Exam #2: Health Screening in the General Population

Question 1

What are the criteria for an appropriate screening test?

Answer 1

• Disease should be common enough to warrant screening
• Morbidity and mortality must be substantial
• An effective preventative intervention must exist
• Intervention must give a more beneficial outcome when applied in the PRE-SYMPTOMATIC stage vs. the symptomatic stage
• Screening should be broadly applicable and suitable for routine application
• Test accuracy must be maintained over time
• Screening should be free of adverse effects

Question 2

What is the difference between sensitivity and specificity?

Answer 2

Sensitivity= number of people with the condition that have a positive test

Specificity= number of people without the condition that have a negative test

Question 3

What is the difference between PPV and NPV?

Answer 3

PPV= probability that a positive test is actually positive

NPV= probability that a negative test is actually negative

Question 4

What is the USPSTF grading scale?

Answer 4

A= recommended- substantial benefit 
B= recommended- mod. to substantial benefit 
C= recommend AGAINST- small benefit 
D= recommend AGAINST- more harm than benefit 
I= inconclusive evidence

Question 5

What are the JNC-8 recommendations for the initiation of HTN treatment?

Answer 5

Treatment is warranted for:

1) Patient younger than 60 w/ a blood pressure greater than 140/90
2) Patient older than 60 w/ a blood pressure 150/90
3) Patient older than 60 WITH DM or CKD, and a blood pressure greater than 140/90

**Check every 2 years in patients older than 18*

Question 6

What are the 2013 ACC/ACH guidelines on treatment of blood cholesterol?

Answer 6

1) Determine cardiac risk w/ new calculator
2) Initiate statins if risk is 7.5% of higher

Assess every 4-6 years in 20-79 y/o

Question 7

What are the USPSTF screening recommendations for colorectal cancer?

Answer 7

50-75 y/o= screen with FOBT/ FIT Q3, Sigmoidoscopy Q5, or Colonoscopy Q10

76- 85= “C” - not recommended

Older than 85= “D” - not recommended

Question 8

What are the special populations for colorectal screening?

Answer 8

• Family history of HNPCC

- African American (consider screening at 45)

Question 9

What screening is recommended for children 3-5 y/o?

Answer 9

Vision to detect:

• Amblyopia
• Risk factors

Question 10

What vision related disease are African Americans at higher risk for?

Answer 10

Glaucoma

Question 11

What is the rationale against recommending coronary artery Ca++ scoring?

Answer 11

There is insufficient evidence to weight the risks and benefits of the procedure

Question 12

When is aortic aneurysm screening recommended i.e. what patient population?

Answer 12

1) Male
2) Greater than 65
3) Smoked more than 100 packs of cigs in life

Question 13

What are the USPSTF guidelines on lung cancer screening?

Answer 13

Annual screening for lung cancer with low dose CT is recommended if:

1) Between 55 and 80
2) 30 pack-year hx
3) Currently smoking or quit in the past 15 years

Question 14

What are the PSA screening recommendations?

Answer 14

• Under 40= don’t screen
• 40-54 AND average risk= don’t screen
• 55-69= shared decision
• 70 or older- not recommended

Question 15

Is testicular cancer screening recommended?

Answer 15

NO

Question 16

What are the recommendations for mammography?

Answer 16

Biannual mammography for women 50-74 y/o

Question 17

What are the STI screening recommendations?

Answer 17

Screen women at the onset of sexual activity