Prev Med

Question 1

what guidelines will be tested

Answer 1

USPSTF, they are the most reliable preventative medicine guidelines, and the standard of care

Question 2

What guides you choice in choosing a test

Answer 2

mortality benefit

Question 3

Most important preventative medicine question:

Which cancer screening method lowers mortality the most? (which of the following is most likely to benefit the patient?)

Answer 3

mammography screening above age 50

Question 4

Breast Cancer

Age to start mammography canbe controversial (40-50), but the age of maximum benefit is clear

Answer 4

> 50

Question 5

Breast Cancer

screening overview

Answer 5

mammography should be done starting at age 40 to 50every 2 years. the reduction is mortality is greated above age 50.screening can stop at age 75

on average you will detect 10 cases of breates cancer by screening 1000 women above age 50, but you will detect only 2 cancers by screening 1000 women between the ages of 40 and 49.

the MRI, CT, andUS do not yet have a clear place in terms of screening for breast cancer.

Question 6

breast self examination

Answer 6

is the wrong answer, although it may seem to benefit there is no proof

Question 7

Breast Cancer

selective estrogen receptor modulators (SERMs)

Answer 7

tamoxifen, raloxifene

result in a 50 to 66% reduction in breast cancer when compared with placebo

greatest benefitis is in those with 2 first-degree relatives with breat cancer (mother or sister).

Question 8

Breast Cancer

aromatase inhibitors

Answer 8

useful in preventingmetastases in those with provenbreast cancer butthey are not proven to bneeift those who are asymptomatic

Question 9

Breast Cancer

Her/Neu2

Answer 9

gues the use of trastuzumab, which bocksthereceptor inthosewith ptovencncer

Question 10

Breast Cancer

BRCA

Answer 10

associated with increased risk of breast and ovariancancer. however, this does not mean it is clearly bneeficial screening test. the missing piece is: what to do when th epatient is positive for BRCA? this is not clear. the only truly unambiguous statement about BRCA testing is that a psotivie test means on increased risk of cancer

management remains undetermined

Question 11

when BRCA is positive

Answer 11

offering prophylactic bilateral mastectomy is the wrong answer

Question 12

Cervical Cancer Screening

Answer 12

the first pap smear is done at age 21. pap every 3 years ages 21-30. pap smear devinitely lowers mortality. bc htere ar enoly 7000-10000 cases of cerical cancer a year, but 185000 cases of breast cancer, pap smear is not nearly as beneficial as mammoraphy.pap semar is done every 3 years. papillomavirus vaccine is routine for all women between the ages of 11 and 26. combined pap and hpv testing at ages 30 to 65 stretches the interval to 5 years

Question 13

pap smear is done from

Answer 13

21 to 65 years of age

Question 14

adding hpv testing to pap increases interval to

Answer 14

5 years

Question 15

chlamydia screen women

Answer 15

15-25 years old

Question 16

Colon Cancer Screening

Answer 16

the lifetime risk of colon cancer for an american is 6-8%. each year 50000 people die of colon cancer in the us.95% of these deaths are preventable with screening

Question 17

Colonscopy

Answer 17

every 10 years after age 50

Question 18

virtual colonoscopy

Answer 18

misses cancers in polyps less than 0.5 cm

Question 19

capsule endoscopy

Answer 19

detects small bowel bleeding, not a colon cancer cancer screening method

Question 20

dre

Answer 20

not proven to lower mortality in any disease, always a wrong choice

Question 21

Prostate Cancer Screening

Answer 21

unfortunately ther is no clearly beneficial test to lower mortality in prostate cancer screening. neither the prostate specific antigen nor the digital rectal exam has proven sufficiently sensitive or specific to lower mortality. althouth PSA does detect prostate cancer, the lesions detected are most often not ones that need treatment. of patients with prostate cancer, 25% have a normal PSA, and 25% of those with an elevated PSA do not have cancer

Question 22

if the question asks mortality nefit for PSA

Answer 22

say no

Question 23

if the question says teh patient wants/requests a PSA

Answer 23

say yes

Question 24

Lung cancer screening

Answer 24

Long-tem smokers with 30 pack years of smoking should be screened by chest CT at age 55. CXR detects many lesions that turn out to be insignificant and misses many small cancers. High-resolution CT scanning lowers lung cancer mortality in those with a long history of smoking. screen annually

Question 25

what is always th sinlg emost beneficial disease preventive method of any type

Answer 25

smoking cessation

Question 26

Lipid Screening recommended for healthy patients when

Answer 26

men are above age 35 women are above age 45

Question 27

Lipid Screening unhelathy patients

Answer 27

recommended for all patients with diabetes, htn, coronary artery disease, or the equivalents of coronary artery disease (carotid disease, peripheral vascular disease, aortic disease)

Question 28

Hypertenstion screening

Answer 28

blood pressure testing is indicated for all pts above the age of 18 at every bisit htn screening has never been properly evaluated in a meaningful way and probably never will, bc you would have to withhold bp measurement and observe for years to detect a mortality difference which would be unethical screening adults should be every 2 years

Question 29

Diabetes Mellitus screening

Answer 29

when the pt has htn or hyperlipidemia no recommendation when the pt is asymptomatic

Question 30

Diabetes Mellitus numbers

Answer 30

2 measurements ofver 125 or hba1c>6.5%

Question 31

Vaccinations for adults 2 most beneficial

Answer 31

influenza and pneumococcus

Question 32

Influenza and Pneumococcal Vaccine overview

Answer 32

live attenuated vaccine should not be used in pts over 50 with the medical conditions: chronic heart, lung, kiver, and kidney disease including asthma hiv/aids steroid users immunocompromised pts in general such as cancer or functional or anatomic asplenia diabetes mellitus

Question 33

egg allergy is not a contraindication to

Answer 33

flue vaccine

Question 34

pneumococcal and influenza vaccine are recommended for all pts with

Answer 34

chronic heart, lung, kiver, and kidney disease including asthma hiv/aids steroid users immunocompromised pts in general such as cancer or functional or anatomic asplenia diabetes mellitus

Question 35

pneumococaal vaccine for adults

Answer 35

first give 13 polyvalent then after 6-12 months follow up with 23 polyvalent

Question 36

indications for influenza vaccine

Answer 36

everyone yearly healthcare workers pregnant patients

Question 37

indications for pneumococcal vaccine

Answer 37

``` everyone above age 65 cochlear implant csf leaks alcoholics one vaccine above 65 only single revaccinatino after 5 years if the pt is immunocompromised or the first injection was prior to age 65 tobacco smokers ```

Question 38

zoster vaccine prevents what in adults

Answer 38

shingles

Question 39

herpese zoster vaccine

Answer 39

ahtluth varicella vaxxination is routenile indicated in all children, there is a higher-dose version of the varicella vaccine that is indicated in all patients above age 60. this prevetns post-herpetic neuralgia

Question 40

Hep a and b vaccines are the most beneficial in those with

Answer 40

chronic liver disease

Question 41

Hep a and b vaccine indications

Answer 41

always indicated in kids indicated in adults if: chronic liver disease men how have sex with men or mutliple sex partners household contacts with hep a and b injection drug users

Question 42

indications for hep a vaccine

Answer 42

travelers to countries of high endemicity

Question 43

indications for hep b vaccine

Answer 43

end-stage renal disease(dialysis) healhtcare workers diabetes

Question 44

Tetanus vaccine

Answer 44

td every 10 years one tdap (tetanuse with acellular pertussis) as on of the boosters tetanus immune globulin in those never vaccinate

Question 45

Meningococcal vaccine indications

Answer 45

age 11 asplenia terminal complement deficiency military recruits residents of college dormitories travelers to mecca or medina in saudi arabia for the hajj (pilgrimage)

Question 46

when to give tetanus

Answer 46

never vaccinated: immune globulin dirty wound: booster after 5 years clean wound: booster after 10 years

Question 47

what is the following indication for meningococcal vaccine

Answer 47

asplenia

Question 48

Osteoporosis screening

Answer 48

every woman should be screened wth bone densitometry at the age of 65 with a dexa scan

Question 49

hip fx in an elderly pt

Answer 49

carries a high risk of mortality preventing fx with biphosphonates to increase bone density is potentially more life saving than bblockers in coronary disease. in an older woman a hip fracture is more deadly than a mi

Question 50

AAA screening

Answer 50

all men abov ethe age of 65 with a smoking hx should be screened once with an us to exclude an aneurysm. also screen 65-75 with a family hx

Question 51

aaa should be repaired if it is wider than

Answer 51

5 centimeters

Question 52

smoking cessation all pts

Answer 52

should be asked do you smoke be advised to stop attempt: find out who wants to stop be assisted: prescribe a method of aiding nicotine dependence arrange to meet with the pt again to find out if they have set a wuit date and have really managed to stop

Question 53

Intimate partner violence ( domestic violence)

Answer 53

all pts hould be asked about the possibility of intimate partner violence. pts will most often not volunteer thi info. yoiu cannot report this form of injury without the consent of the pt

Question 54

Alcoholism overview

Answer 54

a self-diagnosed disease. not defined as an amount of alcohol used or leading to loss of employment as many still maintaintheir jobs

Question 55

alcoholism ask

Answer 55

C: do they feel theneed to cut down the amount they are drinking? A: do they feel angry when asked about their drinking? G: Do they feel guilty about the amount they drink? E: Do they feel the need for a morning eye-opener?

Question 56

Routine screening mehtods that are always incorrect

Answer 56

cxr, ekg, and stress testing are never correct as screening methods in the otherwise healthy general popularion