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Foundations > Preventative Med V > Flashcards

Preventative Med V Flashcards

1
Q

US Preventative Services Task Force

A
  • Makes evidence based recommendations about clinical preventive services. Ex. Screening
  • Volunteer, panel of national experts in prevention & EBM
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2
Q

With regards to the wellness exam & screening, per ACA…

A

USPSTF A/B recommendations are 100% covered

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3
Q

How are screening decisions made?

A
  1. Burden of suffering (the Ds)
    - Death, disease, disability, discomfort, dissatisfaction, destitution
  2. Screening test
  3. Prevention
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4
Q

Harms of screening

A
  • Risks
  • Anxiety
  • Additional dx testing
  • Over-dx
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5
Q

Cardiovascular disease is associated w/ what?

A
  • HTN
  • Hyperlipidemia
  • CHD
  • Carotid artery stenosis
  • Abdominal aortic aneurysm
  • Peripheral artery disease
  • Aspirin prophylaxis
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6
Q

USPSTF recommendations for HTN screening

A
  • 18-39yo = every 3-5 yrs

- ≥ 40 y/o or at increased risk = annual screening

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7
Q

Who are at an increased risk for HTN?

A
  • High-normal BP
  • Overweight
  • African American
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8
Q

Screening for HTN in children/adolescents according to AAP

A

≥ 3 y/o = every health care episode

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9
Q

Screening for HTN in children/adolescents according to NHLB

A

3-17 yo = annually

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10
Q

Screening for HTN in children/adolescents according to AHA (Bright Futures)

A

During annual well child visits beginning at age 3

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11
Q

USPSTF recommendations for hyperlipidemia screening

A
  • <20, insufficient evidence
  • Primary prevention:
    1. Age 40-75, no hx CVD, ≥ 1 CVD risk factor, & 10 yr CVD risk ≥ 10% = low-mod dose statin (Grade B)
  • If CVD risk 7.5-10%, Grade C
  • Age 76+, no hx CVD = Insufficient evidence
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12
Q

CHD USPSTF recommendations

A
  • No hx CHD, using non-traditional risk factors: Insufficient evidence
  • Using EKG: Low risk adults = Grade D, intermediate/high risk = insufficient evidence
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13
Q

Carotid artery stenosis USPSTF recommendations

A
  • Grade D, bc only 10% of ischemic strokes are caused by CAS
  • 1% asymptomatic
  • No overall benefit of CEA, stenting, or medical therapy
  • Limited by low prevalence & harms
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14
Q

AAA according to USPSTF (men)

A
  • 65-75 yo previous smoker = Grade B

- 65-75 yo never smoker = Grade C

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15
Q

AAA according to USPSTF (women)

A
  • 65-75 yo previous smoker = insufficient evidence

- 65-75 yo never smoker: screening not recommended = Grade D

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16
Q

USPSTF guidelines for aspirin prophylaxis

A
  • Use to prevent CVD & colorectal cancer
  • 50-59 yo = Grade B if:
    1. ≥ 10% 10-year CVD risk,
    2. Not at risk of bleeding
    3. Have a life expectancy of at least 10 yrs
    4. Willing to take low-dose aspirin daily for at least 10 yrs
  • 60-69 y/o with a ≥ 10% 10-yr CVD risk = Grade C:
    1. More likely to benefit if not at increased risk of bleeding, life expectancy is at least 10 yrs, willing to take low-dose aspirin daily for at least 10 yrs
  • Adults < 50 y/o & ≥ 70 y/o = insufficient evidence
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17
Q

Colorectal cancer according to USPSTF

A
  • Grade A = adults age 50-75 yo
  • Grade C = adults age 76-85
  • Most appropriate if healthy enough to undergo tx, & no comorbid conditions limiting life expectancy
  • Greater benefit if never been screened
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18
Q

Prostate cancer according to USPSTF (benefits)

A

Grade D

  • Large US study = no benefit
  • Large European study = no more than 1:1000 avoid death by screening
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19
Q

Prostate cancer according to USPSTF (harms)

A
  • False positives
  • Biopsy side effects
  • Overtx
  • Side effects from tx
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20
Q

Skin cancer according to USPSTF

A

Insufficient evidence

21
Q

Breast cancer according to USPSTF

A
  • Age 40-49, individualize = Grade C

- Every 2 yrs age 50-74 = Grade B

22
Q

Breast cancer according to ACOG

A
  • Every year, age 40-74

- ≥ age 75, individualize

23
Q

Lung cancer according to USPSTF

A
  • Grade B: Adults aged 55-80 w/ a hx of smoking
    1. Annual screening w/ low-dose CT if there is a 30-pack-yr smoking hx & pt currently smokes or has quit within the past 15 yrs
    2. Discontinue screening once pt has not smoked for 15 years, or develops a health problem substantially limiting life expectancy or the willingness to have curative lung surgery
24
Q

Chlamydia & gonnorhea recommendations

A
  • Grade B: screen in sexually active women ≤ 24 y/o & older women at increased risk
  • Insufficient evidence for men
25
Q

Hep B recommendations

A
  • Grade B: Those at high risk

- Grade A: Screen pregnant women at 1st prenatal visit

26
Q

Hep C recommendations

A
  • Grade B: Those at high risk & offer 1-time screening to adults born btwn 1945 & 1965
  • Screening adolescents & adults *
27
Q

HIV recommendations

A
  • Adolescents & adults aged 15-65
  • Those younger or older if at increased risk
  • All pregnant women (grade A) *
  • Non-pregnant adolescents & adults *
  • Pre-exposure prophylaxis *
28
Q

Syphilis recommendations

A
  • Grade A: Asymptomatic, non-pregnant adults & adolescents at increased risk
  • Grade A: All pregnant women
29
Q

Thyroid disorder recommendations

A

Insufficient evidence

30
Q

Thyroid cancer recommendations

A

Grade D

31
Q

Osteoporosis recommendations

A
  • Grade B: women ≥ 65 y/o & younger women whose fx risk is equal to or greater than that of a 65 y/o white woman who has no additional risk factors
  • Insufficient evidence for men
32
Q

CVD- Peripheral artery disease USPSTF recommendations

A

Risk assessment w/ ankle brachial index = insufficient evidence

33
Q

Cervical cancer USPSTF recommendations

A
  • Women 21-65 (pap) every 3 yrs OR

- Women 30-65 (in combo w/ HPV testing) every 5 yrs

34
Q

Cervical cancer USPSTF DRAFT

A

Women 21-65:
- Every 3 yrs for cytology in ages 21-29
- Every 3 yrs for cytology alone in ages 30-65 OR
Every 5 yrs w/ HPV testing alone

35
Q

Cancer: Access hereditary risk

A
  • Need for genetic counselor

- Tumor markers

36
Q

Cancer: Address preventative factors

A
  • Avoid tobacco
  • Physical activity
  • Healthy weight
  • Diet rich in fruits, vegetables, whole grains, & low in saturated/trans fat
  • Limit alcohol consumption
  • Protect against STIs
  • Avoid excess sun
37
Q

Psychosocial health concerns

A
  • Depression
  • Substance related problems
  • Intimate partner violence
38
Q

Depression recommendations

A
  • Grade B: screen adults, including pregnant & postpartum women
  • Grade B: screen for major depressive disorder in adolescents 12-18 y/o
  • Children ≤ 11 y/o: Insufficient
39
Q

Screening tools for depression

A
  • Patient Health Questionnaire (PHQ)-2
  • PHQ-9
  • Beck Depression Inventory for Primary Care
  • 5-Item World Health Organization Well-Being Index (WHO-5)
40
Q

Tobacco recommendations

A
  • Grade A: ask all adults about tobacco use, advise them to stop using tobacco, & provide behavioral interventions
  • In non-pregnant adults provide U.S. Food & Drug Administration (FDA)–approved pharmacotherapy for cessation to adults who use tobacco
41
Q

Tobacco use in children/adolescents recommendations

A
  • Grade B: provide interventions (education or brief counseling) to prevent initiation of tobacco use
42
Q

Alcohol recommendations

A
  • Grade B: screen adults ≥ 18 y/o for alcohol misuse & provide pts engaged in risky or hazardous drinking w/ brief behavioral counseling interventions to reduce alcohol misuse
  • < 18 y/o: Insufficient evidence
43
Q

Drug use recommendations

A
  • Screening* adolescents, adults, pregnant women: insufficient
  • Children, adolescents not already dx w/ substance use disorder: insufficient
44
Q

Intimate partner violence recommendations

A
  • Women of childbearing age: Grade B: screen & provide/refer women who screen positive to intervention services
  • Elderly or vulnerable adults: Insufficient
45
Q

Obesity recommendations

A
  • Grade B: screen all adults; offer/refer pts w/ BMI of 30 kg/m2or higher to intensive, multicomponent behavioral interventions
  • Grade B: screen children & adolescents ≥ 6 y/o; offer/ refer to comprehensive, intensive behavioral interventions to promote improvements in weight status
  • Weight Loss to Prevent Obesity-Related Morbidity & Mortality in Adults: Behavioral & Pharmacotherapy Interventions
46
Q

Vision recommendations

A
  • Insufficient evidence for glaucoma
  • Insufficient evidence for impaired visual acuity in adults 65+
  • Grade B: vision screening at least once in children aged 3-5 y/o for amblyopia or its risk factors
47
Q

Hearing recommendations

A

Insufficient evidence for hearing loss in asymptomatic adults 50+

48
Q

Falls/fx risk recommendations

A
  • Community-dwelling older adults age 65 or older at increased risk for falls
  • Exercise = Grade B

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