TBL Nov 29 part 2 Flashcards
(27 cards)
What is PPV?
Proportion of pt’s w/ positive test who actually have the disease (so true positives divided by all positives)
What does PPV increase with?
Increasing prevalence
What is NPV?
Proportion of pt’s w/ negative test who are actually free of the disease (so true neg’s divided by all negatives)
What does NPV increase with?
Decreasing prevalence
What does likelihood ratio > 1 mean?
Increased likelihood of disease
If > 5, greater likelihood of detecting the presence of the disease
> 10 is strong evidence to rule in
What must a good screening test have?
A high sensitivity
- able to find true positives
What is RISE mnemonic?
Risks (of this patient)
Immunizations
Screening
Education/counseling
Lead time bias
Diagnosed by screening so found disease earlier than would have if waited for symptoms
Length time bias
Screening tests catch indolent cases of disease (slow growing cancers) but not severe disease (rapid growing cancers) — so people screened have “better prognosis”
TdaP indications:
18-65 - TdaP
- booster every 10 years; wound and > 5 yrs
65+ Td
MMR
can’t give to preggers
want women of childbearing age to get to prevent devo problems
When avoid varicella vaccine?
Active TB
Immunosuppressed
Preggers
Recent immune globulin
Polio
- OPV
- IPV
Oral (live) not recommended in US
Only give IPV if risk (traveler, health care)
When not give influenza vaccine?
Acute febrile illness
Pneumoccal vaccine
One dose for 65 years +
Consider 5-year booster if high risk
Give 2 wks before elective splenectomy
Nursing home residents
When give Zoster?
Adults 60 and older once
HPV
Females 11-16 (may start at 9)
If prior abnormal pap, positive HPV still give
1-3 leading behaviors linked w/ death
- Tobacco
- Poor diet + physical inactivity
- Alcohol consumption
Level C vs. D evidence
Level I
C - consider based on individual pt
D - NOT used as harms > benefits
I - insufficient evidence so make decision based on clinical considerations
Who screen for Syphilis?
HIV?
High-risk adults
All pregnant women
What is new screening for breast cancer?
50-74 years old
Mammography
+/- clinical breast exam
EVERY 2 YEARS (unless limited life expectancy)
When screen cervical cancer?
Start at age 21
Every 3 years
Discontinue at 65 or after hysterectomy for benign reasons
What is best predictor hip fracture?
DEXA scan femoral neck
Osteoporosis screening?
Age 65, at least 2 years between, longer ok
takes 2 years to measure change in BMD
