Columbus: well woman visit

Question 0

What are the American Cancer Society guidelines on diet and nutrition?

Answer 0

Choose most foods from plant sources
Limit intake of high fat foods particularly from animal sources
Be physically active and maintain healthy weight
Limit consumption of alcoholic beverages

Question 1

When does ACOG recommend annual pelvic examinations?

Answer 1

Starting at age 21

Question 2

What are the “five A’s” used for smoking intervention?

Answer 2

Ask about smoking history
Advise smokers to quit
Assess whether patient is willing to quit
Assist patient in quitting; consider nicotine replacement, bupropion, varenicline
Arrange follow-up care

Question 3

When does ACOG recommend mammography?

USPSTF?

Answer 3

Starting at age 40 and then annually

Age 50-74 biennially

Question 4

What are the major sequelae of smoking?

Answer 4

Cancer of the lung, oropharynx, esophagus, kidney, bladder, pancreas, cervix
CAD/COPD
Osteoporosis
Thrombotic disease/stroke
Persistent dysplasia
Pregnancy complications

Question 5

When does ACOG recommend clinical breast examination?

USPSTF?

Answer 5

Age 20-39 every one-three years
Age 40 and above annually

Insufficient evidence to justify exam

Question 6

When does the CDC recommend HPV vaccination?

Answer 6

Girls and boys aged 11 or 12 years. Females up to age 26. Males up to age 21.

Question 7

When does ACOG recommend breast self-examination?

USPSTF?

Answer 7

Recommends breast “self-awareness” and consider instruction of breast self-examination for high-risk patients

Recommends against instruction

Question 8

How long should screening be continued with a history of CIN 2-3 or AIS?

Answer 8

Age-based screening for 20 years

Question 9

When should Pap screening begin and at what frequency?

When can be stopped?

Answer 9

Age 21: Pap alone every 3 years
Age 30-65: HPV plus cytology every 5 years

No screening greater than age 65 or hysterectomy for benign disease

Question 10

What special populations should have more frequent screening?

Answer 10

HIV positive
Immunosuppressed
DES exposed

Question 11

Who should receive annual influenza vaccination?

Who should relieve receive live attenuated vaccine?

Answer 11

Recommended for all adults since 2010-11 flu season.

Healthy non-pregnant people age 2-49

Question 12

When does ACOG recommend colorectal cancer screening?

What tests are suggested?

Answer 12

Age 50 and over.

Colonoscopy every 10 years
Flexible sigmoidoscopy every 5 years
Double contrast barium enema every 5 years
Virtual colonoscopy every 5 years

Question 14

When is pneumococcus vaccination recommended?

Answer 14

Page 65 or older
Significant chronic disease
Immunocompromised individuals
Second dose given at age 65 unless immunized within the past five years

Question 14

When is tetanus booster indicated?

Answer 14

Every 10 years or if more than 5 years since last booster at the time of wound management

Question 15

When is varicella zoster vaccination indicated?

Answer 15

All people 60 or more years. Previous varicella infection is not a contraindication.

Question 17

When is Tdap vaccination indicated?

Answer 17

Adults age 19-64 should receive Tdap once
Pregnant women during each pregnancy between 27-36 weeks
Anyone not previously vaccinated who anticipates close contact with infant

Question 17

When is meningococcus vaccination recommended?

Answer 17

All adolescents age 11-18

College students or military personnel not previously vaccinated

Question 18

When is routine chlamydia screening recommended?

Answer 18

sexually active women age 25 and younger

Question 19

Hepatitis B vaccination is a routine childhood series. What high-risk adults should be screened for immunity or revaccinated?

Answer 19

Sexual contact with known carrier
Multiple sexual partners
Recent treatment for STD
IV drug user
Blood product recipient
Healthcare worker

Question 20

When is hepatitis C screening indicated?

Answer 20

One-time screening for all the adults born between 1945 and 1965

Question 21

When is HIV screening recommended?

Answer 21

Women and girls age 13-64
Patients presenting for TB treatment
Patients presenting for STD treatment
Pre-conceptual evaluation or routine prenatal care
Repeat screening annually for high risk patients

USPSTF recommends screening everyone age 15-65

Question 22

What are the three leading causes of death for women aged 19-39?

Answer 22

1. Accidents
2. Cancer
3. HIV

Question 23

When should women be screened for domestic violence?

What medical conditions are associated with domestic violence?

Answer 23

All women of reproductive age

Chronic pain, depression, alcohol and substance abuse

Question 24

What is the TACE screening tool for alcohol abuse? What quantity suggests at-risk drinking?

Answer 24

Tolerance, annoyed, cutdown, eye-opener More than 7 drinks per week or more than three drinks on one occasion in the past 90 days

Question 25

What are suggested depression screening questions?

Answer 25

Over the past two weeks, have you felt down, depressed, or hopeless? Or Over the past two weeks, have you felt little interest or pleasure in doing things?

Question 26

What therapies are helpful for preventing heart disease?

Answer 26

Consuming fish twice a week, Omega-three fatty acids may be considered in women with CHD Low-dose aspirin in women 65 or older

Question 27

When is pharmacotherapy indicated for elevated blood pressure?

Answer 27

Greater than or equal to 140/90 | Or greater than or equal to 130/80 if diabetic or renal disease

Question 28

When does UW Health recommend lipid screening? What frequency is recommended?

Answer 28

Age 20 and above Every 5 years

Question 29

When does USPSTF recommend cholesterol screening for women? What women are thought to be at higher risk?

Answer 29

Page 45 and older every five years. Starting at age 35 for high-risk women. Family history of lipid disorder Family history of premature coronary artery disease Personal history of coronary artery disease Diabetes Smoker

Question 30

What cholesterol screening is recommended by the USPSTF? Does this require fasting?

Answer 30

Total cholesterol and HDL cholesterol No

Question 32

When is diabetes screening recommended?

Answer 32

Age 45 or older and every three years. Screen earlier for obesity, strong family history, history of fetal macrosomia or gestational diabetes, hypertension, hypertriglyceridemia, PCOS

Question 33

Are the criteria for diagnosis of diabetes?

Answer 33

Fasting plasma glucose greater than equal to 126 2-hour plasma glucose greater than or equal to 200 Symptoms of diabetes and random plasma glucose greater than or equal to 200

Question 34

When is osteoporosis screening recommended?

Answer 34

Age 65 and older Under age 65 if history of fracture, alcoholism, smoker, frail stature, medications causing bone loss, FRAX 10 year risk of 9.3% or greater

Question 34

What medications are approved for prevention of osteoporosis?

Answer 34

Hormone replacement therapy Bisphosphonates Raloxifene

Question 35

What doses does ACOG recommend by age for calcium and vitamin D supplementation?

Answer 35

19-50: 1000 milligrams per day calcium, 600 IU per day vitamin D 51-70:1200 mg per day, 600 IU per day Greater than 70:1200 mg per day, 800 IU per day

Question 36

What reference does ACOG recommend for complete recommendations for well woman examinations?

Answer 36

www.acog.org/wellwoman

Question 37

What T-score indicates osteoporosis? How often should women be screened for osteoporosis based on T-score results?

Answer 37

Greater than or equal to 2.5 Less than or equal to 1.5: 15 years 1.5 to 1.99: 5 years 2 to 2.49: 1 year

Question 39

According to ACC/AHA cardiovascular risk screening guidelines, when should statin therapy be given?

Answer 39

Clinical atherosclerotic CVD LDL greater than or equal 290 mg/dL Age 40-75 with diabetes and LDL 70-189 mg/dL Age 40-75 with no diabetes and LDL 70-189 mg/dL AND 10-year atherosclerotic CVD risk greater than or equal to 7.5

Question 40

When do the new ACA/AHA guidelines recommend starting cardiovascular risk screening?

Answer 40

Age 21