Prevention in General Practice Flashcards by MA CARMELA CONCEPCION SALES

_________may be defined as the means of promoting

and maintaining health or averting illness

Prevention

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It is concerned with removal or reduction of
risks; early diagnosis; early treatment; limitation of
complications, including those of iatrogenic origin;
and maximum adaptation to disability

Prevention

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________includes action taken to avert the

occurrence of disease. As a result there is no disease.

Primary prevention

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_________ includes actions taken to stop or

delay the progression of disease.

Secondary prevention

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Secondary prevention applies measures for
the detection of disease at its earliest stage, i.e. in
the ___________ so that treatment can be
started before irreversible pathology is present

presymptomatic phase,

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_______ includes the management of

established disease so as to minimise disability

Tertiary prevention

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Conceptually, curative medicine falls within the
definitions of secondary and tertiary prevention
while _______ measures are mainly concerned
with primary prevention

public health

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As GPs our role in prevention is twofold.

1 First, we can recognise the ________
that are involved in an illness process and
determine appropriate interventions.

2 Second, we can act to implement the _____

preventable factors

preventive
measure.

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Conditions can be ranked in importance as causes of
premature death according to the ‘person-years of life
lost before 70 years’

_________29%
Neoplasms 19%
____________s 17%
Perinatal conditions 10%
___________ 7%

Accidents, poisoning and violence

Circulatory disease

Congenital conditions

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The Royal College of General Practitioners (UK)
has identified the seven most important opportunities
for prevention as:

1 family planning
2 antenatal care
3 immunisation
4 fostering the bonds between mother and child
5 discouragement of smoking
6 detection and management of raised blood
pressure
7 helping the bereaved

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The two most
common causes of death in Australia are ______ AND _________, each accounting for
approximately 29% of all deaths.

cancer

and cardiovascular disease

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By comparison, the ten leading causes of death
in the world are (in order) ____, _______, ______, _______, _______ HIV/AIDS, cancer, diabetes
mellitus, road injury and prematurity

ischaemic heart disease,
stroke, lower respiratory tract infection, COPD,
diarrhoeal disease,

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The World Health Organization (WHO) defines _________as ‘a state of dynamic harmony between the
body, mind and spirit of a person and the social
and cultural influences which make up his or her
environment

good

health

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That environmental factors are involved in the
aetiology of _________ and other cancers is
indicated by wide variations in incidence between
different countries

colorectal cancer

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Studies in the US indicate that at least 35% of all

cancer deaths are related to _______

diet

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Obese individuals have an increased risk
1.
2.
3.

of colon, breast and uterine

cancers.

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_______s are a risk factor for prostate,

breast and colon cancers

High-fat diet

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Salt-cured, smoked and nitrate-cured foods increase the risk of ________

upper GIT cancers.

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Overall, diet, smoking, alcohol and occupational
exposures (5%) appear to account for over _______of all
cancer mortality

73%

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The development of a number of cancers appears to
be related to a depression of the individual’s___________particularly in relation to cellular immunity,
in a similar way (albeit on a different scale) to the
effect of HIV infection

immune

system,

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a protective effect on the immune system may be provided by:
1
2
3

food antioxidants
tranquillity
meditation

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It is worth noting that the death rate from
coronary heart disease is about _______higher for
smokers than for non-smokers and for very heavy
smokers the risk is almost ________ higher.

70%

200%

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GPs can estimate the absolute 5-year risks of
cardiovascular events in their patients by referring
to the New Zealand Guidelines Group Cardiovascular
Risk Charts ( www.nzgg.org.nz ).
The parameters used are:
1
2
3
4
5

gender and age
smoking status
diabetes status
blood pressure
total cholesterol/HDL ratio

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That environmental factors are involved in the
aetiology of ________ and other cancers is
indicated by wide variations in incidence between
different countries.

colorectal cancer

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The development of a number of cancers appears to be related to a depression of the individual’s immune system, particularly in relation to _______

cellular immunity

The protective effect for asthma and COPD of ___________and other natural antioxidants is highlighted by Sridhar.

vitamin C, fish oils, a low-salt diet

What are the 6 steps to asthma management 1 Establish the severity of the asthma. 2 Achieve __________. 3 Maintain best lung function—identify and avoid _______ 4 Maintain best lung function—follow an _____ 5 Develop an action plan. 6 Educate and review regularly.

best lung function trigger factors. optimal medication program.

In practice, _______ is not only to detect disease at its earliest stage, but also to find individuals at risk or those with established disease who are not receiving adequate care

screening

3 levels of screening 1. ________ with risk factors that predispose to disease 2. _______ individuals with signs of early disease or illnes

‘well’ individuals asymptomatic

_______ individuals whose irreversible abnormalities are unreported but the effects can be controlled or assisted (

symptomatic

Important social history ``` 1. 2 3 4 5 6 7 8 ```

1. Family history. 2. Suicide and accidents. 3. Substance abuse 4. Exercise and nutrition 5. Occupational health hazards 6. Physical functioning, home conditions and social supports. 7. Sexuality/contraception 8. Osteoporosis.

Occupational Health Hazards: * coal miners— * gold, copper and tin miners— * asbestos workers and builders— * veterinarians, farmers, abattoir workers— * aniline dye workers— * health care providers—

``` • coal miners—pneumoconiosis • gold, copper and tin miners—silicosis • asbestos workers and builders—asbestosis, mesothelioma • veterinarians, farmers, abattoir workers— zoonoses • aniline dye workers—bladder cancer • health care providers—hepatitis B ```

Fractures of the_______ have a particularly poor prognosis, with up to a third of these women dying within 6 months

femoral neck

Bone loss accelerates at the time of the menopause, and can be reduced by _______

hormone replacement therapy

Women at risk of osteoporosis are _____________; they drink coffee and alcohol, smoke, eat a high-protein

short, slim, | Caucasian

________has been estimated to exist in up to 15% of women aged 60 and above, and searching for clues may elicit subtle symptoms and signs previously attributed to ageing.

Hypothyroidism

Screening for children Height/weight/head circumference: 1. Record height from age ______ and weight at regular intervals to age 5 years 2. Record head circumference at birth and then up to ________months.

3 6

Hips. Screen for congenital dislocation at birth, | _____weeks, ______ months and _____months

6–8 6–9 12–24

Screening for hip dislocation: The flexed hips are abducted, checking for movement and a ‘clunk’ of the femoral head forwards (the test is most likely to be positive at _______weeks and usually negative after _______ weeks) _____ or ______is also abnormal.

3–6 8 Shortening or limited abduction

Strabismus should be sought in all infants and toddlers by ________ (not very sensitive), examining light reflexes and questioning parents, which must be taken very seriously

occlusion testing

_______ can be prevented by early recognition and treatment of strabismus by occlusion and surgery. Early referral is essential

Amblyopia

Visual acuity. At_______ and _____, eyes should be inspected and examined with an ophthalmoscope with a 3 + lens at a distance of 20–30 cm to detect cataracts and red reflexes.

birth and 2 months

At 9 months gross vision should be determined by assessing ability to see common objects. Visual acuity should be formally assessed at school entry using _______

Sheridan Gardiner charts

Hearing. Hearing should be tested by ______ at 9 months or earlier; also by _______ at 1000 and 4000 hertz when a child is 4 years (preschool entry) and 12 years

distraction | pure tone audiometry

Oral health/d ental assessment/fluoride. Advise daily ______ drops or tablets, if water supply is not fluoridated

fluoride

Oral health/d ental assessment/fluoride. Advice should be given on sugar consumption, especially night-time bottles, and tooth cleaning with fluoride toothpaste to prevent _____

plaque.

Scoliosis. Screening of females by the________ test, which is carried out around 12 years of age, is of questionable value because of poor sensitivity and specificity

forward flexion

Congenital heart disease. The heart should be auscultated at birth, in the first few days, a_________and on school entry

t 6–8 | weeks

Femoral pulses. Testing for absence of femoral pulses or delay between brachial/femoral pulses at _______and _____will exclude coarctation of the aorta.

birth and 8 weeks

Speech and language. A child’s speech should be intelligible to strangers by ________years. It is related to hearing.

Screening for adults Weight should be recorded at least every few years._________ is a major reversible health risk for adults, contributing to many diseases

Obesity

Abdominal obesity is a major risk factor for adults. The ________ ratio is regarded as a useful predictor of cardiac disease.

waist:hip circumference

Recommended waist:hip ratios are: • males _____ • females _______

<0.9 <0.8

Blood pressure. Blood pressure should be recorded | at least every _____ years on all people 16 years and over.

1–2

Cholesterol. All adults aged 45 and over should | have a _____estimation of serum cholesterol

5-yearly

The National Heart Foundation recommends keeping cholesterol levels below_______

4.0 mmol/L

Fasting blood glucose. Screen every 3 years for all | patients_______ years of age.

>40

Women aged 18–70 who have ever been sexually active should have a __________ every 2 years, or HPV testing according to recommended national screening guidelines

Pap test

Those over _______ who have never been screened should have two successive tests before screening is ceased

Risk factors for cervical cancer * all women who are or ever have been ____ * early age at first sexual intercourse * multiple sexual partners * ________ infection * cigarette smoking * use of combined oral contraception >5 years * those with ____ and _____ on Pap tests

sexually active genital wart virus LSIL and HSIL

Breast cancer. __________ should be performed at least every 2 years on women aged 50–70 years

Mammography

Breast Cancer It is not useful for screening prior to age 40 years due to difficulty in discriminating malignant lesions from _____.

dense tissue

________must not be used alone to exclude cancer if a lump is palpable.

Mammography

Such lesions require a complete appraisal since, even in the best hands, mammography still has a false-negative rate of at least_____

10%.

Colorectal cancer (CRC). A history should be taken, with specific enquiry as to family history of adenomas or colorectal cancer, past history of ______ and ______

inflammatory | bowel disease and rectal bleeding

Faecal occult blood testing (FOBT) every 2 years is now recommended for screening for people over ______ without symptoms and with average or slightly above average risk.

50 years

Colorectal Cancer Should a positive history be elicited, then the following are recommended: • past history of large bowel cancer or colonic adenomas—

colonoscopy

Colorectal Cancer Should a positive history be elicited, then the following are recommended: • past or present history of ulcerative colitis—

colonoscopy with biopsies

Colorectal Cancer Should a positive history be elicited, then the following are recommended: • familial polyposis, Gardner syndrome—

sigmoidoscopy or colonoscopy

Apart from FOBT screening, the National Health and Medical Research Council (NHMRC) currently recommends ________colonoscopy for people from 25–30 years of age if there is a family history

2-yearly

Family history screening for colorectal CA • ______ or more first or second degree relatives with CRC at any age • two or more first or second degree relatives diagnosed as CRC _______of age • a family member where____ studies identify a high risk

three <50 years genetic

Skin cancer, which is increasing in incidence, is common in Australia, particularly in more northern areas. _______ and ____in particular, may be lethal

Squamous cell carcinoma, and melanoma

Patients should be counselled about cessation of smoking and alcohol consumption, and dental hygiene should be taught. The oral cavity should be inspected annually in patients over the age of ______

40 years.

Although oral cancer has a relatively low incidence, ______ lesions may be detected by inspection of the oral cavity

premalignant

NHMRC endorses_______ vaccine for all infants and pre-adolescents (three doses)

hepatitis B

Do not postpone immunisation for minor illnesses such as _____ Acellular______ vaccine, which reduces the risk of reactions, has become a standard component of triple antigen.

mild URTI. pertussis

Age Immunisation Birth: ____ 2 months: 4 months DTP, Hib, hepatitis B, polio, pneumococcus,_______ 6 months DTP, polio, Hib, pneumococcus and _____ and ___

Hepatitis B DTP, Hib, hepatitis B, polio, pneumococcus, rotavirus rotavirus ``` hepatitis B (or at 12 months), rotavirus ```

12 months: 18 months Varicella, pneumococcus (ATSIP), measles, mumps, rubella (MMR) 4 years ______ School programs 10–15 years (contact state authorities) _______

Measles/mumps/rubella (MMR), Hib, meningococcus C and hepatitis B (or at 6 months) DTP, polio, MMR (if not given at 18 months) HPV, varicella, DTP (adult), hepatitis B

Common adverse effects are _______,______._____and a local reaction to the injection

irritability, malaise, | fever

________is recommended for fever and local pain; however, routine use at the time of or immediately after vaccination is not recommended.

Paracetamol

Children with minor illness (providing the temperature is______º C) may be vaccinated safely. Otherwise it should be delayed

<38.0

A simple past _____ and ______ is not a contraindication to | pertussis vaccination

febrile convulsion or pre-existing | neurological disease

Absolute contraindications include __________ within 7 days of a previous DTP or an immediate severe or___________to DTP.

encephalopathy anaphylactic reaction

_______ is recommended on an annual basis for persons of all ages with chronic debilitating diseases, especially chronic cardiac, pulmonary, kidney and metabolic diseases, persons over 65 years of age, Indigenous Australian adults over 50 years of age and persons receiving immunosuppressant therapy.

Influenza immunisation

This should be considered | for the same risk groups as influenza vaccine

Pneumococcal disease.

Those at higher risk of fatal pneumococcal infection (e.g. ______ and _________), should receive a booster every 5 years

post-splenectomy or Hodgkin lymphoma

Hepatitis A. Immunisation is recommended for: • certain ________ at risk (e.g. health workers, child care workers, sewage workers) • non-immune __________men

occupational groups homosexual

Hepatitis A. Immunisation is recommended for: * those with chronic _____ * recipients of _______ * travellers to hepatitis A endemic areas

liver disease blood products

Hepatitis B. Immunisation is recommended routinely for all children at ____, ____,, ______ and ______, and for individuals of all ages who, through work or lifestyle, may be exposed to hepatitis B and have been shown to be susceptible

birth, 2 months, 4 months | and at either 6 or 12 months

Booster doses are not recommended for immunocompetent people but are recommended for ______ individuals

immunosuppressed

________is recommended for all children, especially those | in child care.

Hib immunisation

It is ideal to achieve immunity by the age of _______months and preferably commencing at 2 months.

Risk factors for Hib disease include ___, _____, _______ and ____

day care attendance, presence of ill siblings under 6 years of age in the home and household crowding.

People at reasonable risk from ______ particularly abattoir workers, should be given this vaccine, which is virtually 100% effective

Q fever,

Both females and males should be immunised against measles, mumps and rubella at the age of 12 months and 4–5 years using the _____

trivalent vaccine.

_________This is available and one dose is given at 18 months. Those over 12 years have a course of two injections

Varicella vaccine.

Meningococcal disease is caused by Neisseria meningitides, which has 13 serogroups of which A, B and C account for over 90% of isolated cases, with _______ responsible for most cases.

serogroup B

The main vaccine that is available is a quadrivalent polysaccharide vaccine against serogroups _______ for use in individuals over 2 years as a single injection

A, C, Y and W125

Rotavirus. A course of three oral live attenuated | rotavirus vaccines is given to children to cover a common cause of______

childhood gastroenteritis.

Rotavirus. Inform parents of the risk of ______ with the first dose

intussusception

Human papilloma virus. A course of three injections is given to Year 7 (or equivalent) schoolgirls (and boys in some states), although this is recommended for all females from ___

9–26 years

Prevention in General Practice Flashcards

(101 cards)