Preventative Medicine - MTB Flashcards
(55 cards)
1
Q
Cancer screening test that lowers the most mortality
A
Mammogram
- mortality benefit greatest > 50 years old
- test should be stated in all women > 50
2
Q
Clinical breast examination
A
has no proven benefit
3
Q
Cervical cancer screening
A
Pap smear lowers mortality
4
Q
Pap smear
A
- cervical cancer screening
- should start at 21 REGARDLESS OF SEXUAL ACTIVITY ONSET
- should be done at least every 3 years until 65
5
Q
Colonoscopy
A
- at age 50 years, then every 10 years
6
Q
Cervical cancer
A
- Pap smear at age 21, then every 2-3 years
- stop at age 65 unless no previous screening
7
Q
HPV testing
A
- right for ASCUS
- If ASCUS is HPV-positive, do colposcopy
8
Q
Colon cancer screening if family member had the disease
A
Screening should begin at 40 or 10 years earlier than the family member was diagnosed, whichever is earlier
9
Q
Hereditary nonpolyposis colon cancer syndrome (HNPCC)
A
- aka Lynch syndrome
- defined as colon cancer in 3 family members in 2 generations having the disease with 1 having it prematurely (before 50)
- screening should begin at 25 and be done every 1-2 years
10
Q
Prostate Cancer Screening
A
- no recommendation to screen patients routinely for prostate cancer either w/ PSA or DRE
- recommendation AGAINST men > 75 on disadvantages of treatment
11
Q
Indications for influenza vaccination and pneumococcal pneumonia vaccination
A
- Pts with chronic lung, heart, liver, kidney and cancer
- HIV-positive patients
- Patients on steroids
- Patients with diabetes
12
Q
Influenza vaccine is recommended yearly in general population. Has greatest benefit following persons:
A
- Everyone > 50
- Pregnant women
- Health care workers
13
Q
Pneumococcal vaccine is different from influenza vaccine in that:
A
- Indicated for patients > 65
- Administered as single injection
14
Q
Meningococcal vaccination
A
- is now routine at age 11
- children especially at high risk, who be vaccinated even early
- are those functional or anatomic asplenia
- those with terminal complement deficiency
15
Q
HPV vaccination
A
- quadrivalent vaccine that should be administered to ALL FEMALES BTWN 13 and 16
- acceptable in boys
16
Q
Varicella-Zoster Vaccine
A
- against the reactivation of varicella zoster (shingles) should be performed in everyone above 60 years
- vaccine is higher-dose form of varicella vaccine given to children
17
Q
Smoking Cessation
A
- should be screened for tobacco use and advised against it
- effective method is use oral meds (BUPROPION and VARENICLINE)
- less effective therapies are nicotine patches and gums
18
Q
Osteoporosis
A
- should screened with bone densitometry at age 65
19
Q
Abdominal Aortic Aneurysm
A
- all men about age 65 who were ever smokers should be screened once with an ultrasound
20
Q
Diabetes Screening
A
- routine only in those with hypertension
21
Q
Hypertension
A
- all patients above age 18 should have their blood pressure checked at every office visit
22
Q
Hyperlipidemia
A
- Men > 35 and women > 45 should be screened for hyperlipidemia
23
Q
Mammography
A
- should be done starting at age 40 - 50 every 2 years
- reduction in mortality greatest above 50
- screening can stop at age 75
24
Q
Who is most likely to benefit an asymptomatic patient with multiple first-degree relatives with breast cancer?
A
Tamoxifen or raloxifene – result in 50% to 66% reduction in breast cancer
25
BRCA Testing
- not necessarily beneficial screening test
| - positive test means an increased risk of cancer
26
Cervical Cancer Screening
- Pap smear is done from 21 to 65 years (every 3 yars)
27
Combined Pap and HPV testing
- starts at ages 30 to 65 stretches the interval to 5 years
28
Chlamydia screening
- screen women 15 - 25 years old
29
Capsule endoscopy
- detects small bowel bleeding
| - it is not a screening method
30
Digital rectal exam
- not proven to lower mortality in any disease
| - always a wrong choice
31
Lung Cancer Screening
- no test to lower mortality from lung cancer
| - CXR detects many lesions that can be insignificant
32
Lipid Screening
- recommended for all patients with diabetes, HTN, CAD, or CAD equivalents: carotid disease, peripheral vascular disease, aortic disease
33
Cholesterol and LDL measurement is recommended for healthy patients when:
- Men > 35
| - Women > 45
34
Hypetension
- indicated for all patients above age 18 at every visit
| - screening adults should be done every 2 years
35
Diabetes Mellitus
- screening for diabetes with fasting blood glucose (2 measurements > 125 mg/dL or HgA1C > 6.5%) is done when patients has:
- hypertension, hyperlipidemia
36
Two most beneficial vaccine for adults
- Influenza (either inactivated or live attenuated vaccine)
| - Pneumococcus
37
Live attenuated vaccine
- should NOT be used in patients> age 50
38
Both influenxa and pneumococcal vaccine are recommended for all patients:
- Chronic heart, liver, lung and kidney disease including asthma
- HIV/AIDS
- Steroid users
- Immunocompromised pts such as cancer or functional or anatomic splenia
- Diabetes mellitus
39
Pneumococcal vaccine indications
- everyone above age 65
- cochlear impant
- CSF leaks
- Alcoholics
- One vaccine ABOVE 65 ONLY
- Single revaccination after 5 yrs if patient is immunocompromised or if first injection is before 65
40
Influenza vaccine
- everyone yearly
- healthcare workers
- pregnant patients
41
Herpes (Varicella) Zoster Vaccine
- routinely indicated in all children
| - higher dose version of varicella vaccine indicated in all patients above age 60 (prevents post-herpetic neuralgia)
42
Hepatitis A and B vaccines most benefit in which patients
- Chronic liver disease
43
Hep A and B vaccines combined indication
- Chronic liver disease
- Men who have sex with men and multiple sex partners
- Household contacts w/ Hep A and B
- Injection drug users
44
Hep A specific indications
- Travelers to countries of high endemicity
45
Hep B specific indications
- End stage renal disease (dialysis)
- Healthcare workers
- Diabetes
46
Tetanus Vaccine
- Td (toxoid) every 10 years
- One Tdap (tetanus w/ acellular pertussis) as one of boosters
- Tetanus immune globulin in those never vaccinated
47
Meningococcal Vaccine
- routinely indicated at age 11 visit
Also indicated for adults w/ following circumstances
- Asplenia
- Terminal complement deficiency
- Military recruits
- Residents of college dorms
- Travelers to Mecca or Medina in S. Arabia for Hajj (pilmrimage)
48
Strongest indication for meningococcal vaccination
Asplenia
| - presents person at high risk for disseminated meningococcal injection
49
Tetanus immunization for person never vaccinated
Immune globulin
50
Tetanus immunization in person with dirty wound
Booster after 5 years
51
Tetanus immunization in clean wound
Booster after 10 years
52
Osteoporosis
- should be screened with bone densitometry at age 65 with DEXA scan
- Hip fracture in elderly pt carries an extremely high risk
- preventing fracture with bisphosphonates
53
Abdominal Aortic Aneurysm
- all men above age 65 w/ smoking hx should be screened at least once to exclude aneurysm
- AAA should be repaired if it is wider than 5 cm
- Also screen 65 - 75 w/ family hx of AAA
54
Domestic Violence
- all pts should be asked about possibility of intimate partner violence
- cannot report injury w/o consent of patient
55
Alcohol Dependence
- self-diagnosed disease
- ask CAGE
* Feel need to CUT DOWN on drinking?
* Do you get ANGRY when people ask about drinking?
* Do they feel GUILTY about amount drinking?
* Do you feel you need for morning EYE-OPENER?
