pregnant women?

A
  1. Hep B
  2. Syphilis
57
Q

What are 7 risk factors for chlamydia/gonorrhea?

A
  1. Age
  2. African American/Hispanic
  3. Hx of STIs
  4. New or multiple sex partners
  5. Exchanging sex for money/drugs
  6. Nonmonogamous relationships who do not use condoms consistently
  7. Specific communities
58
Q

What is the test for syphilis?

A

Venereal Disease Research Laboratory (VDRL) or Rapid Plasma Regain (RPR) test.

59
Q

How do you screen for alcohol misuse?

A
  • AUDIT
  • Abbreviated AUDIT-C
  • Simply ask: “How many times in the past year have you had 4 or more drinks/day?”
60
Q

What population is mainly targeted by the USPST with their recommendations?

A

Intended for the general population who have no signs/symptoms of dx or risk factors for specific dx entities (unless otherwise noted).

61
Q

What are the subclasses of Alcohol Use Disorder (AUD)?

A
  • Mild
  • Moderate
  • Severe
62
Q

What are the 7 risk factors for BRCA-related cx?

A
  1. Family hx of breast cx before age 50
  2. Bilateral breast cx
  3. Breast and ovarian cx
  4. Breast cx in a male
  5. Multiple cases of breast cx
  6. 2 types of BRCA-related cx
  7. Ashkenazi Jewish ethnicity
63
Q

List the 5 Grade A/B screening recommendations for older women.

A
  1. Breast cx
  2. Colorectal cx
  3. Hep C infx
  4. Lipid disorders
  5. Osteoporosis
64
Q

How many times should someone be screened for hep c?

A

Screening with date of birth as the only risk factor requires 1 screening. Those with additional risk factors should be screened periodically.

65
Q

How many women are affected by IPV?

A

More than 1 in 4.

66
Q

What were the 4 primary changes the ACA enacted in healthcare?

A
  1. All must carry health insurance.
  2. Expand Medicaid to incomes at 138% of poverty level.
  3. Make lower-cost insurance available on the exchanges.
  4. Require all insurance to cover essential health benefits package at no cost to consumer.
67
Q

What tests are used for depression screening?

A

Self-administered tests that have been previously validated:

  • PHQ
  • PHQ-2
  • Geriatric Depression Scale for older adults
  • Edinburgh Postnatal Depression Scale for postpartum and pregnant women.
68
Q

T/F Brief interventions are effective at increasing quit rates.

A

True

69
Q

What is the test for tobacco use?

A

Implement the 5 As:

  1. Ask about tobacco use.
  2. Advise to quit.
  3. Assess willingness.
  4. Assist to quit.
  5. Arrange follow-up and support.
70
Q

What is the initial screening for BP?

A

Mean of 2 BP measurements, with patient in seated position, at least 5 minutes apart.

71
Q

What is an overweight BMI?

A

25-29.9

72
Q

When is a management plan developed and what is the focus?

A

Once risk factors are identified. The plan should include measures that focus on reducing short/long-term consequences.

73
Q

What is the optimal screening interval for DMT2?

A

Unclear, but reasonable to rescreen every 3 years if normal levels.

74
Q

ACA utilizes older breast cx recommendations. What are they?

A
  • Mammography q 1-2 years with or without clinical breast exam.
  • Begins at age 40.
75
Q

What is the test for rubella?

A

Serologic confirmation of rubella immunity.

76
Q

What are the tests for DMT2?

A
  • Fasting plasma glucose
  • 2-hour postload plasma glucose
  • Hemoglobin A1c
77
Q

Define secondary prevention.

A

Services that enable early identification of risk factors or diagnosis of disease conditions in asymptomatic patients.

NURP 501 - Ex 1 (63 decks)

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