Preventative

Question 1

Abdominal Aortic Aneurysm Screening

Answer 1

one-time screening with ultrasound for men 65-75 who have ever smoked

Question 2

Who should get low-dose aspirin prophylaxis and for what?

Answer 2

• recommended for adults 50-59 who have a 10% or greater 10-year cardiovascular risk
• used to lower risk of CRC and cardiovascular disease

Question 3

When should hypertension screening start?

Answer 3

recommended for anyone over the age of 18

Question 4

What is the recommendation for BRCA screening?

Answer 4

• screening recommended for women who have family members with breast, ovarian, tubal, or peritoneal cancer using a tool based on family history
• those who test positive should have genetic counseling and BRCA testing

Question 5

What recommendation is there for the use of medications to prevent breast cancer?

Answer 5

• tamoxifen and raloxifene (SERMs) reduce breast cancer risk compared to placebo
• they have the most benefit for women with 2 or more first-degree relatives with breast cancer, but should be offered based on shared decision making

Question 6

What are the guidelines for breast cancer screening?

Answer 6

screening mammography for women 50-75 every 1-2 years

Question 7

What are the recommendations for cervical cancer screening?

Answer 7

• every three years with cervical cytology alone for women 21-29
• every five years with cervical cytology and high risk HPV testing for women 30-65
• it is not indicated for woman who have had a hysterectomy and never had a high-grade lesion

Question 8

Who should have annual gonorrhea and chlamydia screening?

Answer 8

recommended for sexually active women 24 or younger and in older women who are at increased risk

Question 9

What is the basic CRC screening recommendation?

Answer 9

• for the general population, do colonoscopy every 10 years from 50-75
• with CRC or adenomatous polyps in any first-degree relative less than 60 or any two first-degree relatives: start at 40 or 10 years younger and go every 5 years
• with CRC or adenomatous polyps in any first-degree relative over 60 or any two second-degree relatives: start at 40 and go every 10 years

Question 10

When should depression screening start?

Answer 10

age 12

Question 11

What guidelines are there for diabetes screening?

Answer 11

recommended in those 40-70 years old with a BMI greater than 25, HTN, or HLD using fasting blood glucose or HbA1c

Question 12

Who should be screened for hepatitis B?

Answer 12

recommended for persons at high risk for infection and in all pregnant women at their first prenatal visit

Question 13

Who should be screened for hepatitis C?

Answer 13

recommended for all persons at high risk for infection and one-time screening in adults born between 1945-1965

Question 14

Who should be screened for HIV?

Answer 14

recommended once for all persons 15-65 years old and in those younger or older at increased risk

Question 15

What are the recommendations for lung cancer screening?

Answer 15

annual screening recommended using low-dose CT for adults 55-80 who have at least a 30 pack year smoking history and have smoked within the past 15 years

Question 16

Who should receive a routine DEXA scan?

Answer 16

• postmenopausal women younger than 65 at increased risk as determined by a formal assessment tool
• all women at age 65

Question 17

Which cancer screening provides the greatest mortality benefit?

Answer 17

mammography

Question 18

For adults, what are the two most beneficial vaccines?

Answer 18

influenza and pneumococcus

Question 19

For which adult populations should live vaccines not be given?

Answer 19

for adults over age 50 and for adults with chronic medical illness

Question 20

Who should receive the inactivated flu vaccine?

Answer 20

those 50 years of age or older or who have chronic medical illness

Question 21

What are the indications for influenza vaccination?

Answer 21

it should be given to everyone yearly

Question 22

In what sequence should the pneumococcal vaccines be given?

Answer 22

• start with the 13 polyvalent
• after 6-12 months, give the 23 polyvalent
• revaccinate after 5 years for those who are immunocompromised or had their first injection prior to 65

Question 23

Who is the zoster vaccine indicated for?

Answer 23

all patients above age 50

Question 24

Hepatitis A and B vaccination are indicated for who?

Answer 24

• both are indicated for all children, adults with chronic liver disease or inject drug use, and men who have sex with men
• HepA is also indicated for travelers
• HepB is also indicated for healthcare workers, diabetics, and those with ESRD

Question 25

Describe the recommended tetanus vaccination schedule.

Answer 25

- Td should be given every 10 years | - Tdap should be given with every pregnancy and in place of one Td booster

Question 26

Describe tetanus post-exposure prophylaxis.

Answer 26

- immunoglobulin should be given to those never vaccinated - for those with a dirty wound, give a booster after 5 years - for those with a clean wound, give a booster after 10 years

Question 27

Who is the meningococcal vaccine indicated for?

Answer 27

- indicated at age 11 for all individuals - indicated for adults with asplenia, terminal complement deficiency, military recruits, residents of college dorms, and those with HIV

Question 28

Describe HepA post-exposure prophylaxis.

Answer 28

- it is indicated for household and sexual contacts - for individuals between 12 and 40 years old, HepA vaccination is sufficient - for those outside 12-40, have liver disease, or are immunocompromised, also give immune globulin

Question 29

Describe who should receive HepB post-exposure prophylaxis and what they should receive.

Answer 29

- indicated for needle-stick and sexual exposures to those positive for HBsAg if patients don't have anti-HBs - give immune globulin and vaccination unless patients already have anti-HBs

Question 30

What is used as pre-eclampsia prophylaxis and when is it started?

Answer 30

aspirin after 12 weeks gestation for women at high risk

Question 31

For whom are statins recommended?

Answer 31

- those with clinical atherosclerotic disease - those with LDL greater than 190 - those 40-75 with diabetes and LDL 70-189 - those 40-75 with an LDL 70-189 and ASCVD of 7.5% or greater