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42 Cards in this Set
- Front
- Back
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Lead-time Bias
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- survival appears to be longer because of earlier detection
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Length Bias
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- survival appears to be longer because persons able to participate in trials have less aggressive disease
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USPSTF Screening Recommendations
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- height and weight
- BP - EtOH and smoking - Depression - DM (pts with HTN) - dyslipidemia (men > 35 or men/women > 20 with family risk) - every 5 years if normal - mammogram (>40 and q2 yr) - BRCA - high risk women - PAP - q3 until 65 - Chlamydia (women <25>25) - routine voluntary HIV - bone density (women > 65 or at risk women 60-65) - AAA screening (once in men 65-75 years) |
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weight health indicators
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- BMI
- waist circumference (>102 cm/40 in men or > 88 cm/35 in women) = increased risk of cardiovascular - waist-hip ratio - better than BMI but measurement inaccuracy limits) |
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Lipid Screening
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- > 35 yo men or men/women > 20 with family risk factors
- random non-fasting (if tchol >200 or HDL <40 then fasting panel) - if normal and 0-1 risk factor then recheck in 5 years |
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DM Screening
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- check in adults with sustained BP > 135/80
- this decreases cardiovascular risks * also screen in patients with elevated cholesterol levels |
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Osteoporosis Screening
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- women older than 65 and women at risk 60-64 yo
* best predictor is weight < 154 pounds - also risks = age and no estrogen replacement - interval is 2-5 years DEXA of the femoral neck |
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AAA Screening
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- men 65-75 yo who have ever smoked
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ID Screening Issues
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- asymptomatic bacturia in pregnancy
(risk of preterm labor, low birth rate, UTI) - HIV - routine for all 13-64; especially pregnant (repeat 3rd term?) - Hep B - pregnant women at first prenatal visit - gonorrhea - women at risk - chlamydia - women <24 yo and if pregnant or high risk - syphilis - all at risk and all pregnant women |
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Colorectal Cancer Screening Issues
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- men and women > 50 yo (but not greater than 85 yo)
- multiple family members with history, screen earlier 1) colonoscopy q 10 years 2) FOB annually 3) flex sig q 5 years WITH FOB q3 |
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Breast Cancer Screening Issues
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- mammogram with/without digital breast exam for women >40
- q 1-2 year follow-up * US okay in pregnant women with breast symptoms - ACS recommends self-exam starting at 20 yo - BRCA for family history |
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Cervical And Anal Cancer Screening Issues
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- women who are sexually active and have a cervix
- within 3 years of start of sex but NO LATER than 21 yo - screen until 70 yo - q year unless low risk (then q3) * no conclusion about HPV screening - ANAL Pap smear - for HIV and HPV infected men/women IS NOT RECOMMENDED |
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Prostate Cancer Screening Issues
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- ACS recommends DRE > 50 yo
- but USPSTF does not recommend FOR OR AGAINST if < 75 and definitely not > 75 yo |
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Not USPSTF Recommended CA Screening
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- pancreatic
- testicular - LAD - skin - thyroid - ovaries - oral region - lung |
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Pregnancy Screening
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- Fe deficiency
- HIV - Hep B (1st and 3rd trimester) - syphilis - asymptomatic bacturia - chlamydia / gonorrhea |
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Penetrance
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- likelihood of developing a disease if autosomal dominant inheritance
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Analytic vs Clinical Validity
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- test accurate but doesn't necessarily identify who will develop the disease
- eg BRCA + WITH family hx = 85% vs BRCA in general population = 40-55% |
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Risks of testing when there are few measures to prevent or delay onset
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1) emotional distress
2) genetic labeling (for work, etc) 3) survivor guilt |
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Genetic Testing
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1) personal or family history suggesting
2) test can be adequately interpreted 3) test will aid in diagnosis or help guide treatment |
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Hepatitis A Vaccine
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- medical, occupational, lifestyle risks
- men who have sex with men - illicit drug users - chronic liver disease - travelers to developing countries +/- food handles * inactivated - 2 doses minimum 6 mos apart ** unclear if safe in pregnancy |
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Hepatitis B Vaccine
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- medical, occupational, lifestyle risks
- men who have sex with men - illicit drug users - chronic liver disease - travelers to developing countries - children through age 18 - HIV + or other STD positive - sexually active but not monogamous - occupational exposure to blood - clients and staff for developmentally delayed / corrections - illicit drug users - advanced kidney disease approaching dialysis * safe in pregnancy * recombinant and non-infectious - 3 doses - 0, 1, 6 months; 0, 1, 4 months; 0, 2, 4 months - if delayed, resume from where left off - can be given together with Hepatitis A if age > 18 |
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HPV Vaccine
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- cervical CA risk
- HPV 6, 11, 16, 18 - women age 9-26 REGARDLESS of sexual activity * NOT for pregnant women 0, 2, 6 month interval with minimal time 4 / 12 weeks for 2nd/3rd doses - no revaccination needed |
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Influenze Vaccine - who gets it
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- advised for all adults
- chronic care facilities - dormitories - health care workers - pregnant women whoe 2/3 trimesters are during flu season - DM - chronic cardiopulmonary or kidney disease - hemoglobinopathies - immunocompromised - those at risk for aspiration |
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Influenza Vaccine Types
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- trivalent INACTIVATED for all ages given IM
- intranasal LIVE (age 2-49) * live should not be given to: pregnant, chronic diseases, DM, renal disease, hemoglobinopathies, immunosuppressed, those with pulmonary disease or can't protect airway ** not for egg allergy or history of Guillain-Barre |
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MMR Vaccines
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- live attenuated
- 2 dose series - children at 1 year and then at 4-6 yo - immigrants - NOT during pregnancy or during pregnancy planning |
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Meningococcal Vaccine
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- young adults
- dorms or barracks - exposed to meningitis outbreaks - asplenia - terminal complement deficiencies - travelers to endemic regions - lab workers - MPSV4 - 2-10 or >55 - need revaccination if nothing for > 5 years * unclear in pregnancy - MCV4 - more robust response; no need to revaccinate; 11-55 yo * MCV linked to Guillain-Barre |
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Pneumococcal Vaccine
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> 65 yo
- Alaskan natives - Native Americans - long-term facilities - radiation therapy - immunosuppressed - DM - Chronic pulmonary - cardiovascular disease - chronic liver or kidney disease - asplenia - cochlear implants - immune disorders - malignancies - 23 antigen types - protects against 60% bacteremic disease - unclear in pregnancy - only one revaccination > 65 yo or if at risk AFTER 5 years |
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Polio Vaccine
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- only if traveling to at risk locations
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Tetanus / Diptheria / Acellular Pertussis Vaccine
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- Td onlyi f series incomplete
- modified bacterial toxins but not toxic themselves - 3 doses (0, 1/2, 6/12) - interruption does not mean restart - Boosters q10 years * Tdap can substitute for one of the 3 doses Tdap - acellular - single dose in adults 19-64 to replace Td booster - BUT only given once then resume q10 Td UNLESS expected exposure to infant ** Presenting with wounds - Td revaccination if fewer than 3 doses given or STATUS UNKNOWN - clean/minor wound = no booster and continue q10 years - all other wounds = booster if last > 5years or unknown |
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Varicella Vaccine
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- live attenuated
> 13 yo with no evidence of immunity (birth prior to 1980, documented age-appropriate vaccination with varicella vaccine, lab evidence of immunity, history of disease - documented) * later than 1980 doesn't apply for healthcare workers, immunocompromised, pregnant women - 2 vaccine doses (0, 4-8 weeks) - don't repeat if delayed * do not give: pregnancy, immunocompromised ** avoid pregnancy for 3 MONTHS |
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Zoster Vaccine
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- live attenuated
- > 60 yo - REGARDLESS if there is a prior history of Shingles - NOT USED IN TREATING Herpes zoster or post-herpetic neuralgia or prevention of chickenpox * not in pregnancy, active/untreated TB, diseases or malignancies of immune system, immunosuppressed ** not necessary to test prior to giving - no booster needed - less effective in older patients - decreases duration of disease and decreases post-herpetic neuralgia |
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Five "A's" Framework
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- Assess
- Advise - Agree - Assist - Arrange |
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Five "R's" for smoking cessation
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- Relevance
- Risks - Rewards - Roadblocks - Repetition |
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Smoking Cessation Data
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- individual counseling increases by 50%
- intensive not > brief - only small benefit from literature - all nicotine replacement products increase quit rate by 50-70% - replacement better than smoking in pregnant but should still be avoided - contraindications to replacement: recent MI (2 weeks), severe arrhythmia, worsening or severe angina - antidepressants DOUBLE quit rates vs placebo |
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Bupropion
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- category B
- similar efficacy to nicotine replacement - no evidence adding nicotine was useful CI: seizure d/o, situations that lower seizure threshold (alcohol or benzo withdrawal, recent MAOI use) |
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Nortryptaline
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- CI: recovery from acute MI, recent MAOI use, risk of urinary retention
- equal to Bupropion similar to Nicotine replacement alone |
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Varenicline (Chantix)
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- nicotine receptor agonist
- 12 weeks increased odds three-fold over placebo - better than Bupropion - side effect: nausea - Category C * ? association with depression, SI - therefore CAUTION WITH PSYCH HISTORY |
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CAGE Questionnaire
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C - cut down
A - Annoyed G - Guilt E - Eye opener - May not be as accurate in women or blacks - highly predictive if >= 2/4 |
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Alcohol Cessation: Medications
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- more useful when combined with social support
1) disulfiram - nausea, flushing, sweating, tachycardia when EtOH consumed - CI: EtOH use, Flagyl, severe cardiac disease, unwilling to quit 2) Naltrexone - decreases reward of drinking and reduces craving CI: liver disease, opioid dependence 3) Acamrosate - decreases abstinence related anxiety, restlessness, dysphoria CI: renal disease treat 3-12 months |
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5 P's Of Sexual History
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- Partners
- Practices - Prevention of Pregnancy - Protection from STDs - Past STDs |
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SAFE Screening For Abuse
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S - stress/safety
A - afraid/abused F - friends/family E - Emergency Plan |
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Clinical Indicators of Abuse
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- inconsistent explanation of injuries
- delay in seeking treatment - somatic complaints - depression, anxiety, sleep - exacerbations or poor control of chronic disease - STDs - unplanned pregnancies - appointment changes - overly protective partner won't leave room - suicide attempts - substance abuse |
