Hp&p E2 Adult Screening And Prevention

Front 1

Aspirin-Prevention Women

Back 1

USPSTF Grade A
- Women 55-79
- Protects from first ischemic stroke
- 75mg/d

Front 2

Aspirin-Prevention Men

Back 2

USPSTF Grade A
- Men 45-79
- Protects from first MI
- 75mg/d

Front 3

What immunizations are needed for primary prevention in adults?

Back 3

- Tetanus (60% US cases are patients 60 yoa)
- Influenza (More than 90% of influenza related deaths occur among people 60+ yoa)
- Herpes Zoster (multiple sequala in older patients, for those 60+ yoa)
- Pneumococcal (significant cause of morbidity and mortality in the elderly)

Front 4

Who needs pneumococcal vaccine?

Back 4

- All adults 65 yoa and older
- Anyone 2-64 with long term health problems
- Anyone 2-64 taking drug or treatment that is immunosuppressive
- Residents of nursing homes or long-term care facilities

Front 5

What are the criteria for a screening test?

Back 5

- It should be a serious disease (morbidity/mortality)
- An effective treatment should exist
- Diagnosis at an earlier, pre-symptomatic stage should permit less morbid treatments and/or better outcomes
- The screen should be simple, sensitive, and reasonably specific

Front 6

HIV Screening

Back 6

USPSTF Grade A
- Screen for HIV in all adolescents and adults at increased risk for HIV infection
- Assess this through patient history: (MSM after 1975, unprotected sex with multiple partners, injection drug users, people who exchange sex for money/drugs, past or present HIV infected sex partners, persons being treated for STDs, and blood transfusion between 1978 and 1985)

Front 7

What is cancer screening?

Back 7

- Testing an individual with no symptoms suggestive of cancer

Front 8

Oral Cancer Screening

Back 8

USPSTF Grade I
- Direct inspection and palpitation of the oral cavity
- 6th most common form of cancer
- Risk factors (tobacco is the biggest, tobacco+ETOH, and HPV)

Front 9

How many women born today will be diagnosed with breast cancer in their lifetime?

Back 9

12.2% (1 in 8)

Front 10

Breast Cancer Mammogram Screening

Back 10

USPSTF Grade B
- biennial for women 50-74
Grade C
- biennial for women <50
Grade I
- for women 75+
ACS
- annually starting at age 40

Front 11

Prostate Cancer Screening

Back 11

USPSTF Grade I
- men younger than 75
Grade D
- men older than 75
ACS
- men >50 with life expectance >10 years, discuss pros and cons

Front 12

Breast Cancer Screening: BSE

Back 12

USPTSF Grade D

Front 13

Breast Cancer Screening: Genetic BRCA

Back 13

USPSTF Grade B
- If family hx is associated with increased risk for deleterious mutations in BRCA1 or BRCA2 genes, refer for genetic counseling and evaluation
Grade D - for those without family hx

Front 14

Breast Cancer Screening: CSE

Back 14

ACS
- CBE every 3 years for women in 20s and 30s and annually for women >40 as long as women is in good health

Front 15

Colorectal Cancer Screening

Back 15

USPSTF Grade A
- Beginning at age 50 til 75, men and women should have FOBT annually, flexible sigmoidoscopy Q 5 years or colonoscopy Q 10 years (if positive the colonoscopy should be done)

Front 16

Cervical Cancer

Back 16

USPSTF Grade A
- screening for cervical cancer in women who have been sexually active and have a cervix
Grade D
- women older than 65 and have adequate recent screening, not high-risk
- also for women who have had total hysterectomy
ACS recommends stoping screening at age 70

Front 17

How many cases of non-melanoma skin cancer found in the U.S. each year?

Back 17

> 2 million

Front 18

How many cases of skin cancer did melanoma cause in 2010?

Back 18

68, 130 cases

Front 19

What are some skin cancer risk factors?

Back 19

- Unprotected and/or excessive exposure to UV radiation
- Occupational exposures to certain elements
- Fair complexion
- Family history
- Multiple or atypical moles
- Severe sunburns as a child (ACS)

Front 20

What are the new findings about UVB and UVA?

Back 20

- UVB radiation is responsible for sunburn and plays major role in causing skin cancer
- UVA is less intense than UVB, is 30-50 times more prevalent than UVB and penetrates to deeper layers of the skin (also believed to cause skin cancer)
- FDA allows product labels to claim they prevent skin cancer, only if protect against UVA and have SPF of 15 or higher

Front 21

HTN Screening

Back 21

USPSTF Grade A
- for age 18 and above
- before you go in room BP should've been taken
- after walk in room, notice age, body habitus
- history (family, personal of HTN, MI, DM, etc, ETOH, other drug use, exercise, diet?)
- physical exam (take bp yourself, look fr edema, JVD, etc.)

Front 22

HTN is highly prevalent amount who? It is the leading risk factor for what?

Back 22

- highly prevalent among older adults (60-80%)
- leading risk factor for ischemic heart disease and stroke

Front 23

Blood pressure screening

Back 23

USPSTF Grade A
- in adults age 18+
(can practice weight control and control dietary intake, exercise, etc.)

Front 24

Diabetes Mellitus Type 2 Screening

Back 24

USPSTF Grade B
- Recommends screening for DMII in asymptomatic adults with sustained BP > 135/80 mmHG
ADA recommends screening at 3 year intervals

Front 25

Diabetes Mellitus Type 2 Screening Tests

Back 25

- Fasting plasma glucose
- 2 hour post load plasma glucose (ppg)
- HgbAlC

Front 26

AAA Screening

Back 26

USPSTF Grade B
- recommended for men 65-75 who have ever smoked, or who has first-degree relative who required repair of AAA
(prevalence is lower in women, so screening not effective)

Front 27

Preferred Lipid Screening Tests

Back 27

- Total cholesterol
- HDL-C (on non-fasting or fasting samples)

Front 28

Lipid Disorder Screening Women

Back 28

USPSTF Grade A
- women age 45 and older if they are at increased risk for CHD
Grade B
- women 20-45 if increased risk for CHD
(increased risk-DM, tobacco use, HTN, obesity, etc.)

Front 29

Lipid Disorder Screening Men

Back 29

USPSTF Grade A
- men 35 and older
Grade B
- men 20-35 at increased risk for CHD
(inc. risk-DM, HTN, Obesity, personal hx of CHD or non-coronary atherosclerosis, FHx of CVD in male relatives before age 50, and females before age 60, tobacco use)

Front 30

Osteoporosis Screening

Back 30

USPSTF Grade B
- women 65+ or beginning at age 60 in those at increased risk for osteoporotic fractures

Front 31

What is FRAX?

Back 31

Risk Assessment Tool
- Gives 10 year probability of fracture
- Integrates risks associated with clinical risk factors plus bone mineral density at femoral neck

Front 32

What are new IOM recommendations for women?

Back 32

- Screening for GDM
- HPV testing for women over age 30
- Counseling on STI's
- Counseling/Screening for HIV
- Counseling to prevent unintended pregnancy
- Screening/counseling to detect and prevent interpersonal and domestic violence

Front 33

What are some basic ADL's?

Back 33

- eating
- personal hygiene
- dressing/undressing
- transferring from bed to chair and back
- voluntarily controlling bowel and bladder
- moving around

Front 34

What are some instrumental ADL's?

Back 34

- doing light housework
- preparing meals
- taking medications
- using the telephone
- managing money
- shopping for groceries or clothing

Front 35

How common is dementia?

Back 35

occurs in 20-50% of people over 85 yoa

Front 36

Depression Screening

Back 36

USPSTF Grade B
- screen adults when staff-assisted depression care supports are in place to assure accurate diagnosis, effective, treatment, and follow-up

Front 37

What is the third most common ailment in older adults (affects 40-66% of those>75)

Back 37

hearing loss

Front 38

glaucoma screening is important for:

Back 38

those with positive family hx and African-Americans

Front 39

Obesity Screening

Back 39

USPSTF Grade B
- screen all adults for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults