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27 Cards in this Set

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Three types of bias commonly observed in studies evaluating effectiveness of screening tests
lead-time bias, length bias, overdiagnosis
occurs when a screening test leads to earlier identification of a condition, and an apparent improvement in 5-year survival, but does not actually result in improved mortality
lead-time bias
occurs when the variable rate of progression of a disease is not accounted for
length bias (slow-progressing cancer, for example)
dentification of cancers that are not destined to progress, thereby inflating survival statistics
overdiagnosis
2 questions for depression screening
over the past 2 weeks, have you felt depressed? ... felt little interest or pleasure in doing things?
BP screening
all adults >18 (USPSTF); JNC 7- q2y if BP <120/80; q1y if 120-139/80-89
screening tests for pregnant women (USPSTF) (4)
HIV, hep B, syphilis, asymptomatic bacteriuria
screening tests for persons at risk for STIs (USPSTF) (4)
HIV, hep C, chlamydia, gonorrhea
periodic screening recommended by USPSTF
HL, osteoporosis, AAA; breast CA, cervical, colon cancer
NCEPATPIII recommendation for dyslipidemia screening
fasting lipid q5y in all adults >20y with normal initial lipid
USPSTF recommendations for type 2 DM screening
asymptomatic adults with sustained BP >135/80
NOTE: Diabetes Association recommends screening all adults age 45 years and older without risk factors
and all adults with a BMI of equal to or greater than 25 who have one or more of the following risk factors: gestational diabetes, hypertension, hyperlipidemia, and family history of type 2 diabetes in a first-degree relative.
Appropriate screening tests for DM (3)
fasting plasma glucose level, hemoglobin A1c level, or a 2-h, 75-g oral glucose tolerance test
USPSTF recommends screening for osteoporosis
all women >65; younger women with elevated risk
USPSTF recommends screening for AAA
all men between 65-75 who ever smoked
definition of USPSTF for "ever smoked"
100 lifetime cigarettes
The USPSTF recommends against screening for these conditions: (4)
carotid artery stenosis, COPD, hereditary hemochromatosis, PAd
CDC recommendations for HIV screening
all persons between the ages of 13 and 64 years should be screened for HIV infection
CDC recommendations for Hep C screening
persons at increased risk of infection (history of illicit injection drug use, history of receiving clotting factors before 1987 or blood products or organs before 1992, or on chronic hemodialysis at any time) + 1 time screening for baby boomers regardless of risk factors
define baby boomers
born 1945-1965
USPSTF recommendation for chlamydia screening
all women 24 years of age or younger who are sexually active and all women older than 24 years who are at increased risk of infection (history of sexually transmitted infection [STI], new or multiple sexual partners, inconsistent condom use, or exchanging sex for drugs or money)
USPSTF recommendation for gonorrhea screening
sexually active women who are at increased risk of infection (same risk factors as for chlamydial infection).
USPSTF recommendation for asmptomatic bacteriuria
(urine culture) pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit, whichever comes first
the only available breast cancer screening modality that has been shown to reduce mortality
mammography
USPSTF recommendation for mammography screening
biennial screening mammo for women 50-74; should be individualized between 40-49
Pap smear shows atypical squamous cells of undet significance - options?
referring for colposcopy, obtaining HPV DNA testing and then referring for colposcopy if positive, or repeating the Pap smear in 6 to 12 months.
Pap smear shows abnormal smear, next step?
colposcopy