Preventive Medicine

Question 1

Lung cancer screening and grade of recommendation

Answer 1

B: 50 to 80 years, with 20 pack per year smoking currently or quit within 15 years. Low dose CT chest annually

Question 2

Colon cancer screening

Answer 2

When?
A: 50-75
B: 45-49
C: 76-85 (healthy and 10 or years life expectancy)
High risk: at age of 40 or ten years before age of relative diagnosis

High risk population?
- Single first degree relative diagnosed with CRC before the age of 60
- Multiple first degree relative at any age

FOBT: yearly
FIT: Yearly
SDNA FIT: 1-3 years
CT colongraphy: every 5 years
Sigmoidoscopy: every 5 years
Sigmoidoscopy + FIT annually: every 10 years
Colonoscopy: every 10 years

Gold standard: Colonoscopy > flexible sigmoidoscopy + annual FIT (same mortality benefit)

Question 3

Prevention of NTD

Answer 3

0.4 to 0.8mg at least 1 m prior to conception

4mg if epileptic, DM, or previous baby with NTD

Question 4

Depression and suicidal screening

Answer 4

Depression:
B: start from age of 12
I: younger than 12 years old

Suicidal:
I

Question 5

AAA screening

Answer 5

Men 65-75 whoever smoke: B
Men 65-75 never smoke: C
Women 65-75 never smoke: D
Women 65-75 ever smoke: I

Question 6

Cervical cancer screening

Answer 6

• 21 to 65: A (regardless of sexual or hpv vaccine history)
• Older than 65: D
• younger than 21: D
• underwent cervical removal with no hx of CIN-2: D

21-29: Pap smear alone x3 years

30-65:
Pap smear alone every 3 year
HrHPV testing or HrHPV testing + Pap smear every 5 years

Question 7

Breast cancer screening

Answer 7

B: 50-74
C: 40-49
I: Dense breast U/S, All women DBT, 75 or older

Others High risk:

• Start at age of 40 with ANNUAL Mammogram: Personal or family history of breast, ovarian, or peritoneal cancer - Radiotherapy of the chest between 10-30 years old.
• Start with MRI at age of 25, and mammogram at age of 30: BRACA positive

Question 8

Osteoporosis screening

Answer 8

Women 65 or older: B
Post-menopause younger than 65 at increased risk ( as determined by formal clinical risk assessment tool ): B

Men: I

Question 9

What are the live / killed vaccines?

Answer 9

Viral: all live except HI HI [ Hepatitis A,B - Infleunza - IPV ]

Bacterial: all killed except TB [ Typhoid - BCG ]

Question 10

Infleunza vaccine?

Answer 10

• Annually
• inactivated “killed”: IIV3 and IIV4 ( 3 for older than 6m, and 4 is approved for <6m )
• Recombinent; 18 years old
• Live inranasal vaccine: 2-49 years old

Question 11

Egg allergy and infleunza?

Answer 11

• Only rash: give
• Anaphylaxis from eggs: give and monitor for 30m
• Anaphylaxis from vaccine: do not give

Question 12

Ovarian cancer screening

Answer 12

D: Against

Question 13

Prostate cancer screening

Answer 13

C: 55-69 years
D: 70 years and older

C for who?
- Black
- Family history of prostate cancer, particularly before age of 65
- Known or likely to have BRCA1 or BRCA2

Question 14

Pancreatic cancer screening?

Answer 14

D: AGAINST

Question 15

Hypertension Screening

Answer 15

A: Adult aged 18 and older
I: Adolescent and children

Question 16

Dyslipidemia screening

Answer 16

The age to screening for Dyslipidemia SHOULD be not later than 40 years old
Can be started at any age for non-pregnant and age 21-39, based on patient cardiac risk factors and desire to start statin

B: ASCVDs risk 10% or greater > prescribe statin
C: 7.5% to less than 10% > selectively offer statin based on 1 or more CVD risk factor
I: 76 or older
I: 20 years or younger

ASCVDs risk should be reevaluated form age 40-75 every 5 years
Fasting or Nonfasting lipid profile
For nonfasting: order the fasting if TG level >400

Question 17

Obesity screening

Answer 17

B: 6 years and older

Question 18

Aspirin for primary prevention of CVD and Colorectal cancer

Answer 18

B: 50-59: with ASCVD risk 10% or more, and no increased risk of bleeding, and life expectancy is 10 years or more, and willing to take aspirin for 10 years

C: 60-69: with ASCVD risk 10% or more, and no increased risk of bleeding, and life expectancy is 10 years or more, and willing to take aspirin for 10 years

I: 70 years or older

I: younger than 50 years

Question 19

Substance Abuse - Unhealthy drug use screening

Answer 19

B: adult 18 years or older, by asking

I: Adultscent

Question 20

Fall prevention in community-dwelling older adults: intervention

Answer 20

B: 65 years or older FOR exercise intervention
C: 65 years or older offer multifactorial intervention
D: against vitamin D supplementation in 65 or older