Family Flashcards
(73 cards)
1
Q
At what age should you get the 2-dose shingles vaccine?
At what age should you defer to the single-dose shingles vaccine?
A
Double dose: 50+ (preferred)
Single dose: 60+
2
Q
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?
A
2 months
- 4 doses
65+
- at least 1 dose
3
Q
According to USPSTF, what demographic should get screened for AAA?
- What screening method?
A
Men ages 65-75 who have smoked at least once
- Ultrasonography
4
Q
For men aged 65-75 who have never smoked, when might you screen them for AAA?
A
Based on factors including: HTN, fam hx, overweight, atherosclerosis, caucasian
5
Q
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?
A
B
C
6
Q
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?
A
I
D
7
Q
In what demo does the USPSTF recommend breast cancer screening?
- How often?
- What screening tool?
A
Women ages 50-74
- Biennial
- Mammography
8
Q
What are the USPSTF’s grades for the following, w/r/t breast cancer screening with mammography:
- Before age 50?
- 50-74?
- 75+?
A
C
B
I
9
Q
What is the USPSTF’s grade for teaching all women self-breast exams?
A
D (recommend against teaching it)
10
Q
Describe what happens during mammography.
A
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
Q
What are 2 things to remind women about before their breast exam?
A
- Don’t schedule for when breasts will be tender
- Don’t wear deodorant
12
Q
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?)
A
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
Q
What are the r/f’s for breast cancer?
A
- Age
- Genetic mutation (BRCA1/2)
- Nulliparity, early menarche (<12), late menopause (>55), late age of first pregnancy, no breastfeeding
- Obesity
14
Q
What are the general tx options for breast cancer?
A
- Radiation
- Chemotherapy (including hormonal tx)
- Surgery
15
Q
Describe the screening demographic/age guidelines for cervical cancer. (2)
- What grade does USPSTF assign this?
A
- < 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
Q
The USPSTF assigns the grade of D to screening women for cervical cancer below age __.
A
21
(immune system fights off virus)
- Also D for women who have had a hysterectomy
17
Q
What are some exceptions to screening for cervical cancer in women ages 21-65?
A
- Total hysterectomy (no cervix)
- CIN 2 or 3
- Already have cervical cancer
18
Q
What are the benefits and harms of getting cervical cancer screening?
A
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
Q
What are the r/f’s for cervical cancer?
A
- 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
Q
What is the tx for cervical cancer?
What if it is still just a high-grade precancerous lesion?
A
- Hysterectomy or chemoradiation
- Ablative or excisional therapies (cryotherapy, laser ablation, loop excision, cold-knife conization)
21
Q
Colorectal cancer is the ___ leading cause of cancer, and the ___ leading cause of cancer death.
A
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
Q
At what age does the USPSTF recommend colorectal cancer screening?
- What grade do they assign this?
A
50-75
- A
23
Q
What grade does the USPSTF assign to colorectal cancer screening ages 76-85?
86+?
A
C
D
24
Q
List the different colorectal cancer screening tests and their temporal guidelines.
A
- 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
31
Describe how a flexible sigmoidoscopy or colonoscopy works.
Air or CO2 inserted to inflate intestines, then thin, flexible tube inserted into the rectum and then up into the large intestine; a tiny video camera at the tip lets doctor see up to most of sigmoid colon and can take bx's (can see even further with colonoscopy).
32
What are the benefits of colorectal cancer screening?
- Reduced cancer mortality
| - Less invasive tests may reduce the # of colonoscopies needed (but still must f/u w/ colonoscopy if positive)
33
What are the specific harms of colonoscopy screening?
Flexible sigmoidoscopy?
Fecal tests?
Colonoscopy
- Perforation of the colon = 4/10,000
- Serious complications (eg major bleed, severe pain, etc) = 25/10,000
- Poor reaction to sedation
Sigmoidoscopy
- Serious complications (perforation, bleeding from bx site) = 3/10,000
Fecal tests
- Small risks
34
What are the r/f's for colorectal cancer?
- Family hx (1st degree relative or multiple other family members)
- Inherited syndromes (e.g. HNPCC/Lynch, FAP)
- Inflammatory bowel disease
- Obesity
- Lack of physical activity
- Smoking
- Alcohol
- African American
35
Lung cancer is the ___ leading cause of cancer, and the ___ leading cause of cancer death.
2nd
| 1st
36
What demographic does the USPSTF recommend lung cancer screening for?
- How is the screening performed?
- How often?
- What grade?
55-80 y/o with 30 pack year smoking hx + either actively smoking or quit in the last 15 years
- Low-dose CT scan
- Annually
- B
37
If someone is in the 55-80 year age range and smokes, when should screening be discontinued? (2)
1) Once a person has not smoked for 15 years
2) Once a person develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
38
What are the benefits and harms of getting annual low-dose CT for lung cancer screening?
BENEFITS
- Prevent lung cancer-related deaths
HARMS
- False negatives
- False positives (95% of positive results do not lead to a dx of cancer--may require further imaging or invasive procedure)
- Incidental findings
- Over-dx
- Radiation exposure
39
What are the risk factors for lung cancer?
- Smoking
- Age (esp. 55+)
- Less time b/w smoking cessation (ie risk decreased w/time since smoking cessation)
- Occupational exposure
- Radon exposure
- Family hx
- COPD or pulmonary fibrosis
40
What are the different tx options for lung cancer?
- Surgical removal (if early stage non-small cell lung cancer)
- Chemotherapy
- Radiation
41
Per USPSTF, what demo should get screening for osteoporosis?
What frequency if positive?
a) Women aged 65+
b) Women <65 whose fracture risk is >/= than that of a 65 y/o white woman w/ no additional risk factors.
- No consensus, but every 2 years (every 10 years if negative)
42
What is the USPSTF's grade for osteoporosis screening women age 65+ or <65 but w/ r/f's?
What about for men of the same criteria?
B
I
43
What are the osteoporosis screening modalities?
Dual energy x-ray absorptiometry (DEXA) of the hip and L-spine or (less common) qualitative ultrasonography of the calcaneus
44
Define osteoporosis.
Osteoporosis is characterized by low bone mass, microarchitectural disruption, and increased skeletal fragility.
45
Why chose qualitative US of the calcaneus vs. DEXA?
- Quantitative ultrasonography is less expensive and more portable than DXA and does not expose patients to ionizing radiation.
- Quantitative ultrasonography of the calcaneus predicts fractures of the femoral neck, hip, and spine as effectively as DXA. However, current diagnostic and treatment criteria for osteoporosis rely on DXA measurements only, and criteria based on quantitative ultrasonography or a combination of quantitative ultrasonography and DXA have not been defined.
- DEXA is easy, fast, painless as well
46
What is it like to get a DEXA scan at a hospital?
- How much is radiation are you exposed to?
- About how long will it take?
Lie on padded platform while mechanical arm passes over your body.
- Very low radiation exposure (< 1 CXR)
- 10-30 min
47
What are peripheral devices, and how do they differ from a full DEXA scan?
- Where are they commonly found? (1)
- What's a major advantage of them vs. a full DEXA?
Small, portable machine that can measure bone density at far ends of skeleton (ie fingers, wrist, heal).
- Often found in pharmacies
- Less expensive than those on central devices
48
On DEXA, what is defined as osteopenia? Osteoporosis?
```
Osteopenia = T-score between -1.0 and -2.5
Osteoporosis = T-score between < -2.5
```
T-score = SD below the young-adult mean
49
__% of postmenopausal women will have osteoporosis-related fracture during their lifetime.
50%
50
What are the benefits and harms of getting a DEXA scan for osteoporosis screening?
BENEFITS
- Reduce osteoporotic fractures (can lead to chronic pain, disability, loss of independence, decrease QoL, and increased mortality)
HARMS
- False positives
- False negatives
- Anxiety
- Cost
- Time
- Some small harm w/tx
51
What are the r/f's for osteoporosis?
- F > M
- Caucasian women
- Age
- Low BMI
- Menopause < 45
- Parental hx of hip fx
- Smoking
- Daily alcohol use
- Corticosteroid use
(Obesity is protective)
52
What are the tx options for osteoporosis?
Drug therapies: bisphosphonates, PTH, raloxifene, estrogen, calcitonin
Calcium (1,500mg), Vitamin D (at least 800 IU)
Weight bearing exercise
53
Ovarian cancer has the __ highest mortality rate of all GYNECOLOGIC cancers and is the __ leading cause of cancer death overall.
1st (highest)
| 5th
54
What grade recommendation does the USPSTF give for ovarian cancer screening?
D
55
What is the age-adjusted incidence of ovarian cancer per 100,000 women?
What implications does this have?
13/100,000 (1.3/10,000)
Makes any potential screening tool have poorer PPV and therefore less useful
56
What were two potential tools that could be used to screen for ovarian cancer, but were found to be not useful because ovarian cancer deaths were not decreased?
- Transvaginal ultrasound
| - Serum CA-125
57
What are the r/f's for ovarian cancer?
- Age
- BRCA mutation (may screen)
- Lynch syndrome (HNPCC)
- Family hx (2+ first-degree relatives w/ovarian cancer or combo of breast + ovarian cancer)
- Early menarche, late menopause, nulliparity, etc.
- Obesity
58
What are some protective factors for ovarian cancer?
- Oral contraceptive use
- Pregnancy
- Breastfeeding
- B/l tubal ligation
- Removal of ovaries
59
Prostate cancer is the #__ non-skin cancer in men.
Men's lifetime dx risk is __%
Men's lifetime risk of dying from prostate cancer is __%
#1
15. 9%
2. 8%
60
What grade recommendation does the USPSTF give for prostate cancer screening?
D
61
What was the screening modality that would be considered for prostate cancer?
PSA
62
What are the potential benefits and harms of prostate cancer screening w/PSA?
BENEFITS
- Many asymptomatic cancers identified
- Reduction in prostate cancer deaths (small amount)
- Decreases symptomatic metastatic disease
HARMS
- Over-dx (ID's many cancers that will not progress or progress so slowly that they will not become clinically significant during pt's lifetime)
- 80% false positive rate --> negative psychologic results, increased testing (e.g. bx)
- Serious harm from therapy (5/1,000 die w/in 1 month of surgery, + serious complications like ED)
63
What are the r/f's for prostate cancer?
- Age
- African American men (2x more likely to die)
- Family hx
- Exposure to agent orange
- Prostatitis
- Smoking
*BPH is NOT a r/f
64
What is the tx for prostate cancer?
- Surgery
- Radiation
- Androgen-depravation therapy
65
Testicular cancer is the most common cancer amongst males of this age range (approximate).
- Its annual incidence is: low/med/high
15-34
| -low
66
What grade recommendation does the USPSTF give for testicular cancer screening of asymptomatic pts?
- What types of screening modalities does it account for?
D
| - Self-examination or clinician examination
67
What are the benefits and harms of screening for testicular cancer?
BENEFITS
- Few because low incidence and high cure rate, even at advanced stage
HARMS
- Anxiety, stress
- False positives
- Harms of diagnostic tests/procedures
68
What are the r/f's for testicular cancer?
- Cryptorchidism
- Hx of testicular cancer
- Trisomy 21
- Klinefelter syndrome
69
What are the tx's for testicular cancer?
Greater than __% of newly dx'd cases are cured
- Orchiectomy
- Radiation
- Chemotherapy
90%
70
At what age can you get the PPSV-23 vaccine?
How long must you wait to receive the vaccine if you just got the PCV-13 vaccine?
65 or older
1 year
71
If a 65 y/o got the PPSV-23 vaccine today, but has not received the PCV-13 vaccine, how long must they wait to receive the PCV-13 vaccine?
1 year
72
Review these items that can elevate PSA in men, besides prostate cancer.
- Advancing age.
- Benign prostatic hyperplasia (BPH)
- Digital rectal exam (DRE)
- Prostate biopsy or surgery
- Catheterization
- UTI
- Urinary tract surgery
- Medications (finasteride, dutasteride, flutamide, nilutamide, and bicalutamide), supplements
- Sexual intercourse
- Riding a bicycle
- Sports injury
- Pelvic injury or trauma to the prostate
- Prostatitis
- Prostate cancer
73
Recall the side effects of bisphosphonates.
- Esophageal Irritation
- Osteonecrosis of the jaw (esp. when given IV)
- Transient hypocalcemia
- Renal impairment
- Ocular side effects
