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Flashcards in Routine physical examination Deck (23):
1

Age when assessment of cardiovascular risk is done

Absolute cardiovascular risk assessment should be conducted at least every 2 years in all adults aged 45 years and older who are not known to have CVDs or to be at clinically determined high risk

2

What information is required for cardiovascular risk assessment (8)

age, sex, smoking status, total and HDL cholesterol, systolic blood pressure (SBP) and if the patient is known to have diabetes or left ventricular hypertrophy (LVH).

3

What categories place people at an already high cardiovascular risk (7)

diabetes and age >60 years
diabetes with microalbuminuria (>20 µg/min or urine albumin:creatinine ratio (UACR) >2.5 mg/mmol for males, >3.5 mg/mmol for females)
moderate or severe CKD (persistent proteinuria or estimated glomerular filtration rate (eGFR) 7.5 mmol/L
Aboriginal or Torres Strait Islander peoples aged over 74 years (Practice Point)

4

When is kidney disease screened for and what are the tests

>30 yo when high risk every 1-2 years
BP
ACR
eGFR

5

Classify high risk for kidney disease

Smoking >40
HTN
Obesity
FHx kidney disease
Diabetes
ATSI >30

6

When should stroke risk be assessed and what should be done

High absolute risk >15%, previous stroke, previous TIA every 12 months from age 45

Question about symptoms TIA
Determine if AF treated
Manage risk factors
Treat with anti-HTN and lipid lowering

7

When should diabetes be screened for

Patients should be screened for diabetes every 3 years from age 40 years using AUSDRISK (B). Aboriginal and Torres Strait Islander peoples should be screened from age 18 years. Those with a risk score of 12 or more should be tested by fasting plasma glucose

8

What is increased risk, high risk

+risk >40, ATSI

High risk=
AUSDRISK score of 12 or more
all people with a history of a previous cardiovascular event (acute myocardial infarction or stroke)
women with a history of gestational diabetes mellitus
women with polycystic ovary syndrome
patients on antipsychotic drugs

9

When should lipid screening occur

Every 5 years from age 45

10

When is patient high risk for lipid disorder

Absolute cardiovascular risk >15%
Patient with the following clinically determined high-risk factors:
diabetes and age >60 years
diabetes with microalbuminuria (>20 µg/min or UACR >2.5 mg/mmol for males, >3.5 mg/mmol for females)
CKD (persistent microalbuminuria or Stage 4 renal failure eGFR 7.5 mmol/L
Aboriginal and Torres Strait Islander peoples aged over 74 years

11

When should BP screening occur

Every 2 years from aged 18

12

When does CRC screening occur

Organised screening by FOBT is recommended for the asymptomatic average risk population from age 50 years every 2 years (A) until age 75 years with repeated negative findings

13

What is average risk CRC

Asymptomatic people with:
no personal history of bowel cancer, colorectal adenomas or ulcerative colitis and no confirmed family history of CRC,
or
one first- or second-degree relative with CRC diagnosed at age 55 years or older

14

Moderately increased risk

Asymptomatic people with:
one first-degree relative with CRC diagnosed before age 55 years,
or
two first-degree or one first- and one second-degree relative/s on the same side of the family with CRC diagnosed at any age (without potentially high-risk features as in Category 3)

15

What is the screening for moderately increased risk

Colonoscopy every 5 years from aged 50 or 10 years earlier than youngest diagnosed

16

What is considered high risk

symptomatic people with:
three or more first- or second-degree relatives on the same side of the family diagnosed with CRC (suspected Lynch syndrome, also known as hereditary non-polyposis CRC or HNPCC) or other Lynch syndrome-related cancers†
or
two or more first- or second-degree relatives on the same side of the family diagnosed with CRC, including any of the following high-risk features:
multiple CRC in the one person
CRC before age 50 years
a family member who has or had Lynch syndrome-related cancer
or
at least one first- or second-degree relative with CRC, with a large number of adenomas throughout the large bowel (suspected familial adenomatous polyposis: FAP)
or
somebody in the family in whom the presence of a high-risk mutation in the adenomatous polyposis coli (APC) or one of the mismatch repair genes has been identified

17

Monitoring in high risk

Refer to genetic screening
Bowel cancer specialist plan
Flexible sigmoidoscopy, colonoscopy

FAP (no APC mutation defined): every 12 months from age 12–15 years to age 30–35 years and every 3 years after age 35 yearsII
Lynch syndrome: 1–2 yearly from age 25 years or 5 years earlier than the youngest affected member of the family (whichever is earliest). Aspirin 100 mg/day is effective prophylaxis

18

Which immunisations are recommended in older population >65 years

Influenza
23cPPV- one dose recommended unless disease predisposing to invasive pneumococcal

19

Which vaccinations may older people need booster for

Tetanus
Diptheria
Pertussis

20

Health maintenance consultation for men

Immunisations
Cancer screening
Screening for chronic disease->cardiovascular disease, T2DM, Obesity, Depression.
Risk behaviours->smoking, alcohol, gambling, sex
Advise on healthy lifestyle:
-exercise
-weight
-diet
-safe sex practises
-seat belts
-avoid driving under influence of drugs and alcohol

21

Categories of evidence for management

A: There is strong evidence that the intervention improves health outcomes and its benefits substantially outweigh its potential harms. These services are strongly recommended.
B: There is at least fair evidence that the intervention improves health outcomes and its benefits outweigh its potential harms. These services are recommended.
C: The balance of the benefits and potential harms is too close to justify making a general recommendation.
D: There is at least fair evidence that the service is ineffective or the potential harms outweigh the benefits. These services are not recommended.
E: There is insufficient evidence, or the available evidence is of such poor quality, that the balance of benefits and harms cannot be weighed and recommendations for or against the service cannot be made.

22

When may 5 year repeat pneumococcal vaccination be appropriate

In patients presenting with CKD, hepatic disease, immunodeficiency and asplenia.

23

Those at risk of hepatitis B

health-care workers, those
exposed to blood or blood products, dialysis patients, intravenous drug users,
persons with multiple sexual partners or recent sexually transmitted diseases,
and men who engage in sexual relations with other men.