EXAM 1- SCREENING Flashcards

Question

Papanicolaou Smear aka Pap test Uses

Answer 1

Screening for cancer of the cervix | Detects neoplastic cells in cervical secretions

Answer 2

Can be done by GYN or PCP, done by swabbing cervix and using under screen to check for active bacteria or infections and sent and read to see if there are neoplastic cells that indicate risk or CA

Answer 3

Age 21-65 years PAP every 3 years Age 30-65 years Combination of cytology and HPV testing Grade A recommendation Over age 65: no screening Grade D Total Hysterectomy No screening grade D when no h/o prior abnormality

Answer 4

pap with cervical cytology q 3 yr no HPV testing

Answer 5

Screen with cervical cytology every 3 years or in women who want to lengthen screening interval, screen with cervical cytology and HPV testing every 5 years.

Answer 6

Recommend against screening if adequate prior screening and not at high risk for cervical cancer.

Answer 7

women < 30 y/o

Answer 8

Begin Pap smears at age 21, regardless of when sexual activity began. Age 21-29: Screen with cervical cytology alone every 3 years. Age 30-65: Screen with cervical cytology and HPV testing (co-testing) every 5 years (preferred) or screen with cervical cytology alone every 3 years (acceptable). Women >65 years of age with a history of CIN 2, 3, or adenocarcinoma in situ: Continue routine screening for at least 20 years after treatment or regression. In some women, this may mean screening past age 65. HPV testing alone should not be used as cervical cancer screening.

Answer 9

age 21, regardless of sexual activity beginning

Answer 10

screen with cervical cytology alone q 3 yr

Answer 11

Screen with cervical cytology and HPV testing (co-testing) every 5 years (preferred) or screen with cervical cytology alone every 3 years (acceptable).

Answer 12

Continue routine screening for at least 20 years after treatment or regression. In some women, this may mean screening past age 65.

Answer 13

should not be done as cervical CA screening

Answer 14

three consecutive negative cytology results or two consecutive negative co-tests within the last 10 years before stopping with the most recent test within the last 5 years.

Answer 15

Discontinue after age 65 with adequate prior screening* and not at high risk of cervical cancer (ie, history of high-grade precancerous lesion or cervical cancer, in utero DES exposure, or immunocompromised).

Answer 16

Discontinue after age 65 with adequate negative prior screening* and no history of CIN 2 or higher within the last 20 years.

Answer 17

continue for HIV

Answer 18

Discontinue after hysterectomy in women with no prior history of CIN 2 or higher in the past 20 years, or cervical cancer ever. evidence of adequate negative screening not required.

Answer 19

Recommends against screening in women who do not have a history of a high-grade precancerous lesion (CIN 2-3) or cervical cancer

Answer 20

1. age 2. date of last menstrual period 3. pregnancy status 4. postpartum or postmenopausal 5. hx of abnormal pap smears 6. surgery 7. hx of carcinoma 8. any forms of treatment

Answer 21

LBCC more satisfacotry

Answer 22

1. menstruating 2. vaginal infection specimen should not be allowed to dry on slide other altering factors- lubricating jelly on speculum, douching, tub bathing, drugs like digoxin and tetracycline

Answer 23

Patients with suspicious pap must have colposcopy cone biopsy, and/or dilation and curettage diagnosis made only with biopsy of tumor

Answer 24

Fungal, parasite, and herpes infections can cause cellular changes on pap- must culture for these specifically

Answer 25

Prostate specific antigen Screening for early detection of prostatic cancer

Answer 26

``` 2nd leading cause of CA death in men lifetime risk 15.9% risk of death 2.8% 70% men > 70 yrs have occult prostate CA that does not effect health status, more likely to die from something else 22-23% mortality <70 yrs ```

Answer 27

AA (increased incidence) | family hx- relative risk of 2 with 1st degree relative, 5 when 2 affected

Answer 28

Sensitivity 59% Specificity is unknown but suggested to be as high as 94% Poor reproducibility May add to CA detection when combined with PSA

Answer 29

68-80% sensitivity | 60-70% specificity

Answer 30

Recommend against PSA screening for prostate cancer | Grade D recommendation = little clinical benefit

Answer 31

Third most common cancer in the US Second leading cause of cancer death in US 5% life time risk for developing colon cancer 20%of colon cancer diagnoses are in individuals with specific risk factors

Answer 32

personal or family h/o colorectal cancer/adenomatous polyps in 1st degree relative UC Familial polyposis or hereditary nonpolyposis colorectal cancer

Answer 33

2 samples of 3 different stools to six test card panels Positive Hgb or blood: turns blue False negative with Vitamin C False positive with ASA, NSAIDS, red meat (within past week) DRE single panel test sensitivity 9% should not be used

Answer 34

Sensitivity 25-38% & specificity 98%

Answer 35

Sensitivity 64-80% & specificity 87-90%

Answer 36

Colonoscopy every 10 years | Annual FIT

Answer 37

CT colonography every 5 years FIT–fecal DNA every 3 years Flexible sigmoidoscopy every 5–10 years

Answer 38

capsule colonoscopy every 5 years | Septin 9 testing is not recommended.

Answer 39

start average risk patients at age 50 years and continue until age 75 years FOBT, sigmoidoscopy or colonoscopy aged 76 to 85 years and less than 10 yrs of life expectancy Recommend against routine screening Grade C recommendation USPSTF does not recommend colorectal cancer screening for adults older than 85 years

Answer 40

Guaiac-based fecal occult blood test (FOBT), every year Fecal immunochemical test (FIT), every year FIT-DNA, every 1 or 3 years

Answer 41

``` Colonoscopy, every 10 years Computed tomographic (CT) colonography, every 5 years Flexible sigmoidoscopy, every 5 years Flexible sigmoidoscopy with FIT; sigmoidoscopy every 10 years, with FIT every year ```

Answer 42

testing with a tier 1 test should begin at age 45 years for African Americans and at age 50 for patients of all other races

Answer 43

colonoscopy at age10 years younger than the youngest age at diagnosis of a first-degree relative, or age 40, to be repeated every 5 years.

Answer 44

tier 1 test age 40, continue same intervals as average-risk patients.

Answer 45

a fiber optic tube to directly inspect the entire colon approximately 5 feet long has two fiber optic bundles: one provides a light source inside the colon and the other transmits the image from the colon to a high definition monitor and recording device third channel can be connected to a suction apparatus to remove debris blocking the view fourth channel can be used to insert a biopsy device

Answer 46

must cleanse their bowel prior to a colonoscopy usually given conscious sedation for the procedure done by a gastroenterologist can biopsy suspicious lesions and remove polyps at the time of the procedure without the need for another preparation and a separate sedation and procedure

Answer 47

about two feet long: examines first 60 CM of colon If h/o polyps need full colonoscopy If polyps are seen cscope is needed Detects 66% of men if a polyp is found and triggers full colonoscopy 55% of lesions in women as cancers are more proximal can be done with the patient awake and on an examining table in the primary care provider's office Discomfort often limits the examination to the first foot of the colon (sigmoid colon)

Answer 48

Leading cause of death men and women (combined) 2012 > 160,000 deaths This is more than breast, prostate and colon cancer combined

Answer 49

85% lung cancers caused by smoking 65 y/o 1ppd 50yr smoker: 10% risk of developing lung cancer over next 10 years 75 y/o 2ppd/50 yr smoker: 15% risk

Answer 50

annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years (2013 update) for at risk pts

Answer 51

sensitivity 94% specificity 73%

Answer 52

have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

Answer 53

clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about lung cancer screening with patients aged 55 to 74 years who have at least a 30-pack-year smoking history, currently smoke or have quit within the past 15 years, and who are in relatively good health

Answer 54

1 pack/day for 30 years = 30 pack yr hx 2 packs/day for 15 years = 30 pack yr hx ACS

Answer 55

CAD/CHD leading cause of death in the US 1/3 CHD events are related to a TC> 200mg/dL Age 40years: 49% lifetime risk Men & 32% women

Answer 56

``` TC and HDL not affected by eating TG: affected by eating May be 20-30% higher must be fasting TC can vary by 6% a day HDL can vary by 7.5% a day Recommend two measurements prior to initiating therapy ```

Answer 57

Grade A Screen all men age 35 Screen all women age 45

Answer 58

Screen men age 20-35 and women age 20-45 ``` WITH Family history of CAD prior to age 50 Diabetes HTN Smoking ```