Usmle Step 2 Screening And Prevention + Misc

Front 1

colon CA -- how to screen?

Back 1

high-sensitivity FOBT annually
OR sigmoidoscopy q 5 y + high-sensitivity FOBT q 3 y
OR colonoscopy q10y
if abNL --> colonoscopy

Front 2

Colon CA -- who to screen?

Back 2

if no inherited syndromes and no IBD:
50 - 76 yo
if 76-85 yo, no rec / do not screen routinely
if > 85 yo, do not screen

do not use ASA / NSAID for prevention

*if 1 family member with colon cancer= begin 10 years earlier than the family member developed their cancer or age 40, whichever is younger
* if there are 3 family member, 2 generation, or 1 premature before 50 year (HNPCC)= start screening at age of 25 with colonoscopy every 1—2 years
*if there is family Hx of FAP = start screening with sigmoidoscopy at age of 12 year every year
*if the patient has previous Hx of colon cancer= patient should have colonoscopy at 1 year after resection, then every 5 years
*If confirmed colon adenomas, regardless of histological type should have full screening colonoscopy.
*If <2 tubular adenoma removed may followed up with colonoscopy every 5—10 years.
*If 3—10 tubular adenoma or villous adenoma or high grade dysplasia should have follow-up colonoscopy in 3 year

Front 3

Gyn CA

Back 3

Pelvic Exam
20-40 Q3y
>40 QY

Front 4

Endometrial CA

Back 4

Biopsy
Once at menopause

Front 5

Breast CA --

Back 5

50- 74 yo --> mammo q 2 y

40-40 yo:
if high risk (>25% lifetime) / BRCA+ --> mammo

USPSTF recommends against teaching breast self-examination (BSE)

USPSTF recommends against routine use of tamoxifen or raloxifene for primary prevention of breast cancer if low or average risk.
USPSTF recommends clinicians discuss chemoprevention with women at high risk for breast cancer and at low risk for adverse effects of chemoprevention.

Front 6

Cancer Checkup

Back 6

20-39 Q3Y
>=40 QY
includes thyroid, testis, ovary, lymph nn, oral, skin.

Front 7

Hep B immuniz

Back 7

high risk: healthcare workers, exposed to blood or blood products, dialysis pts, IV drug users, persons with multiple sexual partners or recent STD, gay men

Front 8

Influenza vacc

Back 8

>50 y/o QY
high risk, women who will bepregnat during flu season

Front 9

Pneumococcus vacc

Back 9

>65 y/o, or high risk of infection.
One-time revaccination after 5 years is recommended for CKD, liver dz, immunodef, asplenia, or vaccinated > 5 years previously and were younger than 65 years at
the time of initial vaccination.

Front 10

Rubella vacc

Back 10

Any woman child-bearing age, lack of immunization. NOT PREGNANT WOMEN
Not to immunocompromised except HIV

Front 11

Td

Back 11

Q10Y. give for wound if uk hx or <3 doses. Unclean/major wounds give if >5y since last

Front 12

Classification and tx HTN

Back 12

<120/<80 normal no tx
120-139/80-89...pre none unless dz
140-159/99...stage 1 start thiazides
>160/>100..stage 2 thiazide and more

Front 13

General Cholesterol #s

Back 13

Total <200
Triglyc <150
HDL >60 (<40 is low)

Front 14

Screen for Cholesterol

Back 14

Q5Y >20
TC, LDL, HDL, TG
unless strong history, etc

Front 15

DM2 screening?

Back 15

if HTN (> 135/80)

Front 16

diabetes Dx

Back 16

Fasting gluc >126, or
2-hr OGTT > 200, or
or random >200 w/ Sx, or
A1C > 6.5 x 2

Impaired Gluc Tol = 2-hr levels of 140 to 199 mg/dL
Impaired Fasting Gluc = 110 - 125

Gestational Diabetes (2 or more abNL):
Fasting Glucose > 95 mg/dl
Glucose at 1 hour > 180 mg/dl
Glucose at 2 hours > 155 mg/dl
Glucose at 3 hours > 140 mg/dl

Front 17

LDL levels and interventiona

(CHD risks, etc)

Back 17

No risks >2 risks CAD* VHR tx
<160 <100 <100 <70 NONE
160-189 100-129 -o- 70-99 diet > - meds
>190 >130 >100 /100 MEDS

<100 mg/dL for CAD / CAD equiv (DM, PAD, Sx carotid artery dz, AAA)

VHR: CAD + MI, DM, other severe/poorly controlled risk factors

Front 18

CAD RFs?

Back 18

1. Age men>=45, women >=50 (or premature menopause w/o estrogen replacement
2. Fam Hx premature CAD (male MI <55 or female <65)
3. ** smoking **
4. HTN (140/90 or on meds)
5. HLD
6. DM
7. obesity
8. lack of exercise
9. stress

Front 19

Newborn Screen

Back 19

PKU, congen hypothyroid. Rest varies by state: biotinidase deficiency, maple syrup urine disease, congenital adrenal hyperplasia, cystic fibrosis, galactosemia, homocystinuria, hemoglobinopathies, toxoplasmosis, and tyrosinemia.

Front 20

Ped hearing

Back 20

initial before 1 month, tx by 6 m/o
follow-up ages 4-10 or risk factor

Front 21

Ped vision

Back 21

vision screen age 3 or 4

vision risk assess at all HM visits, esp <5 y/o esp w/ hx premie, met/genetic dz, others

screen 6, 8, 10, 12, 15, 18 y/o

Front 22

Ped Developmental and behavior screens

Back 22

developmental 9, 18, 30 mos

autism 18, 24 mos

Front 23

Ped Iron and Lead screen

Back 23

Iron defic anemia- 4 mos,
Hgb/HCt - 18, 24 mos, then QY

Lead (target <10 mcg/dL) - screen ages 12 and 24 mos

Front 24

Ped Oral Health screen

Back 24

6, 9 mos (18, 24, 30 mos or until dental home)

referral to dental home at 1 y/o

Front 25

Ped TB screen

Back 25

only if exposed or imunocompromised

Front 26

Ped Lipid profile screen

Back 26

Risk assessment Q2y

Lipid profile between 18 and 21 y/o

Front 27

Ped EtOH screen

Back 27

CRAFFT >2 points=high risk
Car - ridden w/ someone under infl
Relax - to relax/feel better/fit in
Alone - when alone
Forget - forget things did whn using
Friends - tell you to cut down?
Trouble - because of etoh/drugs

Front 28

Spirometry COPD/obstructive

Back 28

FEV1/FEV less than normal, FEV1 may be normal

Front 29

Spirometry Emphysema/restrictive

Back 29

FEV1/FEV normal. FEV1 may be low

Front 30

Gastric vs Duodenal ulcers in PUD

Back 30

Duod (most common) gastric
high acid low acid
h. pylori NSAIDs
age 40s 50s
food improvs -> worse no change

Front 31

Osmotic diarrhea

Back 31

nonabsorbable solute. lactose or other intolerance. stops with cessation of ingestion

Front 32

Secretory diarrhea

Back 32

toxins (cholera, ecoli), VIP tumors, bile acids p resection.

continues w/ NPO

Front 33

Malabsorption diarrhea

Back 33

celiac sprue, Crohns, gastroenteritis, exocrine pancreatic insuff

stops with NPO

Front 34

Infectious diarrhea

Back 34

fever, WBC in stool (if shigella, salmonella, yersinia, campy), travel hx
giardia: steatorrhea, protozoal cysts.

metronidazole.

Front 35

Exudative diarrhea

Back 35

IBD or cancer

due to inflammation and seepage of cluid from mucosa

Front 36

Altered intestinal trnsit diarrhea

Back 36

after resection and meds

Front 37

Hemochromatosis

Back 37

AR, liver/pancreas/heart/skin/joints/
impotence, amenorrhea, hair loss, koilonychia (spooning fingernails).

MOST COMMON INHERITED DISORDER IN CAUCASIANS

Men>women

elevated iron, transferrrin, ferritin, DNA test. Tx w/ phlebotomy

Front 38

Wilson's disease

Back 38

AR, low ceruloplasmin, high Urine copper, low serum copper, dx w/ liver biopsy. CNs and psych.

tx pencillamine

Front 39

alpha 1 antitrypsin

Back 39

AR, younger adult w/ cirrhosis, emphysema. low A1AT blood levels. Tx w/ replacement A1AT.

Front 40

What cancers have no recommended screening?

Back 40

Screening for bladder, testicular, pancreatic, or thyroid cancer in asymptomatic
adults is not recommended (Level D

Front 41

What is the screening for prostate CA?

Back 41

USPSTF currently finds insufficient evidence to recommend for or against routine screening (Level I) for prostate cancer using digital examination or prostate-specific antigen (PSA) in men younger than 75 years. Although testing improves detection of prostate cancer, the evidence for improved outcomes is inconsistent.

Screening for prostate cancer in asymptomatic men older than 75 years is also not recommended (Level D).

Front 42

AAA screening?

Back 42

abd U/S for men 65 - 75 who have ever smoked

Front 43

peripheral arterial disease (PAD)?

Back 43

no screening

Front 44

obesity screening?

Back 44

all adults: BMI, counseling for wt loss

Front 45

screening for all adults?

Back 45

obesity, EtOH

Front 46

depression screening?

Back 46

if there are mechanisms in place for assuring accurate diagnosis, treatment, and follow-up.

Front 47

Hep A immunization?

Back 47

chronic liver dz, use clotting factors, have occupational exposure to the Hep A, who use IV drugs,
gay men, or who travel to countries where hep A is endemic

Front 48

Varicella / chicken pox immunization?

Back 48

for those with no reliable history of immunization or disease, who are seronegative on testing for varicella
immunity, and who are at risk for exposure to varicella virus

Front 49

Meningococcal immunization?

Back 49

for persons with certain complement deficiencies,
functional or anatomic asplenia, or who travel to countries where the disease is endemic. All 11-12 years olds should be vaccinated with meningococcal conjugate vaccine (MCV4). Now, a booster dose should be given at age 16 years.

Front 50

exercise?

Back 50

Exercise decreases cardiovascular risk factors, increases insulin sensitivity, decreases the incidence of the metabolic syndrome, and decreases cardiovascular mortality regardless of obesity. The benefits of counseling patients regarding exercise are not so clear and counseling does not seem to increase the number of patients who exercise.

Front 51

lipids?

Back 51

fasting cholesterol and LDL q 5 yrs
*Men > 35 y.o.
*Women > 45
*in high risk patient start at age of 20 year, then q 1 yr

Front 52

Cervical CA / pap?

Back 52

> 21 yrs.
q 1 yr until 3 consecutive [-].
Then q 3 yrs until 65
if > 30yo, q 3 y or q 5 y (if w/ HPV test)

Front 53

osteoporosis?

Back 53

*DEXA (hip + Lspine) or quantitative U/S (calcaneus)
*women > 65yo, OR women < 65 w/ RF comparable to 65yo white female w/ no other RF.
*men -- no rec

Front 54

osteoporosis RFs?

Back 54

low BMI, EtOH, smoking, parental history of hip fracture, and increased age

Front 55

breast CA RFs?

Back 55

Age
Age at first menstrual period
Age at first live delivery
Number of first-degree relatives (mother, sisters, daughters) who have had breast cancer
History of breast biopsy
Number of breast biopsies (positive or negative)
At least one biopsy with atypical hyperplasia
Race/ethnicity

Front 56

Visual acuity screening in children

Back 56

at least once between the ages of 3 and 5 years

Front 57

Syphilis screening: pregnant women

Back 57

all pregnant women

Front 58

Syphilis screening: nonpregnant persons

Back 58

if at increased risk

Front 59

Rh incompatibility screening: first pregnancy visit

Back 59

rec Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care.

Front 60

Rh incompatibility screening: 24–28 weeks' gestation

Back 60

recommends repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh (D)-negative

Front 61

newborn screening? prophylaxis?

Back 61

PKU, hypothyroid, hearing loss, sickle cell

prophylactic ocular topical medication for all newborns for the prevention of gonococcal ophthalmia neonatorum

Front 62

screening if pregnant?

Back 62

EtOH, anemia, bacteriuria (at 12 to 16 weeks' gestation or at the first prenatal visit, if later), chlamydia, folate (0.4 to 0.8 mg), gonorrhea, Hep B, Rh incompatibility, smoking syphilis

Front 63

HIV screening?

Back 63

all teens + adults at inc risk

Front 64

Iron supplementation in children

Back 64

for asymptomatic children ages 6 to 12 months who are at increased risk for iron deficiency anemia.

Front 65

Dental caries prevention: preschool children

Back 65

clinicians prescribe oral fluoride supplementation at currently recommended doses to preschool children older than age 6 months whose primary water source is deficient in fluoride.

Front 66

ASA prophylaxis for CAD?

Back 66

men 45-79 if benefit of dec MI outweighs risk of intestinal hemorrhage

women 55-79 if benefit of dec MI outweighs risk of intestinal hemorrhage

Front 67

CAD equivalents

Back 67

noncoronary atherosclerotic dz
(carotid artery dz, peripheral artery dz, or AAA)

DM, hyperglycemia w/o overt DM, CKD

Front 68

CAD risk factors

Back 68

Age: male ≥45, female ≥55 or premature menopause without estrogen replacement therapy

FamilyHx of MI or sudden in 1st deg relative: male < 55, female < 65

smoking

HTN >140/90 or on BP meds

HDL < 40

negative risk factor: HDL > 60

Front 69

LDL goals

Back 69

CAD or equiv: < 100
2 or more RFs: < 130
0 or 1 RF: < 160

Front 70

when to start BP meds

Back 70

CAD or equiv: ≥130 (drug optional at 100 to 129)
2 or more RFs: ≥160 (drug optional at 130 to 159)
0 or 1 RF: ≥190 (drug optional at 160 to 189)