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50 Cards in this Set
- Front
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Case: 52-year old man with no active medical problems is being evaluated during an "annual physical." He has no complaints on history and has a normal physical exam.
What are the recommended screening tests for cardiovascular conditions? |
- BP - Lipids |
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Case: 52-year old man with no active medical problems is being evaluated during an "annual physical." He has no complaints on history and has a normal physical exam.
What are the recommended screening tests for cancer? |
- Colorectal Cancer: fecal occult blood testing, flexible sigmoidoscopy (w/ or w/o occult blood testing), colonoscopy, or double-contrast barium enema
- Prostate Cancer: insufficient evidence to recommend for or against universal prostate cancer screening by PSA testing |
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Case: 52-year old man with no active medical problems is being evaluated during an "annual physical." He has no complaints on history and has a normal physical exam.
What are the recommended immunizations? |
Tdap: Tetanus toxoid, reduced Diphtheria toxoid, and acellular Pertussis toxoid: - If he has not had one before - OR if it has been 10 years or more since he has had a tetanus-diphtheria (Td) vaccine - OR if he requires booster protection against pertussis
Influenza vaccine annually in the fall or winter months |
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What is the general approach to a health maintenance exam? |
Prevent further disease: - Immunizations - Cancer screening - Screening for common diseases |
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Why should an adult male be screened for cardiovascular disease (BP, lipids)? |
This is the most common cause of mortality in this group |
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What is a screening test? |
Assessment device or test that should be cost effective with high sensitivity and can be used on a large population to identify persons with disease |
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What is a health maintenance visit? |
Visit focused on preventive care for patients prior to development of disease - Identify patient's current medical conditions - Identify patient's risks for future problems - Perform rational and cost-effective health screening tests - Promote a healthy lifestyle |
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How do you categorize "prevention"? |
- Primary - Secondary |
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What is primary prevention? |
Intervention designed to prevent a disease before it starts; it usually involves identification and management of risk factors for a disease |
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What is secondary prevention? |
Intervention intended to reduce the recurrence or exacerbation of a disease |
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Statin medications to reduce LDL in order to lower the risk of CAD is what kind of prevention? |
Primary - identify risk factors (high cholesterol) to prevent disease (CAD) |
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Removal of colon polyps to prevent development of colon cancer is what kind of prevention? |
Primary - identify risk factors (colon polyps) to prevent disease (colon cancer) |
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Use of statin medication after a person has an MI is what kind of prevention? |
Secondary - intervention (statin) used to lower the rate of recurrence or exacerbation of disease (CAD) |
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Effective screening for diseases or health conditions should meet what criteria? |
- Disease should be of high enough prevalence in the population to make screening effort worthwhile - There should be a time frame that the person is asymptomatic, but during which the disease or risk factor can be identified - There needs to be a test that has sufficient sensitivity and specificity, cost-effective, and acceptable to patients - There must be an intervention that can be made during the asymptomatic period that will prevent the development of the disease or reduce the morbidity/mortality of the disease |
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What is the name of the independent panel of experts in primary care and preventive medicine that reviews evidence and makes recommendations on effectiveness of clinical preventive services? |
USPSTF - United States Preventive Services Task Force |
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How do you know how strong a certain recommendation by the USPSTF is? |
They grade the recommendations in five categories to reflect evidence strength and overall benefit of an intervention (A, B, C, D, I); along with suggestions for practice |
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What is the definition of a USPSTF grade "A" recommendation? What is the suggestion for practice? |
- There is high certainty that the net benefit of the intervention is substantial - Offer or provide this service |
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What is the definition of a USPSTF grade "B" recommendation? What is the suggestion for practice? |
- There is high certainty that the net benefit of the intervention is moderate or moderate certainty that it is moderate to substantial - Offer or provide this service |
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What is the definition of a USPSTF grade "C" recommendation? What is the suggestion for practice? |
- There may be considerations that support providing the service in an individual patient or there is moderate or high certainty that there is no net benefit or harm - Offer or provide the service only if there are other considerations that support offering or providing for the individual |
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What is the definition of a USPSTF grade "D" recommendation? What is the suggestion for practice? |
- There is moderate or high certainty that there is no net benefit or that the harms outweigh the benefits - Discourage use of this service |
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What is the definition of a USPSTF grade "I" recommendation? What is the suggestion for practice? |
- There is insufficient evidence, or the available evidence is of such poor quality, that the balance of benefits and harms cannot be weighed and recommendation for or against the service cannot be made - If service is offered, patients should understand the uncertainty about the balance of benefits and harms |
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What is the leading cause of death in adult men? |
Diseases of the cardiovascular system |
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What are the USPSTF recommendations for screening for cardiovascular diseases? |
- Screen BP for HTN (A) - Screen for lipid disorders for CAD (A/B) - Screen w/ U/S for AAA (B/C/D) |
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Who should receive screening for lipid disorders? |
- Men >35 years (A) - Women >45 years (A) - Men/women >20 years with increased risk factors for cardiovascular disease (B) |
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How should you screen lipids? |
- Non-fasting total cholesterol and HDL - Fasting panels that also include LDL |
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Who should receive screening for AAA? |
- Men 65-75 years who have ever smoked (B)
No recommended screening for: - Men who have never smoked (C)
Recommended against for: - Women, regardless of smoking status (D) |
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Which screening tests are recommended against for evaluating for cardiovascular disease? |
- Screen for peripheral arterial disease in asymptomatic adults (D)
Recommended against in patients with low risk for coronary events (D) / insufficient evidence to recommend for or against in patients with higher risk: - Screen w/ ECG (D/I) - Screen w/ exercise stress testing (D/I) - Screen w/ CT for coronary calcium (D/I)
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Why is there no recommendation for screening for peripheral arterial disease in asymptomatic patients? |
- Low prevalence of problem in asymptomatic adults - Lack of evidence for improved outcomes in asymptomatic stage |
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What are the USPSTF recommendations for screening for cancer? |
Screen w/ colon cancer in adults >50 years (A) |
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How can colon cancer be screened for? |
- Annual fecal occult blood testing (FOBT) using guaiac cards on 3 consecutive BMs collected at home - q3-5 years: flexible sigmoidoscopy w/ or w/o occult blood testing - q10 years: colonoscopy |
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What needs to be done if an annual FOBT or sigmoidoscopy has an abnormal result? |
Colonoscopy |
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For what types of cancer is their insufficient evidence to recommend regular screening? |
- Prostate Cancer: no recommendation for digital exam or PSA in men <75 years (I) - Lung Cancer: no recommendation for using CT scans, CXRs, sputum cytology, or combinations (I) - Thyroid cancer - Skin cancer - Oral cancer |
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For what types of cancer is their enough evidence to recommend AGAINST regular screening? |
- Bladder, testicular, or pancreatic cancer in asymptomatic adults (D) - Prostate cancer in men >75 years |
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What other health conditions can be screened for? |
- Screen w/ BMI for obesity (B) - Screen for diabetes in patients with HTN or HLD (B); but not in asymptomatic adults (I) - Screen for depression if there are mechanisms in place for ensuring accurate diagnosis, treatment, and follow-up (B) - Screen for tobacco use (A) - Screen for misuse of alcohol (B) |
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What should be done for a patient who screens positive for obesity based on BMI? Level of evidence? |
Provide intensive counseling and behavioral interventions to promote weight loss (level B) |
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Who should be screened for diabetes mellitus? |
- Symptomatic patients - Patients with HTN or HLD (B) |
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Who should be screened for depression? |
Patients for whom there are mechanisms in place to ensure accurate diagnosis, treatment, and follow-up (B) |
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What immunization recommendations are made for adults? |
- Td/Tdap - Influenza (for every >6 mo.) - Pneumococcal polysaccharide (>65y) |
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What are the specific recommendations for adults in regards to receiving Td/Tdap vaccinations? |
- All adults between 19-65 years should receive a booster of Tdap (instead of scheduled Td because of waning immunity to pertussis) - Adults who have not had a Td booster in ≥10 years and who have never had a dose of Tdap as an adult should receive a booster vaccination with Tdap - Those who have increased exposure to pertussis (health-care workers, child-care providers, or anyone in close contact with someone <1yr) should also receive a Tdap booster; an interval of 2yrs from last Td is recommended, although a shorter interval is okay if necessary |
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Who should receive the pneumococcal polysaccharide vaccine? |
- All adults >65y - Adults <65y who are alcoholics or smokers, have chronic cardiovascular, pulmonary (including asthma), renal, or hepatic diseases, diabetes, immunodeficiency, or who are functionally asplenic
- One time re-vaccination is recommended after 5 years for those with immunocompromising conditions and asplenia - One time re-vaccination also recommended for those >65y if they were vaccinated longer than 5 years previously and were <65y at the time of initial vaccination |
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What immunizations are recommended for certain populations of adults? |
- Hepatitis B - health-care workers, those exposed to blood or blood products, dialysis patients, IV drug users, persons with multiple sexual partners or recent STDs, and MSM - Hepatitis A - pts with chronic liver disease, pts who use clotting factors, pts who have occupational exposure, pts who use IV drugs, MSM, or pts who travel to areas where HepA is endemic - Varicella - pts with no reliable history of immunization or disease, who are seronegative on testing for immunity, and who are at risk for exposure to varicella - Meningococcal vaccine - college dormitory residents and military recruits, pts w/ certain complement deficiencies, functional or anatomic asplenia, or those who travel to countries where disease is endemic |
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Which adults should receive the Hepatitis B vaccine? |
- Health-care workers - Those exposed to blood or blood products - Dialysis patients - IV drug users - Persons with multiple sexual partners or recent STDs - MSM |
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Which adults should receive the Hepatitis A vaccine? |
- Pts with chronic liver disease - Pts who use clotting factors - Pts who have occupational exposure - Pts who use IV drugs - MSM - Pts who travel to areas where HepA is endemic |
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Which adults should receive the Varicella vaccine? |
- Pts with no reliable history of immunization or disease - Pts who are seronegative on testing for immunity - Pts who are at risk for exposure to varicella |
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Which adults should receive the Meningococcal vaccine? |
- College dormitory residents - Military recruits - Pts w/ certain complement deficiencies - Pts w/ functional or anatomic asplenia - Pts who travel to countries where disease is endemic |
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What are the healthy lifestyle changes that should be encouraged at adult health maintenance visits? |
- Tobacco cessation - Prevention of alcohol misuse - Exercise - Healthy diet - Safe sex practices - Seat belts - Avoid driving while under the influence of alcohol or drugs |
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What are the benefits of exercise? |
Reduce risk of - Cardiovascular disease - Diabetes - Obesity - Overall mortality |
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A 52-yo man comes into the out-patient clinic for an annual "check-up". He is in good health, and has a relatively unremarkable family history. For which of the following disorders should a screening test be performed? a) Prostate cancer b) Lung cancer c) Abdominal aortic aneurysm d) Colon cancer |
Colon cancer
Level A recommendation by USPSTF for colon cancer screening for pts >50y. Insufficient evidence to recommend for or against routine lung or prostate cancer screening. AAA is recommended in men 65-75y who smoke. |
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A 62-yo man with recently diagnosed emphysema presents to your office in November for a routine exam. He has not had any immunizations in more than 10 years. Which of the following immunizations would be most appropriate for treatment of this individual? a) Td only b) Tdap, pneumococcal, and influenza c) Pneumococcal and influenza d) Tdap, pneumococcal, influenza, and meningococcal |
B - Tdap - Pneumococcal - Influenza
In an adult with chronic lung disease, one-time vaccination with pneumococcal vaccine and annual vaccination with influenza is recommended. A Tdap booster should be recommended to all adults who have not had a Td booster within 10 years and have never had a Tdap vaccine as an adult. |
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A 49-yo sedentary man has made an appointment because his best friend died of an MI at age 50. He asks about an exercise and weight loss program. In counseling him, which of the following statements regarding exercise is most accurate? a) To be beneficial, exercise must be done everyday b) Walking has not been shown to improve meaningful clinical outcomes c) Counseling has not been shown to increase number of pts who exercise d) Intense exercise offers no health benefit over mild to moderate amounts of exercise |
Counseling has not been shown to increase number of pts who exercise
Benefits of exercise are clear. Exercise decreases CV risk factors, increases insulin sensitivity, decreases incidence of metabolic syndrome, and decreases CV mortality regardless of obesity. Benefits of counseling pts regarding exercise are not so clear and counseling does not seem to increase the number of patients who exercise. |
