Screening Recommendations

Question 1

What fields are represented in USPSTF?

Answer 1

Preventative medicine, primary care, internal medicine, family medicine, beds, behavioral health, OB, nursing

Question 2

Category A

Answer 2

Recommended service-high certainty that the net benefit is substantial

Question 3

Category B

Answer 3

Recommended service-high certainty that benefit is moderate or moderate-substantial

Question 4

Category C

Answer 4

Service is recommended selectively or based on professional judgement/patient preference

Question 5

Category D

Answer 5

Recommended to NOT do the service, risk outweighs benefit

Question 6

Category I

Answer 6

Insufficient evidence

Question 7

How are screening decisions made?

Answer 7

Burden of suffering, sensitivity/specificty/safety of test, prevention effectiveness

Question 8

Burden of suffering (the D’s)

Answer 8

Death, disease, disability, discomfort, dissatisfaction,destitution

Question 9

Harms of screening

Answer 9

Risks associated with the test, anxiety, additional diagnostic testing, over-diagnosis, limited benefit

Question 10

Cardiovascular Disease screening tests

Answer 10

Hypertension, hyperlipidemia, coronary heart disease, carotid artery stenosis, abdominal aortic aneurysm, peripheral artery disease, aspirin prophylaxis

Question 11

What is considered increased 10-year CVD risk?

Answer 11

> 7.5%

Question 12

Hypertension

Answer 12

Grade A for 18+, screen every 3-5 years until age 40, then annually

Annually if at increased risk (high BP, obese, African American)

Question 13

Hypertension Children/adolescents

Answer 13

AAP: >3 years old at every health care episode

NHLB, bright futures, AHA: annually beginning at age 3

Question 14

Hyperlipidemia

Answer 14

Primary prevention- low-mod dose statin Grade B: age 40-75, no hx of CVD, >1 CVD risk factor &10 year risk >10%

Question 15

Coronary Heart Disease

Answer 15

hs-CRP, ankle-brachial index, coronary artery calcification score with no hx-insufficient evidence

EKG-Grade D

Question 16

Carotid Artery Stenosis

Answer 16

Grade D- only 10% ischemic stroke caused by CAS, 1% of CAS are asymptomatic

Question 17

Abdominal Aortic Aneurysm

Answer 17

Men-Grade B if 65-75 who’ve ever smoked

Women- Grade D who’ve never smoked, insufficient evidence if they have smoked

Question 18

Peripheral Artery Disease

Answer 18

Insufficient evidence

Question 19

Aspirin Prophylaxis

Answer 19

Grade B: 50-59 w/ >10% 10 year risk, no risk of bleeding, life expectancy at least 10 years, willing to take daily for 10 years

Question 20

Types of Cancers

Answer 20

Colorectal, prostate, skin, breast, cervical, lung

Question 21

Colorectal Cancer

Answer 21

Grade A:50-75 years old

Grade C: 76-85, if healthy enough for treatment

Question 22

Prostate Cancer

Answer 22

Grade D 70+

Grade C 50-69 after discussing risk/benefits

Question 23

Skin Cancer

Answer 23

Grade B recommendation for counseling 6 months-24 years

Otherwise insufficient

Question 24

Breast Cancer

Answer 24

Grade B: every 2 years 50-74
Grade C: 40-49

ACOG: offer at 40, start no later than 50; every 1-2 years until 75

Question 25

Cervical Cancer

Answer 25

Grade A: women 21-65 every 3 years w/pap alone, 30-65 every 5 w/ HPV testing DO NOT TEST for HPV under 30

Question 26

Lung Cancer

Answer 26

Grade B: 55-80 with hx of smoking-annually w/ 30pack year hx and quit w/in last 15 years

Question 27

Cancer

Answer 27

Assess hereditary risk

Question 28

STI's

Answer 28

Chlamydia/gonorrhea, Hep B, Hep C, HIV, Syphilis

Question 29

Chlamydia/gonorrhea

Answer 29

Grade B: sexually active women <24 and older women if increased risk

Question 30

Hep B

Answer 30

Grade A: pregnant women @ first prenatal visit | Grade B: anyone high risk

Question 31

Hep C

Answer 31

Grade B: high risk; offer once to baby boomers (1945-1965)

Question 32

HIV

Answer 32

Grade A: 15-65, younger if increased risk, all pregnant women

Question 33

Syphilis

Answer 33

Grade A: asymptomatic, anyone at risk, early in pregnant women

Question 34

Psychosocial Health Concerns

Answer 34

Depression, substance related, intimate partner violence

Question 35

Depression

Answer 35

Grade B: general adults, pregnant &postpartum | Grade B for major depressive disorder in 12-18

Question 36

Substance Related

Answer 36

Grade A: ask all adults for tobacco & drug use | Grade B: anyone >18 for alcohol; provide intervention/education in children for tobacco

Question 37

Intimate Partner Violence

Answer 37

Grade B: women of reproductive age, refer to ongoing support if positive

Question 38

Endocrine Disorders

Answer 38

Thyroid, osteoporosis, obesity

Question 39

Thyroid

Answer 39

Grade D: thyroid cancer | Dysfunction is insufficient

Question 40

Osteoporosis

Answer 40

Grade B: women >65 w/bone measurement testing; postmenopausal women <65 at increased risk Insufficient for men

Question 41

Obesity

Answer 41

Grade B: BI >30 refer to behavior intervention; children >6 screen and refer

Question 42

Vision

Answer 42

Grade B: 3-5 years old for amblyopia | Insufficient otherwise

Question 43

Hearing

Answer 43

Insufficient in asymptomatic over 50

Question 44

Injury Prevention

Answer 44

Grade B: Exercise intervention to prevent falls over 65 | Grade D: no vit D supplementation to prevent falls