FINAL- Review Flashcards
1
Q
policies, vaccines, seat belts, lifestyle changes, prophylaxis, fluoride
A
primary prevention
2
Q
Screening → identify and treat diseases early
A
secondary prevention
3
Q
prevent disease progression
A
tertiary prevention
4
Q
who really has the disease (t= positive)
Ability of the test to identify correctly those who HAVE the disease
A
Sensi(+)ivity
5
Q
who really does NOT have the disease (F=false)
Ability of test to identify correctly those who DON’T have disease
A
Specificity
6
Q
Tells us the probability that a positive test result is correct.
Portion of people with + results, who truly HAVE disease
A
PPV
7
Q
tells us the test is negative of someone who does not have the disease
Portion of people with (-) result that truly DON’T have disease
A
NPV
8
Q
(Overall) often used for chronic conditions (how many people have the disease RIGHT NOW)
A
prevalence
9
Q
(NEW) often used for acute conditions that do not have long duration (e.g. flu)- how many new cases in a given period of time
A
incidence
10
Q
illness
A
morbidity
11
Q
death
A
mortality
12
Q
what is the triple aim?
quadruple aim?
A
improve health outcomes
reduce per capita costs
improve quality of care
+ improving the clinician’s or care teams experience
13
Q
medical word recognition: testing for health literacy
Easy and fast to administer
A
REALM-SF
14
Q
what test?
What is my main problem?
What do I need to do?
Why is it important for me to do this?
A
Ask me 3 test
15
Q
Ice cream label test
Look at a nutrition label of ice cream and are asked 6 Q’s(calculation, general knowledge)
A
newest vital sign test
16
Q
have patients bring their medications/review with provider for teach back
A
brown bag med review
17
Q
must provide language services to all patients at no cost to them to improve access to care. No families translating for patients.
A
CLAS standards
18
Q
kleinman 8 questions to utilize
A
- what do you call the problem
- what do you think caused the problem?
- why do you think it started when it did?
- what do you think the sickness does? will it have a long or short course
- how severe is the sickness? will it have a long or short course
- what kind of treatment do you think pt shoudl receive?
- what are the chief problems the sickness caused
- what do you fear most about the sickness
19
Q
adult learning theory
A
problem oriented, internally motivated, self-directed. Have experience.
20
Q
used to elicit behavior change in adults: increase the motivation for change then commit- patient driven not physician driven
Use open-ended questions
Listen with empathy
Avoid advice without permission
A
motivational interviewing technique
21
Q
Prochaska’s Stages of Change
A
Precontemplation Contemplation Preparation Action Maintenance Relapse
22
Q
erikson stage infant to -18 months
A
trust v mistrust
23
Q
erikson stage toddler
A
autonomy v shame and doubt
24
Q
erikson stage preschool
A
initiative v guilt
25
erikson stage school age
industry v inferiority
26
erikson stage teenager
identity v confusion
27
erikson stage young adult
intimacy v isolation
28
erikson stage middle age
generativity v stagnation
29
erikson stage elderly
integrity v dispair
30
who should get flu vaccine?
when?
Trivalent?
All adults
starting in the fall
trivalent flu if over 65
31
who should get Pneumococcal polysaccharide
| Pneumovax 23 (PPSV23)
65 or older
If never received OR
Received 1 or 2 doses before age 65, and it has been 5 yrs since last dose
32
who should get Pneumococcal conjugate vaccines
| Prevnar 13→ (PCV13)
```
19-64
if they...
Smoke
Chronic disease of heart, lung, or liver
Diabetes
Alcoholism
Cochlear implant or leaking spinal fluid (PCV13)
Spleen removed
Sickle cell
Weakened immune system
Received organ or bone transplant
```
33
when do kids get Pneumococcal conjugate vaccines
| Prevnar 13→ (PCV13)
All children younger than 2 receive 4 doses (2,4,6, & 12-15 mos)
34
who should get TDaP, Td
19 or older
Must complete 3 shot series
Booster every 10 years (& if dirty wound)
Administer during each pregnancy (27-36wks preferred)
TDaP if older and have grandbabies
35
who should get MMR ? when ?
Started at age 11-12; booster at age 16
(2 doses - 28 days apart)
Considered immune if:
Born 1957 or later (consider testing for immunity if born before)
High risk groups (healthcare workers, college students, international travelers)
36
who should get varicella vax
| what is important to know?
All adults without evidence of immunity
2 doses. Attenuated virus
Avoid pregnancy for 1 month after vaccination
37
who should get Hep A Vax
People who travel or work outside US
Chronic liver disease, HIV, drug use, homeless
Within 2 weeks post-exposure
38
who should get Hep B vax
```
Household and sexual contacts positive for HBsAG, IV drug users
High risk sexual behaviors
Hemodialysis patients
Chronic liver disease
Healthcare personnel
```
39
when do kids get Hep B vax?
3 doses (0,1,6 mos)
If series not completed do not restart, just give until 3 doses received
4 weeks b/t doses 1 & 2
40
who should get Hib vax?
Not routinely recommended for all adults
Anatomic or functional asplenia
Elective splenectomy
Recipients of hematopoietic stem cell transplant
41
who should get Zoster (Shingles)
50 years and older
Shingrix preferred (2 doses 2-6 mos apart)
If previously received Zostavax (51% effective)- give Shingrix (90% effective)
RSV, shingrix, ZVL, Zostavax (Live Virus Vaccine)
42
CI for Shingles vax?
CI: pregnancy/breastfeeding; receipt of acyclovir, famciclovir, or valacyclovir 24 hours before vaccination
CI: Current shingles infection
43
what to do if a person is vaccinated with pneumococcal vaccine before age 65
give booster dose of Pneumovax (PPSV23) 5 years after initial dose
44
Blood Pressure
Screening recommendations ?
Age? considerations?
A
age 18
Take BP at home before treating
45
cervical cancer letter rating
| ages 21- 65?
A for 21- 65
46
Colorectal letter rating ages
50-75
45-49
```
50-75 = A
45-49 = B
```
47
```
Time range?
HSgFOBT or FIT____
Stool DNA-FIT: ___ years
CT Colonography :q__ years
Flexible Sigmoidoscopy: q ___ yrs
Flexible sigmoidoscopy: q ___ yrs + ____ FIT
Colonoscopy: q ___ yrs Gold standard
```
```
HSgFOBT or FIT yearly
Stool DNA-FIT: 1-3 years
CT Colonography :q5 years
Flexible Sigmoidoscopy: q 5yrs
Flexible sigmoidoscopy: q 10yrs + yearly FIT
Colonoscopy: q 10 yrs Gold standard
```
48
HIV screening letter? ages?
A
15-65 (once)
more if high risk
49
abdominal aortic aneurysm letter screening? ages?
B
| 65-75 for men who have EVER smoked
50
ASA letter rating for ages 50-59
B
| >10% 10 yr CVD risk
51
ASA letter rating for ages 60-69
C
| >10% 10 yr CVD risk
52
ASA letter rating for ages <50
I
53
mammogram letter rating for women 50- 74
| how often?
B
First degree relative with BRCA 1 or 2 mutation
Radiation to chest b/t 10-30yo
Li-Fraumeni, Cowden, Bannayan-Riley-Ruvalcaba
Biennial (every other year)
54
mammogram letter rating for women 40-49
C
| If woman chooses
55
mammogram letter rating for women +75
I
56
Depression letter rating for wat ages?
B
| 12+
57
IPV, Elder abuse letter rating
B
58
lung cancer letter rating
for ages 50-80
who?
B
20 pack year smoking hx & currently smoke
OR Have quit within past 15 yrs
59
what should someone get if they have 20 pack year smoking hx & currently smoke
OR Have quit within past 15 yrs
Annual screening w/ low-dose computed tomography (LDCT)
STOP if not smoked for 15 yrs
60
alcohol screening letter? ages? best screening tool?
```
B
18+
CAGE
- Cut down
- annoyed
-guilty
- eye opener
```
61
PSA letter rating for men 55-69
C
| Weight benefits and harms w/ pt
62
PSA letter rating for men +70
Recommended against, typically not tx at this age
63
blood sugar rating level for ages 40-70
Risk factors
considerations?
B
Overweight or obese
Fam. hx DM, PCOS, gestational diabetes
American Indians Alaskan Natives
Asian Americans
Hispanics
Pacific Islanders
64
cholesterol testing letter recommendation?
No current recommendation for screening. Calculate 10yr risk of CVD. No optimal screening interval established
65
CVD risk 10% →
B recommendation for statin
66
CVD risk 7.5%
C recommendation for statin
67
what does healthy people 2020 say about cholesterol screening for men and women
Men age 35
Women age 45
Unless increased risk then start screening at age 20
68
EKG letter rating for low-risk pts? intermediate or high risk?
D for low risk pts
| I for intermediate/ high
69
drug screen letter rating. ages?
I for 18+
70
hearing letter rating for ages > 50
I
| Do screening test if any symptoms or if cognitive/ affective symptoms associated with hearing loss
71
vision letter rating
I
| Perform Screening test if pt has symptoms of glaucoma
72
carotid artery stenosis letter rating
D
| Recommends against screening in general population
73
Gonorrhea/chlamydia
(screen Without symptoms)
letter rating for Women: <24 or increased risk
B
74
Gonorrhea/chlamydia
(screen Without symptoms)
letter rating for men
I
75
HSV letter rating
D
76
Hep B letter rating
B - only high risk pop
77
Hep C letter rating
| ages? considerations?
B
1 time screening adults born b/t 1945-1965
High risk pop
No vaccine available
78
what should you screen for 1 time in adults born b/t 1945-1965
Hep C
79
HIV letter rating
| ages? consderations?
A
15-65
yearly or sexual contact
80
syphilis letter rating
A
| if at increased risk
81
Prostate produces fluid for semen. If enlarged constricts urethra.
Clinical Manifestations:
Urinary frequency, urgency, difficulty
Nocturia
Difficulty starting urination
Dribbling AND straining with incomplete bladder emptying
BPH
Can ask patient to keep urinary diary or do International Prostate Symptom Score
Goal is to alleviate symptoms and slow progression. If no improvement refer to urologist (maybe TURP)
Does NOT correlate with prostate cancer
82
OTC medications for BPH that can cause urinary sx
Anticholinergics (benadryl) → impair bladder contractility
Sympathomimetics (pseudoephed) → increase urinary outflow resistance
Diuretics
83
what to know about PE for BPH?
| Labs?
Digital rectal exam (prostatitis or nodules?) → prostate is symmetric, rubbery, and enlarged
UA, creatinine, PSA (infection or neoplasm?)
84
Behavior modifications for BPH
decreasing fluids before bed, avoid above OTC meds
85
Rx for BPH
alpha-adrenergic antagonists (alpha-blocker)--> relax bladder neck muscles and muscle fibers in prostate to allow for easier urine flow
Flomax
Rapiflo
86
what is First indicator of CV disease**
ED
87
what are organic, drug-induced and psychogenic causes of ED?
Organic: aging, diabetic neuropathy, multiple sclerosis, hypogonadism
Drug induced: SSRIs (Paxil), antipsychotics, recreational drugs, alcohol, beta-blockers, thiazide diuretics, smoking.
Psychogenic: anxiety, depression, relationship issues, stress
88
Drugs to tx ED
phosphodiesterase-5 inhibitors (viagra, cialis, levitra)
89
hard, fixed nodule. Often in teenage or young men with ℅ heaviness and tenderness in testicle. Usually painless
Testicular CA
90
Abrupt onset, extremely painful scrotum often with n/v. Affected testicle is higher. Absent cremasteric reflex. Younger men (10-20yo). Emergency!
testicular torsion
91
cessation of menses for 12 consecutive months
menopause
Hormone therapy approved for moderate to severe sx of menopause (hot flashes, night sweats, vaginal atrophy, prevention of osteoporosis)
92
If a pt with known menopause is bleeding it is _______ until proven otherwise.
cancer
93
* women with uterus must add _______ to any estrogen taken
progesterone
94
when to start screening for osteoporosis?
| high risk pts?
age 65
long term steroid use, anorexia or bulimia, long term use PPIs (omeprazole), gastric bypass, celiac.
95
what causes osteoporosis
estrogen deficiency. Common in white and Asian women, thin, family hx.
96
When to treat osteoporosis
T-score -2.5 or less, or hx of hip or vertebral fracture
97
what is Female Athlete Triad: for osteoporosis
low weight, hx of amenorrhea, LBD
98
Osteoporosis Lifestyle risk factors
```
low Ca intake, vit D deficiency, inadequate physical activity
Alcohol consumption (3+drinks/day)
High caffeine intake
Smoking (active or passive)
```
99
DEXA measures BMD of hip and spine
Osteoporosis=
Osteopenia=
```
Osteoporosis= T-score -2.5 or lower SD
Osteopenia= T-score -1.5 and -2.4 SD
```
100
what does FRAX tell us
10 year probability of fracture
101
what is 2x more common in elderly?
adverse drug rxn
```
Reduce polypharmacy (more than 5 drugs)
Beta blockers SE=depression
Use BEERS CRITERIA when prescribing/deprescribing meds for older adults
```
102
For elderly when is baseline vision screening recommended?
Age 40
103
JNC 8 BP recommendations for > 60 yrs
< 150/ 90
104
screening tests to be done on elderly
AUDIT. CARET (more detailed than cage)
| depression
105
TUG
Timed get up and go
106
FRAT
falls risk assessment tool
107
GDS
geriatric depression scale
108
MMSE
mini-mental status exam
109
IADL
instrument activities of daily living
110
alleviation of symptoms and suffering for people with serious illness to improve QOL (Not only for ppl with imminent death)
palliative care
111
care for someone with 6 mos or less to live. Provided when a person is no longer trying to cure illness.
hospice
112
specific wishes regarding a person’s care in the case they cannot make decisions for themselves
advanced directives
113
what age to start pap smear? interval?
21 ( 3 year intervals if normal)
114
is HPV needed for ages 21-29 routinely?
no, but order "reflexive HPV" so if PAP shows abnormality it can be done
115
when to start HPV co-testing with PAP? interval?
Start HPV co-testing at 30 (at 5-year intervals if normal)
116
when to stop PAP/ HPV testing?
Stop screening @ 65 if no CA hx and/or if total hysterectomy
117
what to do in a woman who has HPV, LSIL
colposcopy is preferred
118
when to give Gardasil?
what strains does it work on?
dosing schedule?
11-26 y.o - against 16/18
| 3 dose: 1 shot, 2 months, then 6 months
119
how often to screen for HPV/ PAP once a woman is 30?
Q5 years PAP and HPV together when last pap was negative and HPV was negative
... can do PAP Q3 but Q5 you should get HPV test
120
why is HPV not routinely recommended under 30?
common infection usually clears on its own
121
who should receive annual cervical cancer screening?
received DES in utero, hx Cancer, CIN 2
122
what kind of prevention is preconception care
primary care
123
How much folic acid for preconception?
400 mcg daily
124
total # pregnancies (including current)
Gravidity
125
total pregnancies beyond 20 weeks (the time pregnant, not number of fetuses; ie twins, triplets…) does not include current if not born yet
Parity
126
what is considered term pregnancy ?
37 weeks and beyond
127
what is considered preterm pregnancy?
20-36.5 weeks
128
male exposure to ZIKA
wait 3 months from initial symptoms or diagnosis
if no symptoms wait 3 months anyway
use condoms with sex
129
female exposure to zika
wait 2 months after initial symptoms or diagnosis (symptoms or not)
use condoms
130
what to do if male and female exposed to ZIKA
wait 3 months before pregnant
131
contraindicated vaccines during pregnancy
```
MMR (Rubella)
Varicella
Herpes Zoster
Live, attenuated flu → live inactivated flu safe
HPV
```
132
What vaccines should mom get right after delivery if not immune?
Rubella and Varicella
133
who should get Hep B vax?
high risk (STI, risky sexual behaviors)
134
Nagele’s Rule
LNMP - 3 mon + 7 days + 1 year
135
```
Prenatal visit schedule for low risk/healthy
First visit _____ weeks
Before 28 weeks:______
Weeks 28-36: every ___ weeks
Week 36- birth: _____
```
```
First visit 8-10 weeks
Before 28 weeks: monthly
Weeks 28-36: every 2 weeks
Week 36- birth: weekly
Total visits: 13
```
136
initial pregnancy labs to check
```
Beta Hcg
Blood type, Rh
Urinalysis c/s
Tx all UTIs
Check urine protein (pre-e)
CBC
Hgb/Hct
Titers
Rubella
Varicella
STI
HBsAg, HIV, gonorrhea,
chlamydia, syphilis,
herpesvirus 1/2
```
137
when to give Tdap during pregnancy
between 27 - 36 weeks or after
138
when to screen for GD during pregnancy
results?
standard at 24-28 weeks, 1 hr get 50 gm if + of 130, do 3 hr100 gm.
If 2/4 blood tests are abnormal then they have GD. BS 140 or over- GD
139
what kind of BC while breastfeeding?
no estrogen!
140
NOT required prior to initiation of BC
PE, GYN exam, STI testing, lab testing (exception is IUD or fitting pt for diaphragm, need pelvic exam..)
141
stops ovulation (inhibits LH surge) and thickens cervical mucus
Combined Hormonal Contraception (estrogen and progesterone
142
same dose of hormones everyday
Monophasic
143
two different progesterone doses
Biphasic
144
dose varies weekly with a 7 day placebo for withdrawal bleed. Indicated for acne
Triphasic
145
84 days of hormone/7 days placebo pills
Extended cycle
146
Do not use if cigarette smoker over age 35!
NuvaRing
147
higher risk of VTE, releases higher levels of estrogen than oral pills
Transdermal patch
148
Absolute CI to Hormonal Contraceptives:
Hx DVT, factor V Leiden, major sx with prolonged immobilization
Smoker older than 35
Migraine with aura (increase risk of stroke) or migraine w/o aura at 35 years or older
Hx CVA
HTN
Liver disease/infection/inflammation
Cardiovascular disease (known or suspected)
Cancer
149
BC pt education
Use back up method for 7 days. Taking the pill on first day of menstrual cycle provides best protection
F/u visit 2-3 months after starting hormonal BC to check BP (estrogen can raise BP) or SEs
May have increased spotting, should decrease after 3 months. Nausea and breast tenderness are common and should resolve after first month
If breastfeeding: progesterone only contraception...no estrogen!
150
Drug Interactions with oral contraceptives:
Anticonvulsants: phenobarbital, phenytoin
Antifungals: (strong CYP3A4 inhibitors)
HIV/hep C protease inhibitors
Some antibiotics (ampicillin, tetracyclines, rifampin, clarithromycin
St. John’s wort: breakthrough bleeding
151
Indications of thromboembolic event:: ACHES
A- abdominal pain (clot in mesenteric artery- ischemic pain)
C- chest pain (MI?)
H- headaches (stroke/tia?)
E- eye problems/vision change (clot in retinal artery)
S- severe leg pain (DVT?)
152
causes cervical mucus to thicken, preventing sperm entry
Progesterone-Only Contraception
153
injection every 3 months
Not recommended for women who want to become pregnant in 12 months (takes up to 1 year to start ovulating after stopping)
Black Box Warning! Do not use more than 2 years d/t increased risk of osteopenia or
osteoporosis that may not be fully reversible. Avoid use in pts w/ hx of anorexia for this Reason. Recommend Vit D and weight bearing exercise while taking
Weight gain possible SE
Depo-Provera
154
thin plastic rod implanted in upper arm
| Anti-seizure meds may lower effectiveness!
Implanon/Nexplanon
155
Safe for breastfeeding women!
Must be taken at same time EVERY day (3hr window)
Less effective than combined oral contraceptives, but safe option during breastfeeding, older
smokers, and diabetics w/ microvascular disease.
No grapefruit juice or use with hepatitis
Progestin-Only Pills (POP)
156
Works best when taken within 72 hours of intercourse, up to 5 days after intercourse. Available without prescription
Emergency Contraception (“Morning After Pill”)
157
progesterone
Paragard = Copper, effective up to 10 years
Mirena, Skyla, Liletta, Kyleena… different levels of progesteron. Effective 3-7 years
CI if PID, uterine or cervical abnormality, hx ectopic pregnancy
Pelvic exam indicated to check for string
Levonorgestrel
158
Warning signs in patients with IUD: PAINS
P- period late (Copper IUD), abnormal spotting, or bleeding beyond expected
A- Abdominal pain, pain with intercourse
I- infection exposure (STI), abnormal vaginal discharge
N- Not feeling well, fever, chills
S- String missing or shorter
159
what do Breastfed infants need starting at 4 months?
vit D, Iron
160
when does colon cancer screening start?
Screening begins at age 45→ update!
10 years prior (screening) to the age of family member being diagnosed
Or 45 years old for baseline screening for high risk individuals
161
what is never considered normal in women?
Incontinence
162
leading cause of death ages 20-34?
| 35-44?
```
20-34
Accidents
Intentional harm (suicide)
Assault (homicide)
Traffic
```
35-44
Accidents
Malignant neoplasms
Heart disease
163
what is goal of cervical testing?
detect high grade squamous intraepithelial lesion (HSIL) → potential to develop into invasive squamous cell carcinoma of cervix
164
Signs of pregnancy
Positive:
1. Palpation of fetus by clinician
2. fetal visualization
3. FHT
Breast changes, N/V, urinary frequency, fatigue, increase nasal, hegar's sign- 6-8 weeks: softening of neck of uterus , Goodell’s sign- 4 weeks softening of cervix, Chadwicks’ sign
