LATEST 2024 Family Med Aquifer Test Questions And Answers

Breast self-exam (BSE) recommendations - ANSWER- The USPSTF and the American Cancer Society (ACS) both do NOT recommend physicians to teach pts to do BSEs Breast CA screening USPSTF - ANSWER- biennial screening mammography for women aged 50-74 yrs Cervical cancer screening guidelines - ANSWER- age 21: screening begins 21-29: q3 yrs 30-65: q5 hrs if co-tested for HPV or q3yrs with cytology alone Risk groups who need to have more frequent cervical CA screening - ANSWER- immunocompromised HIV positive hx of CIN 2, 3 or CA exposure to DES in utero When to stop cervical CA screening - ANSWER- women 65 yrs who have had adequate screening within the last 10 yrs 3 consecutive nml pap tests with cytology alone or 2 nml paps if co-tested Characteristics of a good screening test - ANSWER- 1. Accuracy (high sensitivity and specificity) 2. Able to detect disease in an asymptomatic phase 3. Minimal associated risk 4. Reasonable cost 5. Acceptable to patient 6. Have an available treatment for the disease Lung CA screening USPSTF - ANSWER- - low-dose CT scan to screen for lung CA in pts ages 55-80 who have smoked for 30 + years -should also be currently smoking or have quit within the prior 15 years Diagnostic tests for breast lesions - ANSWER- - if cystic, aspiration -- fluid sent for cytology; FNA if available - if solid, mammography is the next step - US can be helpful in distinguishing a solid vs cystic lesion Risk factors for developing breast CA - ANSWER- -FHx of breast CA in 1st degree relative - prolonged exposure to estrogen - genetic factors - age - post-menopausal obesity - excessive alcohol intake Tdap immunization - ANSWER- Tetanus, diptheria, and acellular pertussis (Tdap) should replace a single dose of Td for adults 19-64 who have not received a dose of Tdap previously Osteoporosis screening - ANSWER- Women 65 yo : dual energy x-ray absorptiometry (DEXA) recommended) Women 65 yo : for high risk pts Physical activity guidelines - ANSWER- 150 min of mod intensity exercise, 75 min of vigorous intensity or a combo of both per week + strengthening exercises 2 days/wk Atherosclerotic cardiovascular disease (ASCVD) risk calculator - ANSWER- fasting lipids q4-6 yrs in adults 20-79 yrs of age who are free from ASCVD if at increased risk for CAD (ie, diabetics, hypertensive, premature personal hx of atherosclerosis for FHx in males 50 and F 60) to estimate 10-year ASCVD risk q4-6 yrs in adults 40-79 yrs of age without ASCVD Diabetes initial therapy - ANSWER- metformin 500 mg once daily with evening meal, if tolerated, add a second 500 mg dose with breakfast -can reach a total dose of 2000 mg per day +lifestyle modifications! Effects of alcohol - ANSWER- +: small increase in HDL, prevent platelet aggregation but not recommended still -: pts with HF, cardiomyopathy, diabetes, HTN, arrhythmia, obesity, hypertriglyceridemia, or who are taking meds may have AEs red wine: some antioxidants and falvonoids may reduce heart disease risks but no hard evidence to show direct effect Gathering a complete nutrition history - ANSWER- 1. 24-hour dietary recalls - ask about each meal; "WAVE - Weight, Activity, Variety, and Excess" 2. daily dietary intake record (or food diaries) -everything in the last 3-4 days 3. food frequency questionnaire - food intake over the period of a month 4. usual diet history - describes a typical day's diet BMI underweight - ANSWER- 18.5 kg/m2 BMI normal - ANSWER- 18.5-24.9 BMI overweight - ANSWER- 25-29 BMI obese - ANSWER- obese 30-35; very obese 35-40; morbidly obese 40+ Signs of dyslipidemia - ANSWER- Corneal arcus, xanthelasmas, acanthosis nigricans Signs of atherosclerosis - ANSWER- Decreased peripheral pulses, carotid bruit ABCDE of suspiscous skin lesions - ANSWER- Asymmetry Border irregularity Colon non-uniform Diameter 6 mm Evolution or change over time Adult immunization recommendations - ANSWER- - influenza recommended annually - current recommendations recommend substituting a one-time dose of Tdap for Td booster for ages 11-64 to provide additional pertussis protection, then boost with Td q10 yrs - a pneumococcal 23-valent polysaccharide vaccine (PPSV23) for adults who SMOKE - recombinant zoster vaccine (Shingrix) for every adult at age 50 -- 2 vaccine series given 2-6 months apart Is Shingrix indicated if someone received the live zoster vaccine (Zostavax) for adults over 60? - ANSWER- Yes. Recommended to be re-vaccinated with the recombinant (Shingrix) vaccine Medical indications for pneumococcal vaccine in adults younger than 65 - ANSWER- Adults age 19-64 with immunocompromised conditions or anatomical or functional asplenia High-risk indications for Hepatitis B vaccine - ANSWER- -end-stage renal disease, including dialysis patients -persons seeking treatment or evaluations of an STD -HIV -chronic liver disease -persons receiving clotting-factor concentrates -workers with potential exposure to blood/bodily fluids -staff of institutions of the mentally disabled -men who has sex with men -illicit drug use