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Herkimer 2021 > periodic health and screening > Flashcards

periodic health and screening Flashcards

1
Q

Indications of low-dose CT to screen lung ca annually x3

A

1) age 55-74
2) >= 30 pack yr
3) currently smoking OR quit < 15 yrs

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2
Q

Pap tests starting age and intervals

A

> > Starting at age 25 - 69 y/o
(can stop if 3 normal tests in the past 10 years)

> > Every 3 years

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3
Q

mammogram screening starting age and interval

A

Age: 50-74 y/o

Interval: every 1-2 yrs (q2-3 yrs by CTFPHC)

> 75 yr: no mammogram if life expectancy < 5 yrs

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4
Q

FOBT/FIT screening starting age and interval

A

From 50 - 75 y/o
» FOBT/FIT q2 yrs OR
» Sigmoidoscopy q10 yr

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5
Q

Indications of HPV vaccines

A

boys and girls < 26 y/o

girls =< 45 y/o even if already sexually active

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6
Q

screening guideline for osteoporosis

A

1) BMD when 65 y/o OR > 50 y/o w/o risk factors
2) use CAROC or FLAX to risk stratify
3) consider bisphosphonates for moderate (> 10%) to high (>20%) risk
4) ensure calcium 1200mg/d and vitamin D 1000IU/d

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7
Q

Indications of STI screening (Gonorrhea/Chlamydia, VDRL, HIV, HBV)

A

IF high risks

1) < 25 y/o
2) > 2 partners in past yr
3) not using barrier contraception
4) using “survival sex”
5) homeless
6) anonymous sex
7) prostitute
8) partner with STI
9) previous STI

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8
Q

Regular preventative immunization

A
  • flu vaccine q1yr
  • pneumococcal vaccine x 1 > 65 yo
  • tetanus vaccine q10yr
  • Herpes Zoster vaccine > 50 y/o
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9
Q

Indications of pneumococcal vaccine between age 2 - 64

A

Any of the high risks

1) DM
2) CRF
3) HIV
4) smoker
5) homeless
6) IVDU
7) cirrhosis

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10
Q

Indications of DM screening

A

1) < 40 yr: A1C q6-12mo if risk factor or “very high risk”

2)  > 40 yr:  A1C q6-12mo if "very high risk" 
                    A1C q3yr (q1-5yr by CTFPHC)
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11
Q

What is the 5A approach to smoking cessation

A 
Ask if pt smokes 
Advice pt to quit 
Assess willing to quit (stage of change)
Assist in quit attempt 
Arrange follow-up
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12
Q

How to assist in the stage of “preparation” to achieve smoking cessation?

A

Preparation stage: STAR

  • Set a quit date within 2 weeks (can focus on decrease amount ~ 25%)
  • Tell family, friends, coworkers and request support
  • Anticipate challenges
  • Remove tobacco products (make home smoke free)
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13
Q

How to “assist” in quit attempt ( to increase success rate of smoking cessation)

A
  • STAR
  • offer >= 4 (motivational) counseling sessions
  • combo nicotine replacement + meds: most effective than nicotine or meds alone
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14
Q

What are the first-line meds to assist on smoking cessation?

A

Varenicline + Nicotine replacement

  • Start Varenicline 1 week prior to quit ( can use prior to pt being ready to quit)
  • And combine with nicotine replacement
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15
Q

What are the conditions needed to be cautious when prescribing Varenicline for smoking cessation?

A
  • renal failure (CrCl <30 ml/min)
  • depression
  • suicide

(** can still be used in pts with MH disorders)

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16
Q

S/E of varenicline for smoking cessation

A
  • nausea
  • insomnia
  • strange dreams
17
Q

What is the dose of varenicline for smoking cessation?

A
  • 0.5 mg QD x 3 days then
  • 0.5 mg BID x 4 d then
  • 1 mg BID x 3 months
18
Q

What are the 2nd and 3rd line of meds for smoking cessation?

A

2nd line: Bupropion SR (can start 1-2 weeks prior to quit date and combine with nicotine replacement)

3rd line: Clonidine (start 3d prior to quit date) OR Nortriptyline (start 10-28d prior to quit date)

19
Q

What are the contraindications to take Bupropion?

A
  • seizure
  • eating disorder
  • MAOI
  • CYP 2D6 inhibitor
20
Q

What are the common S/E of Bupropion?

A
  • elevated BP
  • insomnia
  • dry mouth
21
Q

What are the common roadblocks of smoking cessation?

A
  • withdrawal
  • fear of failure
  • weight gain
  • depression
  • enjoyment
  • friends
22
Q

What are the conditions needed to be cautious when prescribing nicotine replacement?

A
  • post MI
  • arrhythmia
  • angina
23
Q

What are the common s/e of Clonidine ?

A

acting centrally on alpha-2 adrenergic as an agonist ( has alpha-antagonist effect in the posterior hypothalamus and medulla)

  • dry mouth
  • dizziness
  • sedation
  • constipation
  • hypotension
24
Q

What are cautious conditions and the common s/e of Nortriptyline?

A
  • sedation
  • dry mouth
  • blurred vision
  • retention

be cautious in pt with MI or arrhythmia

25
Q

Preferred meds to quit smoking for pt with hx of depression?

A

Bupropion SR or Nortriptyline

26
Q

safe NRT for pt with CVS hx

A

Nicotine patch is safe

27
Q

To minimize weight gain when quitting smoking

A

bupropion SR, 4mg gum + lozenges

delay weight gain

28
Q

meds to assist pregnant women on quitting smoking

A
  • encourage to quit w/o meds (all class C+D)

- if necessary, use intermittent nicotine instead of patch

29
Q

How to arrange follow-up after assisting pt on smoking cessation?

A
  • follow-up within 1 week of quitting
  • second appointment within 1 month

IF relapse: review, elicit recommitment

30
Q

melanoma screening criteria

A

NOT for population-based screening

Only refer if HIGH RISK for 6-monthly full body exam

  • Older, male
  • personal or family history of melanoma
  • > 15 nevi
  • light skin, red hair
  • multiple sunburns
  • actinic skin damage
31
Q

Colorectal cancer screening guideline

A

Age 50-74

  • gFOBT or FIT every 2 years OR
  • flex sigmoidoscopy q 10 yrs
32
Q

Breast cancer screening guideline

A

Use shared decision-making

  • 40-50 y/o: NO screening
  • 50-74 y/o: mammogram every 2-3 years for average risk
33
Q

Pancreatic cancer screening guideline

A 
Screen ONLY if HIGH risk 
- family hx of pancreatic cancer 
- high-risk syndrome 
  e.g. Peutz-Jeghers syndrome
  BRCA1 with affected relative
34
Q

Investigation for unexplained weight loss

A
  • weight, series
  • height: for BMI
  • hemoglobin
  • Na, K, eGFR
  • urea and creatinine
  • PSA (prostate serum antigen)
  • Fecal occult blood
  • chest x-ray
35
Q

risk of long-term use of PPI

A
  • B12 deficiency
  • C. difficile infection
  • dementia
  • fractures
36
Q

pediatric IV supplement for diarrhea

A
  • Bolus: 20ml per kg

- Maintenance: hourly rate - 4-2-1 ml/kg/hr

Herkimer 2021 (21 decks)

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