Screening Guidelines

Question 1

What is USPSTF CVD- Hyperlipidemia guidelines for people less than 20 years old?

Answer 1

For <20, insufficient evidence

Question 2

What is USPSTF’s recommendation regarding Hyperlipidemia for people 40-75?

Answer 2

If they are 40-75, have no history of CVD but DO have more than 1 risk factor for CVD and have more than a 10% risk factor of having CVD in 10 years then they give it a grade B recommendation–> Give statin!

**If CVD risk is only 7.5-10% then recommendation is grade C

Question 3

USPSTF recommendation regarding Hyperlipidemia for people over 76 without any history of CVD

Answer 3

Insufficient evidence

Question 4

USPSTF recommendation for Coronary Heart disease (using non traditional risk factors)

Answer 4

Insufficient evidence whether tests including hs-CRP, ankle brachial index and Coronary artery calcification score are useful or not

Question 5

USPSTF recommendation for Coronary Heart disease, Using EKG (resting on exercise)

Answer 5

Low risk adults= grade D

Intermediate or high risk adults= insufficient evidence

Question 6

USPSTF recommendations regarding Carotid Artery Stenosis (CVD)

Answer 6

GRADE D

1. 10% of ischemic strokes caused by CAS
2. 1% of strokes are asymptomatic
3. No incremental overall benefit of CEA, stenting or intensification of medical therapy
4. Potential for overall benefits limited by low prevalence and harms

**This example was stressed in class- KNOW**

Question 7

USPSTF guidelines for men 65-75y/o regarding Abdominal Aortic Aneurysm (CVD)

Answer 7

Men 65-75 who HAVE ever smoked- One time screening with U/S= Grade B

Men 65-75 who have NEVER smoked- selectively offer screening rather than routinely screening= grade C

Question 8

USPSTF guidelines for women 65-75y/o regarding Abdominal Aortic Aneurysm (CVD)

Answer 8

Women 65-75 who HAVE ever smoked= insufficient evidence

65-75 who have NEVER SMOKED= grade D, not recommended

Question 9

USPSTF recommendations regarding peripheral artery disease (CVD)

Answer 9

Risk assessment with ankle brachial index= insufficient evidence

Question 10

USPSTF recommendations regarding Aspirin prophylaxis to prevent CVD and colorectal cancer in 50-59 y/o

Answer 10

GRADE B if…

>10% 10 year CVD risk

Not at risk of bleeding

Have a life expectancy of at least 10 years

willing to take low dose aspirin daily for at least 10 yers

Question 11

USPSTF recommendations regarding Aspirin prophylaxis to prevent CVD and colorectal cancer in 60-69 y/o

Answer 11

60-69 y/o with greater than or equal to a 10% 10 year CVD risk= Grade C

More likely to benefit if not at increased risk of bleeding, life expectancy is at least 10 years, willing to take low dose ASA daily for at least 10 years

Question 12

USPSTF recommendations regarding Aspirin prophylaxis to prevent CVD and colorectal cancer in adults younger than 50 or greater than 70?

Answer 12

Insufficient evidence

Question 13

USPSTF recommendations for Colorectal cancer screenings

Answer 13

Grade A= Adults age 50-75 y/o

Grade C= adults 76-85: most appropriate if healthy enough to undergo tx if CA detected and no comorbid conditions limiting life expectency

Question 15

USPSTF recommendations regarding PSA screening as a screen for prostate cancer

Answer 15

>70y/o= Grade D

50-69 y/o= Grade C (Individualized after discussing benefits and harms with clinician and incorporating pt values and preferences in the decision)

Question 16

USPSTF recommendation regarding skin cancer screenings

Answer 16

Insufficient evidence

Grade B recommendation for counseling- counsel young adults, adolescents, children and parents of young children with fair skin about minimizing exposure to UV radiation for persons 6mo-24 years

>24= Grade C

Question 17

USPSTF recommendation for Breast cancer screening for average risk individuals

Answer 17

Age 40-49: Individualze (grade C)

Every 2 years, age 50-74 (Grade B)

Question 18

ACOG recommendation for Breast cancer screening for average risk individuals

Answer 18

• Offer at age 40, start no later than 50 y/o
• Every 1-2 years until age 75 and then discuss discontinuation

Question 19

USPSTF recommendations regarding cervical cancer screening as of August 2018

Answer 19

GRADE A

• women 21-29= cervical cytology (pap smear) alone every 3 years
• 30-65y/o= 3 options: PAP smear (i.e. cervical cytology) alone every 3 years, PAP with HPV every 5 years, or HPV alone every 5 years.

Question 20

USPSTF recommendations regarding Lung cancer screening

Answer 20

Grade B for adults 55-80 w/ hx of smoking

• annual screening with low dose CT if there is a 30 pack year smoking history and the patient currently smokes or has quit w/in the past 15 years
• Discontinue screening once the person hasn’t smoked for 15 years, or develops a health problem substantially limiting life expectancy or the willingness to have curative lung surgery

Question 21

Recommendations regarding screening for thyroid dysfunction vs. thyroid cancer

Answer 21

thyroid dysfunction (screening by looking at TSH)= insufficient evidence

Thyroid cancer (with thyroid ultrasound)= Grade D

Question 22

USPSTF recommendations regarding screening for HTN (CVD) in 18+y/o

Answer 22

Age 18+= Grade A

Screen every 3-5 years until 40 and then screen annually

Annual screaning if at an increased risk (High normal BP- 130-139/85-89, overweight or obese, African American)

Question 24

AAP recommendation for HTN screening in children and adolescents

Answer 24

>3y/o= every health care episode

Question 25

NHLB, Bright Futures and AHA recommendation for HTN screening in children and adolescents

Answer 25

Annually beginning at age 3

Question 26

USPSTF recommendation regarding screening for STIs and blood-borne infections

Answer 26

Grade B- Recommends intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for STIs

Question 27

USPSTF recommendation regarding screening for STIs and blood-borne infections--\> Chlamydia and Gonorrhea

Answer 27

Grade B- screen in sexually active women \<24y/o and older women at increased risk -insufficient evidence for men

Question 28

USPSTF recommendation regarding screening for STIs and blood-borne infections--\> Hepatitis B

Answer 28

- Grade B: Screen those at high risk - Grade A: Screen pregnant women at first prenatal visit

Question 29

USPSTF recommendation regarding screening for STIs and blood-borne infections--\> Hepatitis C

Answer 29

Grade B: Screen those at high risk and offer 1-time screening to adults born b/w 1945 and 1965

Question 30

USPSTF recommendation regarding screening for STIs and blood-borne infections--\> HIV

Answer 30

Screen adolescents and adults age 15-65; screen those younger or older if at increased risk; Screen all pregnant women (Grade A)

Question 31

USPSTF recommendation regarding screening for STIs and blood-borne infections--\> Syphilis

Answer 31

Grade A: screen asymptomatic, non-pregnant adults and adolescents at increased risk Grade A: Early screening in all pregnant women

Question 32

Screening recommendations for depression (maybe from USPSTF?)

Answer 32

- Grade B: Screen the general adult population, including pregnant and postpartum women - Grade B: Screen for major depressive disorder in adolescents aged 12-18 y/o - Children less than or equal to 11 y/o: insufficient - Perinatal depression: in progress, guideline being updated

Question 33

Screening recommendations regarding substance related problems (Tobacco) for adults--\> maybe from USPSTF?

Answer 33

- Grade A: Ask all adults (including pregnant women) about tobacco use, advise them to stop using tobacco, and provide behavioral interventions - In non-pregnant adults, provide US FDA approved pharmacotherapy for cessation to adults who use tobacco

Question 34

Screening recommendations regarding substance related problems (Tobacco) for children and adolescens--\> maybe from USPSTF?

Answer 34

Grade B- Provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school aged children and adolescents

Question 35

Screening recommendations regarding substance related problems (ALCOHOL) for adults--\> maybe from USPSTF?

Answer 35

- Grade B: Screen adults \>18 y/o (including pregnant women), screen for unhealthy alcohol use in primary care sexttings and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use - Age 12-17 y/o: insufficient evidence

Question 36

Recommendation for screening intimate partner violence (potentially from USPSTF?)

Answer 36

Women of reproductive age: GRADE B- Screen for IPV, and provide or refer women who screen positive to ongoing support services Older or vulnerable adults- insufficient

Question 37

Screening guidelines for Osteoporosis (From USPSTF?)

Answer 37

- Grade B: Screen women \>65 y/o with bone measurement testing & also postmenopausal women \<65y/o who are at increased risk of osteoporosis (determined by a formal clinical risk assessment tool) - Insufficient evidence for men

Question 38

Screening Guidelines for obesity (possibly from USPSTF?)

Answer 38

- Grade B: Offer or refer adults with a BMI greater than equal to 30 to intensive, multicomponent behavioral interventions - Grade B: Children and adolescents age greater than or equal to 6, screen for obesity and offer or refer to comprehensive, intensive behavioral interventions to promote improvements in weight status

Question 39

Vision screening recommendations (maybe from USPSTF?)

Answer 39

- Insufficient evidence for glaucoma - Insufficient evidence for impaired visual acuity screening in adults 65+ - Grade B: Vision screening at least once in children aged 3-5y/o for ambylopia or its risk factors

Question 40

USPSTF screening guidelines regarding HTN in children and adults

Answer 40

Insufficient evidence update in progress

Question 42

Hearing screening recommendations (maybe from USPSTF?)

Answer 42

Insufficient evidence for hearing loss in asymptomatic adults 50+

Question 43

USPSTF recommendations for injury screening prevention

Answer 43

Grade B: Recommends exercise interventions to prevent falls in community dwelling adults 65 years or older who are at increased risk for falls

Question 44

USPSTF recommendation on screening for oral health

Answer 44

USPSTF has no recommendations