Office/Lifestyle management Flashcards

Question

What are screening tests for 67 year old s/p hyst?

Answer 1

No further pap smears are required Labs: TSH q 5 years Lipid panel q 5 years Fasting glucose q 3 years Urinalysis Mammogram annually Bone density screening Colorectal screening: - Yearly pt-collected fecal occult blood testing, - Flexible sigmoidoscopy q 5 years, - Yearly pt=collected fecal occult blood testing plus flexible sigmoidoscopy q 5 years, - Contrast barium enema q 5 years, - Colonoscopy q 10 years Substance abuse (alcohol, tobacco, drug)

Answer 2

TDap q 10 years Influenza annually Zoster vaccine Pneumocuccus once in a lifetime

Answer 3

start at age 45 if average risk - pos fam hx: start 10 yrs before age of ddx. - stop screening at 85 SCREENING OPTIONS - colonoscopy sigmoidoscopy + fecal occult blood test - sigmoidoscopy alone for family hx: repeat colonoscopy q5yr (1st degree relative) or q3yrs (2+ first degree relatives).

Answer 4

annually at age 40 - can have false positive results bc low prevalence ofd disease in age 40-49 - consider stopping at age 75 (unless life expectancy more than 10 yrs)

Answer 5

age 50-80 w/ smoking hx: - if 20 pack year hx and current smoker OR quit <15 years ago -> low dose chest CT annually - stop screening once pt > 15 yrs post quitting.

Answer 6

- age < 30 -> US - age > 30, diagnostic mammogram then US (birds 1-3) or biopsy (birds 4-5) If abnormal imaging: - FNA (cytology) - core needle biopsy (histology, preferred) - excision biopsy. - if breast cysts on imaging: aspirate only for non-simple.

Answer 7

Tetanus: Tdap once then boost w/ Td q10yr MMR: single dose. high risk need 2nd dose: healthcare worker, college freshman, international traveler. Hep A: childhood 2 doses 6 mo apart. travelers, illicit drug use. Hep B: once. also healthcare workers, IV drug use, 1+ sexual partners. influenza: annually after 6mo Pneumococcal: age 65+: once w/ PCV20. Meningococcal: 11-18 yrs, 90% effective. Varicella: adults if no immunity Zoster: age 50+, 2 doses HPV: 9-45, 3 shots, deer anogenital, oropharyngeal cancers and warts. COVID: age 12+ RSV: age 60+ once, pregnancy 32-36w6d.

Answer 8

2 blood pressures separated by at least 1 week taken in appropriate way. Normal blood pressure is <120/80. Stage 1: 130-139/80-89 Stage 2: 140-149/90-99 Hypertensive crisis: 180/120

Answer 9

Weight reduction, DASH diet (fruit, veggies, low fat dairy), sodium restriction, physical activity Diabetes, hyperlipidemia, smoking, family history, obesity, sedentary lifestyle

Answer 10

Eval for end organ damage - Heart (EKG to r/o LVH), kidneys (UA, Cr), lipid profile, TSH, fasting glucose, eyes (fundoscopic exam), brain (signs, sx ischemic brain injury/dementia). - lifestyle modification, tobacco/alcohol cessation, exercise, DASH diet. - 1st line drug: thiazide diuretic (HCTZ), CCB, ACEi, ARB. If BP goal notreached within 1 month, add second drug. ACEi/ARB shouldn’t be used together.=, initial therapy for diabetic nephropathy. RF: age, fam hx, obesity, smoking/alcohol, race, high sodium diet, physical inactivity, insufficient sleep

Answer 11

- Primary renal disease (RAS, glomerular disease) - abdominal bruit, hematuria, edema, order UA, Cr - Drugs (OCP, NSAIDs, pseudoephedrine, cocaine): get med hx - Pheochromocytoma (5P’s - palpitations, pallor, perspiration, pain, BP) - tremor, weight loss, anxiety - check for signs, sx - Primary hyperaldosteronism - check electrolytes (low K, high Na) - Hyperthyroidism (anxiety, sweating, heat intolerance, palpitations, weight loss) - check TSH. - hyperPTH - stones, groans, moans, psych overtones - nephrolithiasis, weight loss, bone pain - check Ca - Cushings - OSA - Aortic coarctation - prominent neck pulsations, delayed peripheral pulses, usually asymptomatic. Check CXR for rib notching.

Answer 12

Abdominal Pain, vaginal discharge, low back pain musculoskeletal, trauma, spinal stenosis, urinary complaint (pyelo), nerve impingement.

Answer 13

Use CAGE questionnaire: cut down, annoyed, guilt, eye opener. How do you define at-risk alcohol use? For women >3 drinks per occasion or >7 drinks/week. What strategies would you offer to patient trying to cut down? Behavioral modification program. Avoiding triggers. What substances are commonly misused: alcohol, tobacco, opioids, illicit substances like cocaine, marijuana, heroin.

Answer 14

HPV, meningococcus, Tdap, hep B, influenza, varicella (if at risk), rubella.

Answer 15

9 valent hPV vaccine containing viral-like particles against HPV DNA types 6,11, 16, 18, 31, 33, 45, 52, 58 HPV vaccine protects against 90% genital condylomata and 90% cervical cancers. Protect from future development of HPV-assoc cancers of anus, genital tract, cervix/vagina/vulva and preceding dysplasias. -- give as adjuvant vaccination if undergoing treatment for CIN2+ and never got vaccinated.

Answer 16

9-valent HPV (Gardasil) Quadrivalent HPV Bivalent HPV Which vaccine decreases risk of HSIL (VIN usual ype): Gardasil vaccine

Answer 17

Target age: 11-12. teens/young adults through age 26 who didn’t finish HPV vaccine series. indicated for ages 9-26 but recently extended up to age 45. How many doses should be given: if <15, two doses 6 months apart. IF 15+: vaccine at 0,2,6 mo. NOT: Pregnant, allergic reaction, allergy to yeast.

Answer 18

Protects against multiple strains (4 strains, two in influenza A and two in B, inactivated vaccine IM, flu season is Oct-May. Vaccinate everyone 6 months and older. - Incr risk complications such as hospitalization, respiratory problems, intubations. Can’t get intranasal vaccine. What vaccine do you give for 65+: high dose flu vaccine 2/2 weaker immune system and higher risk of complications.

Answer 19

Open ended and non-judgmental 5Ps: partner, practices, protection (from STI, contraception and condoms), past hx STI, pregnancy intentions

Answer 20

mention to all sexually active adults. Used for prevention of HIV - for protection Any evaluation before PREP? Test for HIV, renal function, lipids, What antiviral med is in oral PREP? Tenofovir. Who would you recommend prep to: partner w/ HIV (specifics??), 1+ sex partners of unknown HIV status, recent STI in past 6 months, look up others.

Answer 21

Empiric tx w/ low abdominal/pelvic pain in sexually active OR 1+ of these: adnexal, uterine or CMT w/ supporting: fever, mucopurulent discharge, WBC on wet prep, +GC/CT, WBC <10, elev CRP or ESR. not needed but more specific: EMB w/ histologic endometritis, TVUS w/ thickened fluid-filled tubes and TOA, laparoscopy c/w PID. Criteria for in-patient therapy: - acute abdomen, pregnant, failed oral abx, inability to follow-up, TOA, severe illness (N/V, high fever)

Answer 22

5Ws: - Wind (pneumonia, ileus/SBO) - Water (UTI) - Wound (infection) - Walking (DVT) - Wonder drugs (drug allergies, reaction, anesthesia, sulfa drugs) Vitals, exam (lung, abdomen, incision, vaginal incision, extremities, CVA/suprapubic tenderness) - Labs: CBC, UCx, Bcx, Wound Cx if indicated - imaging (if indicated): CXR, AXR, dopplers, pelvic US, chest/A/P CT

Answer 23

Days 1-3: pnuemonia/GI Days 3-7: DVT Days 4-7: wound, UTI, pneumonia Days 3-7: phlebitis 7+: bladder/ureteral injury

Answer 24

Cytochrome P450 inducers (rifampin) can decrease efficacy, BMI >30 may decrease efficacy.

Answer 25

Avoid estrogen-containing if hx thrombophilia/DVT Options: barrier-method, permanent sterilization for men AND women (i.e. vasectomy), all other options

Answer 26

68mg etonogestrel. C/I: current breast cancer and active liver disease. Prevents ovulation. Less effective over time. Also thickens cervical mucus. FDA approved for 3 years.

Answer 27

80% Cervical cancer, lung cancer, bladder cancer, VTE, HTN, osteoporosis, infertility, pregnancy complications

Answer 28

use if BMI >30 or >27 + additional RF (T2DM). - FDA-approved: semaglutide, Wegovy. - decrease effectiveness of OCPs and can make ovulation resume after weight loss. - STOP 2 mo prior to attempting conception.

Answer 29

INCREASES triglycerides (Bad!) - normal is < 150 DECREASES LDL and increases HDL (good!) If elevated TG on OCPs, stop and use alternative contraception. assess for other causes: - insulin resistance, renal disease, hypothyroid, poor diet, alcohol use, pregnancy, SERM. *ORAL estrogen (including for HRT) increases triglycerides. TRANSDERMAL estrogen DOES NOT increase triglycerides. - avoid HRT if high 10-yr cardiovascular risk.

Answer 30

-- use if pt smokes 1/2 back a day. 1. Nicotine preparations: patch, gum, lozenge or inhaler - contraindications: severe angina. 2. Varenicline (Chantix): partial nicotine-acetylcholine R agonist. 3. Bupropion: antidepressant with efficacy similar to Varenicline. start at 150mg 1 week prior to quitting. - counsel on withdrawal sx: peak in first 3 days and subside over 1 month. - sx: increased appetite, irritability, weight gain, change sin mood, insomnia, difficulty concentrating.

Answer 31

dress in layers - sleep in cool environment - avoid hot foods - exercise - increase fluid intake - stress reduction Non-estrogen: - SSRI (paroxetine- FDA approved) and SNRI also fluoxetine. - gabapentin - clonidine - rarely used. - progestins (provera, megace, not 1st line bc incr breast cancer risk. for endometrial protection only).

Answer 32

1. Androgen therapy (not FDA approved) - test tosterone before and after to make sure in normal range. 3-6 mo trial. - Trasndermal testosterone patch 300 ug qd - Testosterone cream 1% 0.5mg /d 2. Low dose vaginal estrogen preferred. CONTRAINDICATIONS: - CVD, liver disease, endometrial hyperplasia/cancer, hx breast cancer.

Answer 33

- phosphodiesterase inhibitors (sildenafil) - not FDA approved. - bupropion - filbanserin in PREMENOPAUSAL

Office/Lifestyle management Flashcards

(57 cards)