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Flashcards in Family Deck (73)
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1

At what age should you get the 2-dose shingles vaccine?
At what age should you defer to the single-dose shingles vaccine?

Double dose: 50+ (preferred)
Single dose: 60+

2

Currently, at what age should you first get Prevnar-13 (PCV-13)?
- How many doses?

What age if you didn't get it at as a kid?
- How many doses?

2 months
- 4 doses

65+
- at least 1 dose

3

According to USPSTF, what demographic should get screened for AAA?
- What screening method?

Men ages 65-75 who have smoked at least once
- Ultrasonography

4

For men aged 65-75 who have never smoked, when might you screen them for AAA?

Based on factors including: HTN, fam hx, overweight, atherosclerosis, caucasian

5

What is the USPSTF's grade for screening males 65-75 who've ever smoked?

What is the grade for screening the same demo but who have never smoked, if they have r/f's?

B

C

6

What is the USPSTF's grade for screening FEMALES 65-75 who've ever smoked?

What is the grade for screening the same demo (females) but who have never smoked, if they have r/f's?

I

D

7

In what demo does the USPSTF recommend breast cancer screening?
- How often?
- What screening tool?

Women ages 50-74
- Biennial
- Mammography

8

What are the USPSTF's grades for the following, w/r/t breast cancer screening with mammography:
- Before age 50?
- 50-74?
- 75+?

C
B
I

9

What is the USPSTF's grade for teaching all women self-breast exams?

D (recommend against teaching it)

10

Describe what happens during mammography.

Breasts compressed b/w 2 firm surfaces to spread out the tissue. X-ray captures black and white images of each breast. Images are then examined on a computer screen by a physician who looks for signs of cancer.

11

What are 2 things to remind women about before their breast exam?

- Don't schedule for when breasts will be tender
- Don't wear deodorant

12

What are the benefits and harms of getting biennial mammograms?

(what age group does it benefit most?)

(what age group can it lead to false positives?)
(what age group could it lead to over-diagnosis?)

BENEFITS:
- Reduced mortality (esp. age 60-69)

HARMS:
- Psychological stress
- False positives (esp. 40-49) --> ^^ unnecessary imaging, bx, tx
- Over-dx (esp. older pts) --> tx won't always prolong life
- Radiation exposure (minor)

13

What are the r/f's for breast cancer?

- Age
- Genetic mutation (BRCA1/2)
- Nulliparity, early menarche (<12), late menopause (>55), late age of first pregnancy, no breastfeeding
- Obesity

14

What are the general tx options for breast cancer?

- Radiation
- Chemotherapy (including hormonal tx)
- Surgery

15

Describe the screening demographic/age guidelines for cervical cancer. (2)

- What grade does USPSTF assign this?

- < 21-65: cytology (pap smear) q 3 years
- Option for women 30-65 who want to lengthen screening interval: cytology (pap smear) + HPV testing q 5 years

A

16

The USPSTF assigns the grade of D to screening women for cervical cancer below age __.

21
(immune system fights off virus)

- Also D for women who have had a hysterectomy

17

What are some exceptions to screening for cervical cancer in women ages 21-65?

- Total hysterectomy (no cervix)
- CIN 2 or 3
- Already have cervical cancer

18

What are the benefits and harms of getting cervical cancer screening?

BENEFITS:
- Decreased cervical cancer incidence and mortality

HARMS:
- Psychological stress
- Abnl results --> more testing --> colposcopy/cervical bx --> vaginal bleeding, pain, infxn, inadequate sampling
- Tx has risks (e.g. loop excision --> preterm delivery)
- Over-dx (esp. older pts) --> tx won't always prolong life

19

What are the r/f's for cervical cancer?

- HPV infection
- HIV infection/any immunocompromised state
- Smoking
- Early sexual activity, many sexual partners, h/o STIs
- DES exposure in utero
- Previous tx of high-grade precancerous lesion or cervical cancer

20

What is the tx for cervical cancer?

What if it is still just a high-grade precancerous lesion?

- Hysterectomy or chemoradiation

- Ablative or excisional therapies (cryotherapy, laser ablation, loop excision, cold-knife conization)

21

Colorectal cancer is the ___ leading cause of cancer, and the ___ leading cause of cancer death.

3rd (behind skin, lung)
2nd (behind lung)

- Incidence: Prostate 2nd highest incidence in men, breast 2nd highest incidence in women (behind skin); colorectal is 4th for each, but with combined sexes, moves to 3rd
- Deaths: lung, then for males prostate, breast females, but when you combine sexes, colorectal deaths pass prostate or breast deaths and move into 2nd.

22

At what age does the USPSTF recommend colorectal cancer screening?
- What grade do they assign this?

50-75
- A

23

What grade does the USPSTF assign to colorectal cancer screening ages 76-85?

86+?

C

D

24

List the different colorectal cancer screening tests and their temporal guidelines.

- High sensitivity fecal occult blood test (FOBT); annual
- Stool DNA test (FIT-DNA); annual
- Flexible sigmoidoscopy; q 5 years w/FOBT q 3 years
- Colonoscopy q 10 years

25

What are the 2 types of fecal blood tests?

- Briefly describe each, including their pros/cons.

Guaic
- Detects heme
- Must avoid certain foods like meats, citrus for 3 days, certain meds
- Requires 3 samples over 3 days
- Sp > 99%, sn only 50%

Immunohistochemical (FIT)
- Detects hgb proteins
- No dietary or medicine restrictions
- Requires 1 sample over 1 day
- Sn/Sp each > 99%

26

What does the stool DNA test (FIT-DNA) detect?

Detects tiny amounts of blood in stool (with an immunochemical test similar to FIT) as well as 9 DNA biomarkers in 3 genes that have been found in colorectal cancer and precancerous advanced adenomas.

27

What are the pros and cons of flexible sigmoidoscopy w/ FOBT vs. colonoscopy?

SIGMOIDOSCOPY
- Less invasive, less bowel prep, usually no sedation
- Can bx
- Only 15 min (+ if polyps)
- Requires f/u colonoscopy if polyps found

COLONOSCOPY
- Special diet; enema kit or laxative needed
- Must have complete cleansing, most are sedated
- Visualize entire colon, can bx
- ~30 min (longer if polyps being removed)
- Need an hour post-procedure to recover and someone else to drive you home

28

What is the name of a future, digital technique that may be used to screen for colorectal cancer?

CT colonography (Virtual colonoscopy)
- F/u colonoscopy if positive for lesion

29

How does FOBT work?

Typically use special spoon or other collection device to collect stool sample; then store it in a collection container that comes w/the kit; container is then given to doctor or lab by mail or in person.

30

How do you prep yourself for flexible sigmoidoscopy?

Special diet day before exam, take laxative or use an enema kit, and may need to temporarily adjust meds prior to procedure