PREVENTION Dont Be the WEAKEST LINK April 2015

PREVENTION: Don’t Be the WEAKEST LINK April 2015 Sandra Miller MD Banner Good Samaritan Family Medicine Residency Phoenix

• http: //www. uspreventiveservicestaskforce. org/ uspstf 11/cervcancerrs. htm Mammography doesn't decrease cancer-related deaths long-term Bottom Line Over an average follow-up of 22 years in almost 90, 000 women, there was a clinically insignificant difference of 5 deaths due to breast cancer (500 vs 505) in women who received 5 annual screening mammograms instead of usual care. Over than more 2 decades, only 1. 1% of women died of breast cancer, much lower than the 12. 5% (1 in 8) often cited. (LOE = 1 b) Reference Miller AB, Wall C, Baines CJ, Sun P, To T, Narod SA. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ 2014; 348: g 366.

Why the game works Interactive learning -- vs -- Passive learning

How the game works 3 types of answers: true / false multiple choice open answer (can be passed along) No arguments permitted Scores will be tallied periodically Lowest-scoring participants will be excused Prizes! Scoring starts over with a new round

How the game works Some questions very easy Some questions only a few will know Some questions no one will know Luck is involved

Learning environment Medical education should promote a safe learning environment: * supportive, nonjudgmental * feedback given privately This is not a safe learning environment Risk for humiliation Recruit willing participants, consider pairs or teams

USPSTF classification system A Recommended. High certainty that the net benefit is substantial. Practices should offer this service. B Recommended. High certainty that the net benefit is moderate, or moderate certainty that the benefit is moderate to substantial. Practices should offer. C Not routinely recommended. Considerations may support use in individual patients. Moderate certainty that net benefit is small. Offer only under certain circumstances. D Not recommended. Moderate or high certainty of no net benefits, or that harms outweigh benefits. Practices should discourage. I Insufficient current evidence to balance benefits and harms. Evidence is lacking, conflicting, or of poor quality. Patients should understand benefits & harms if offered.

USPSTF recommendations • Discuss services with "A" and "B" recommendations with eligible patients and offer them as a priority. • Discourage the use of services with "D" recommendations unless there are unusual additional considerations. • Give lower priority to services with "C" recommendations; they need not be provided unless there are individual considerations in favor of providing the service. • For services with "I" statements, carefully read the Clinical Considerations section for guidance, and help patients understand the uncertainty surrounding these services.

Alcohol What is the drinking pattern called when a person consumes 5 or more alcoholic drinks on one occasion? …. Binge drinking

Alcohol In determining alcohol consumption, how many ounces of beer constitutes one drink? …. 12 ounces

Alcohol What quantity of alcohol can be safely consumed during pregnancy? …. Unknown

Alcohol What percent of the adult male population is reported to engage in heavy drinking, meaning 5 or more drinks per day on 5 days of the week? 5% 10% 14% …. 10%

Alcohol What percent of the female population is reported to engage in heavy drinking (same definition)? 2% 5% 7% …. 2%

Alcohol What is the most recent recommendation for number of drinks weekly considered to be medically safe, for each men and women? …. Men = 14 Women = 7

Alcohol Is screening all patients for alcohol use by primary physicians worth the effort? No, it only works if patients want help (contemplative) No, the number needed to screen is too high Yes, if the patient is pregnant or child-bearing age Yes, screen everyone … Yes, screen everyone The U. S. Preventive Services Task Force (USPSTF) recommends screening and behavioral counseling interventions to reduce alcohol misuse (go to Clinical Considerations) by adults, including pregnant women, in primary care settings. Grade: B Recommendation .

Substance abuse When screening pregnant women for drug abuse, what portion of those women using drugs will give a positive history? 25% 50% 75% …. 50%

What is the most important modifiable cause of premature death in the United States? …. Smoking 420, 000+ deaths per year

Tobacco If you quit smoking before the age of 50, you reduce your chance of dying from all causes in the next 15 years by how much? One fourth One third One half …. One half

Tobacco Ten years after quitting smoking, your risk of lung cancer drops by as much as: 20% 40% 60% …. 40% Risk never returns to normal.

Tobacco True or false: the risk of stroke begins to decrease as soon as 2 months after quitting smoking. …. False Takes 2 years to start to drop, returns to normal in about 10 years

Tobacco True or false: The risk of myocardial infarction and death from CAD drops by half within one year of quitting smoking. …. True approaches that of nonsmokers at 15 years

Tobacco What percent of smokers continue to smoke during pregnancy? One third One half Two thirds …. Two thirds

Tobacco True or false: pregnant women who stop smoking by the 30 th week of gestation have infants with higher birth weights than those who continue to smoke throughout pregnancy? …. True

Tobacco Cigarettes are responsible for about what percentage of all deaths from residential fires? 10% 25% 40% …. 25%

Tobacco What is the level of recommendation for regular counseling by the primary care physician about tobacco cessation? …. “A” The USPSTF strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products. "A" recommendation.

Tobacco If a patient tells you he likes to smoke and does not want to make plans now to quit, you would say he is at which Stage of Change? …. Pre-contemplation Contemplation Preparation Action Maintenance

Tobacco Passive tobacco exposure is thought to be responsible for how many deaths each year? 18, 000 28, 000 38, 000 …. 38, 000

Miscellaneous What is the level of recommendation for screening adolescents for scoliosis? B C D I …. . D The U. S. Preventive Services Task Force (USPSTF) recommends against the routine screening of asymptomatic adolescents for idiopathic scoliosis. "D" Recommendation.

Vision Children should have visual screening up to what age? 3 years 5 years 7 years …. 5 years The USPSTF recommends screening to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5 years. "B" recommendation.

Miscellaneous What is the current age recommendation for starting glaucoma screening? 50 55 60 None …. None “I”

Breast Cancer At what age should normal risk women start screening with mammograms for breast cancer? … Age 50 The US Preventive Services Task Force (USPSTF) recommends against routine screening mammographies between the ages of 40 and 49 years (Grade C recommendation). (LOE = 1 a)

Breast Cancer How often should normal risk women get mammograms between ages 50 and 74? …. Every 2 years. USPSTF recommends screening every other year between the ages of 50 and 74 years (Grade B), but stops short of recommending continuing screening after that.

Breast Cancer Regarding BSE, or breast self-examination, what is the recommendation? For it Against it Insufficient evidence …. D = against it

Breast cancer Regarding clinical breast exam by a provider, what is the USPSTF recommendation? For it Against it Don’t know …. Don’t know = “I” recommendation

Breast Cancer • • • USPSTF: No routine mammography for women younger than 50 years Clinical Question: When and how should women be screened for breast cancer? Bottom Line: The US Preventive Services Task Force (USPSTF) recommends against routine screening mammographies between the ages of 40 and 49 years (Grade C recommendation). They continue to recommend screening every other year between the ages of 50 and 74 years (Grade B), but stop short of recommending continuing screening after that. In another turnaround, they also recommend against teaching breast self-examination (Grade D) and give an "insufficient evidence" rating (Grade I) to clinical breast examining, digital mammography, and magnetic resonance imaging. These guidelines are more in step with recommendations in other countries. In the United States, the American College of Physicians is the only other group that does not recommend screening mammography in women younger than 50 years. (LOE = 1 a)

Breast Cancer According the BIRADS classification system of mammogram results, which BIRADS rating (1 through 5) means there are some findings, but they appear to be entirely benign? …. BIRADS-2

Cardiac health What is the optimal time interval recommended between normal screenings for blood pressure? 2 years 3 years 5 years unknown …. unknown

Cardiac health Periodic screening for hypertension is recommended for all persons over what age? 18 21 25 …. . 18 The U. S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults aged 18 and older. "A" recommendation

Miscellaneous screening A fairly new recommendation from the USPSTF now recommends screening for what condition in certain older smokers? …. AAA abdominal aortic aneurysm

Cardiovascular health This abdominal aortic aneurysm screening is recommended for: men women both …. men

Cardiovascular health NEEDS REVISION What condition is needed to warrant AAA screening a male age 65 – 75 with ultrasound? Current smoker Smoked at least 10 pack years Ever smoked …. Ever smoked

Colorectal carcinoma Regarding colorectal carcinoma, what percentage of patients have metastases at the time of diagnosis? 40% 50% 60% …. 60%

Colorectal carcinoma At what age does the USPSTF recommend colorectal screening for all patients? …. 50 The USPSTF strongly recommends that clinicians screen men and women 50 years of age or older for colorectal cancer. "A" recommendation.

Colorectal carcinoma Which method of colon cancer screening is most highly recommended by the USPSTF? Colonoscopy Flexible sigmoidoscopy Fecal occult blood testing None of the above …. None of the above The USPSTF recommends screening for colorectal cancer (CRC) using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. Grade: A Recommendation.

Colorectal carcinoma How many American deaths are there yearly due to colon cancer? 55, 000 70, 000 90, 000 …. 55, 000

Colorectal carcinoma What does the USPSTF recommend regarding colon cancer screening in patients over the age of 85? Appropriate if patient has a 10 -year life expectancy Appropriate if patient is not demented and desires it Appropriate if patient has no anesthesia risks Not appropriate …. Not appropriate The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years. Grade: D Recommendation.

Colorectal carcinoma The Canadian Preventive Task Force recommends what screening method for colon cancer screening in normal-risk patients? …. Nothing

Colorectal carcinoma Does a patient with one first-degree relative with colon cancer warrant earlier and more frequent screening with colonoscopy? Yes No Not clear …. Not clear May be warranted if cancer at young age (before age 60), or if any hereditary cancer syndrome

Cervical cancer What is the presumed etiologic agent for cancer of the cervix? …. HPV, human papilloma virus

Cervical cancer Not including smoking, a woman’s risk for cervical cancer can be correlated with her what? …. Lifetime sexual partners

Cervical cancer By what factor does smoking cigarettes increase a woman’s risk for cervical cancer? 2 x 3 x 4 x …. 2 times

Cervical cancer Current evidence suggests that the average-risk woman between the ages of 21 and 30 with a reliable history of normal Paps, should receive Pap testing at what interval? 1 year 2 years 3 years …. 3 years

Cervical cancer If a 51 year old woman has had a total hysterectomy for fibroids, how often should she get a screening Pap test? …. Never The USPSTF recommends against routine Pap smear screening in women who have had a total hysterectomy for benign disease. D recommendation.

Improving Quality by Doing Less: Overscreening MARK EBELL, MD, MS, University of Georgia College of Public Health, Athens, Georgia JESSICA HERZSTEIN, MD, MPH, Environmental Health Resources, Washington, District of Columbia Am Fam Physician. 2015 Jan 1; 91(1): 22 -24 1996: USPSTF recommends that women with hysterectomy for benign disease no longer have a Pap smear. However, a study found that 69% of such women had a Pap smear within the previous three years, a percentage that did not change between 1992 and 2002. Unnecessary tests lead to at least one intervention in 4% of women during the eight months following the test, including colposcopy and other surgical procedures. Over a 30 -year period, women of all ages in the United States had four times as many Pap smears as women in the Netherlands, yet there was no difference between the two countries in cervical cancer mortality rates….

Cervical cancer When can a normal-risk woman quit getting Paps if she has had regular, normal Paps? 60 years 65 years 70 years 75 years …. 65 years The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer. "D" recommendation.

Cervical cancer The use of what instrument increases the likelihood of collecting endocervical cells during a Pap? … Endocervical brush, though not clear if it makes a difference in ultimate outcomes

Cervical cancer What does the USPSTF feel about using newer Pap technologies such as Thin. Prep? Use it, it’s better Don’t bother, it’s no better Who knows? …. Who knows? The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer. "I" statement.

Cervical cancer What testing (if negative) allows a woman to get a Pap every 5 years after age 30? …. Pap & HPV

Cancer Not including skin cancers, what is the most common carcinoma in American men? …. Prostate

Prostate cancer Approximately how many cases of prostate cancer are diagnosed annually in the U. S. ? 150, 000 250, 000 350, 000 …. 250, 000

Cancer Which cancer accounts for the most cancer deaths in American men? …. Lung

Prostate cancer Based on autopsy studies, histological evidence of prostate cancer is present in what percent of men over 50? 15% 30% 45% 60% …. 30%

Prostate cancer True or false: there is now recent evidence that early detection of prostate cancer improves outcomes. …. False

Prostate cancer Which method is most recommended by the USPSTF for prostate cancer screening: DRE (digital rectal exam) PSA Ultrasound Nothing …. Nothing

Prostate cancer The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years. I statement. The USPSTF recommends against screening for prostate cancer in men age 75 years or older. D recommendation.

Prostate cancer Radical prostatectomy carries roughly what risk for erectile dysfunction? 35% 50% 65% …. 50%

Prostate cancer The 10 -year survival rate for early-stage prostate cancer is almost: 60% 75% 90% …. 90%

Lung cancer What is the 5 -year survival rate from lung cancer, with all stages combined? 7% 13% 18% …. 13% one of the worst prognoses of all cancers

Lung cancer Name one drawback to using CT scans as a screening method for lung cancer. …. High cost High radiation exposure Many false-positives “ … mortality rates due to complications from surgical interventions in symptomatic patients reportedly range from 1. 3% to 11. 6%; morbidity rates range from 8. 8% to 44%, with higher rates associated with larger resections. ”

Lung cancer Which organization or group currently recommends screening smokers for lung cancer with periodic chest X-rays? …. None

Lung cancer What level of recommendation does the USPSTF give for lung cancer screening with CT scans? A / B / C / D / I …… B

Lung Cancer For what age range are CT scan lung cancer screenings recommended? …. . Ages 55 to 80

Lung Cancer • • • Release Date: December 2013 The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. Grade: B recommendation.

• • Evidence Lacking to Support or Oppose Low-dose CT Screening for Lung Cancer, Says AAFP Inability to Make Harms/Benefits Comparison Precludes Definitive Recommendation (01/13/2014) -- Citing a paucity of high-quality evidence on which to base a comparison of relative harms and benefits, the AAFP today released an "I" recommendation regarding the routine use of low-dose CT scans in screening high-risk, older smokers for lung cancer. More • AAFP finds evidence lacking on low-dose CT lung cancer scans The AAFP said there is not enough scientific data to recommend for or against using low-dose computed tomography to screen patients at high risk for lung cancer due to age or smoking history. The Academy's decision runs counter to a U. S. Preventive Services Task Force recommendation that supports annual screening for certain high-risk patients. "A shared-decision -making discussion between the clinician and patient should occur regarding the benefits and potential harms of screening for lung cancer, " the Academy's recommendation statement said. AAFP News Now (1/13)

Lung cancer screening is cost effective, but only if done correctly (Info. POEM review January 2015) • • Bottom Line The United States Preventive Services Task Force (USPSTF) gave lung cancer screening a B recommendation on the basis of the reductions in disease-specific mortality and all-cause mortality seen in the National Lung Screening Trial (NLST). The NLST does not consider cost or cost-effectiveness in its recommendations. This cost-effectiveness analysis suggests that screening is most cost-effective for current smokers, for patients aged in their 60 s, and for those who are at higher risk for lung cancer. (LOE = 1 b) Reference Black WC, Gareen IF, Soneji SS, et al, for the National Lung Screening Trial Research Team. Costeffectiveness of CT screening in the National Lung Screening Trial. N Engl J Med 2014(19); 371: 1793 -1802.

Lung cancer How much more sensitive is a low-dose CT scan in detected a lung cancer compared to a standard chest X-ray? 2 times 3 times 4 times …. 4 times

Skin cancer What type of skin cancer accounts for most skin cancers diagnosed each year? …. Basal cell

Skin cancer Approximately how many deaths are caused annually by malignant melanoma? 4, 000 7, 000 10, 000 13, 000 …. 7, 000

Skin Cancer Other than family history and genetics, including a fair complexion, what personal history puts a patient at higher risk for melanoma? …. History of intense sunburn

Skin cancer At what age does the USPSTF recommend to start screening for skin cancers? 50 years 55 years 60 years No one knows …. No one knows The U. S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for skin cancer using a total-body skin examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer. "I" statement.

Cancer What is the most common cancer in young men aged 20 -35 in the United States? …. Testicular cancer

Testicular cancer How many American men die annually from testicular cancer? Just under: 400 800 1200 …. 400

Testicular cancer What is the level of recommendation for routine screening exams of normal risk, asymptomatic men for testicular cancer by either physicians or by self-exam? A / B / C / D / I …. D The U. S. Preventive Services Task Force (USPSTF) recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males. Rating: "D" recommendation. A family physician with 1500 young men in practice would find 1 case in 15 -20 years

Testicular cancer What puts a young man at greater than average risk for testicular cancer? …. Cryptorchidism, atrophy consider screening actively

Ovarian cancer Where does ovarian cancer rank in causing cancer deaths in American women? 4 th 5 th 6 th …. 5 th 14, 500 deaths/ year

Ovarian cancer What percent of new diagnoses of ovarian cancer have advanced disease at the time of discovery? one third one half two thirds …. two thirds

Ovarian cancer Which is the best screening method for ovarian carcinoma in normal risk patients? serum tumor marker CA-125 bimanual pelvic exam ultrasound none …. none The U. S. Preventive Services Task Force (USPSTF) recommends against routine screening for ovarian cancer. Rating: "D" recommendation.

Ovarian cancer Ovarian carcinoma is most common in what age range? 40 to 50 50 to 60 60 to 70 …. 60+

Diabetes What percent of all people with diabetes (primarily type 2) are currently unaware of their diagnosis? one third one half two thirds …. one half

Diabetes What fasting and random blood sugars, if repeatedly at these levels, will confirm a diagnosis of diabetes? …. Fasting 126 Random 200

Diabetes The USPSTF recommends that people with what other condition be screened for diabetes? …. Hypertension The USPSTF recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg. "B" recommendation

Diabetes What is the level of recommendation for screening all pregnant women for gestational diabetes? A B C D I …. I The U. S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for gestational diabetes. "I" Statement. risks to consider: obesity, family history, older, h/o macrosomia, LGA, fetal death

Thyroid People with what condition are recommended to have screening for thyroid disease? Down Syndrome Obesity Diabetes None …. none The USPSTF concludes the evidence is insufficient to recommend for or against routine screening for thyroid disease in adults. "I" statement.

Hearing Which group of newborns should be screened for hearing loss? All of them Premies Low birth weight Spent any time in the NICU None of them …. All of them The USPSTF recommends screening for hearing loss in all newborn infants. B recommendation.

Accidents Recent recommendations for automobile safety restraints for children include the concept that the type of restraint should be not just based on age, but on what? …. Weight

Miscellaneous Screening for asymptomatic bacteriuria is recommended for what group of patients? …. Pregnant The USPSTF recommends screening for asymptomatic bacteriuria with urine culture for pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit, if later. A recommendation.

Anemia screening is recommended between 6 -12 months for what group of children? high risk infants all infants no infants on milk-based formula …. no infants The U. S. Preventive Services Task Force (USPSTF) concludes that evidence is insufficient to recommend for or against routine screening for iron deficiency anemia in asymptomatic children aged 6 to 12 months. "I" statement

Anemia What is the level of recommendation for routine screening for iron deficiency anemia during pregnancy? …. “B” The USPSTF recommends routine screening for iron deficiency anemia in asymptomatic pregnant women. "B" recommendation

Newborns What is the incidence of PKU? 1 in 4000 1 in 8000 1 in 12, 000 …. 1 in 12, 000

Newborns Repeat PKU testing is recommended before 2 weeks of age if the first PKU was before what age? …. 24 hours

Newborns True or false: most cases of cerebral palsy occur in infants with evidence of birth hypoxia. …. False

Newborns Name one specific neural tube defect. spina bifida anencephaly encephalocele ….

Vaccinations At what ages should a child receive an MMR? …. 12 -15 months 4 -6 years

Infectious disease True or false: A prior BCG vaccination is considered a valid reason to dismiss a positive PPD. …. False

Infectious Disease What is most critical aspect to measure when you read a TB skin test? …. Induration, not erythema

Infectious Disease What is the proper duration of prophylactic INH treatment in an asymptomatic patient with a newly positive PPD? …. Either 6 or 12 months 6 months nearly as effective

Infectious Disease What is the proper dose of INH for TB prophylaxis? …. 300 mg daily

Infectious Disease What is the primary reason for the upsurge of tuberculosis in the late 20 th century? …. AIDS epidemic 100 x more likely

Infectious Disease Ophthalmia neonatorum is caused by what STD? …. Gonorrhea 30 -50% of exposed infants will develop

Infectious Disease What is administered at birth to infants to prevent ophthalmia neonatorum? …. Silver nitrate, erythromycin or tetracycline ointment nearly 90% effective

Infectious disease While the majority of men with gonorrhea become symptomatic, the initial asymptomatic period can last up to: 2 weeks 4 weeks 6 weeks …. 6 weeks

Infectious Disease What portion of women with gonorrhea have no symptoms? 20% 50% 80% …. 80%

Infectious disease What is the most common bacterial STD in the United States? …. chlamydia Estimated 4 million cases per year Females: more PID, infertility, ectopic Males: 1/3 of cases of non-GC urethritis, over ½ cases of acute epididymitis

Infectious disease True or false: Routine screening for asymptomatic chlamydia is recommended for all sexually active adolescents. … True …and for all other higher risk women: prior STD new or multiple partners under age 25 inconsistent use of barrier contraceptives unmarried may also depend on local epidemiology

Infectious disease What is the level of recommendation for HIV screening in patients with risk factors? A / B / C / D / I …. A Risk factors: Other STDs Men having sex with men after 1975 IV drug use, past or present Commercial sex Partner with HIV or any of above risks History of blood transfusions 1978 -1985

Miscellaneous At what age does the USPSTF recommend bone density testing in normal risk women? 60 65 70 Never …. 65 The U. S. Preventive Services Task Force (USPSTF) recommends that women aged 65 and older be screened routinely for osteoporosis. The USPSTF recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures "B" recommendation.

Accidents The fatality rate from motorcycle accidents is how many times higher than in automobile accidents? 6 times 13 times 20 times …. 20 times

Accidents What behavior accounts for nearly half of all motor vehicle accident fatalities? …. Drinking alcohol

Contraception What is the most effective form of contraception? …. Abstinence

Contraception Which country has a higher rate of abortions: United States England France Sweden …. United States

Contraception Within how many hours should the “morning after” pill regimen be used to be most effective? …. 72 hours

Contraception In females under age 17 who have their first premarital intercourse, what portion do not use contraception? Over one third Over one half Over three fourths …. Over one half

Contraception What form of contraception helps lower the incidence of cervical carcinoma? …. Barrier methods: condom or diaphragm

Endometrial cancer What commonly used prescription medication helps reduce the risk of endometrial cancer? …. Oral contraceptives

Vaccinations If you have a newborn whose mother is hepatitis B surface antigen positive, what should that infant receive in addition to a hepatitis B vaccination? …. Hep B Immune Globulin (HBIG) Vaccine alone 62 -92% effective, combo is 85 -95% effective

Miscellaneous Dietary intake of fat should be limited by adults and children – starting at what age for children? 1 year 2 years 3 years …. 2 years

Vaccinations In which age group is tetanus more common in the US: neonates children older adults …. Adults over 50

Infectious disease What is the risk of developing chronic hepatitis B after acute infection? 10% 20% 30% …. 10%

Accidents MVA fatality rates are higher for males than females by what factor? 2 x 4 x 6 x …. 2 times

Miscellaneous Other than stroke, what is the most common cause for loss of independence in the elderly? …. Hip fracture

Miscellaneous At what age is bone density most likely to peak in the average woman? 19 24 29 35 …. 29

Newborn screening How soon should an infant be treated for congenital hypothyroidism in order to prevent the complications of mental and growth complications? First few weeks First few months Within 4 months …. First few weeks

Cardiac health True or False: All men 35 and older should be screened for lipid abnormalities. …. True The U. S. Preventive Services Task Force (USPSTF) strongly recommends screening men aged 35 and older for lipid disorders. A recommendation. The USPSTF recommends screening men aged 20 to 35 for lipid disorders if they are at increased risk for coronary heart disease. Rating: B recommendation.

Cardiac health True or false: all women should be screened at age 35 and older for lipid abnormalities. …. False The USPSTF strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease. A recommendation. The USPSTF recommends screening women aged 20 to 45 for lipid disorders if they are at increased risk for coronary heart disease. Rating: B recommendation.

Cardiac health Screening Young Men and All Women Not at Increased Risk The USPSTF makes no recommendation for or against routine screening for lipid disorders in men aged 20 to 35, or in women aged 20 and older who are not at increased risk for coronary heart disease. C recommendation.

Newborn screening Screening newborns for hip dysplasia is rated for what level of evidence? A / B / C / D / I …. I The USPSTF concludes that evidence is insufficient to recommend routine screening for developmental dysplasia of the hip in infants as a means to prevent adverse outcomes. "I" statement. Occurrence 1 -20 kids per 1000 births No studies have ever evaluated the role of surgical vs. nonsurgical management of hip dysplasia Most surgeries are not performed because of detected screening abnormalities 60% of kids with abnormal screening become normal in a month 90% resolve entirely by 6 weeks to 6 months

Colon cancer Does aspirin help reduce the incidence of colon cancer? Yes, but it’s not worth the side effects. No, it’s a myth. Maybe, no one really knows. …. Yes, but it’s not worth the side effects. The USPSTF recommends against the routine use of aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) to prevent colorectal cancer in individuals at average risk for colorectal cancer. Grade: D Recommendation. Aspirin appears to be effective at reducing the incidence of colonic adenoma and colorectal cancer, especially if used in high doses for more than 10 years. However, the possible harms of such a practice require careful consideration. Further evaluation of the cost-effectiveness of chemoprevention compared with, and in combination with, a screening strategy is required.

Breastfeeding What level of recommendation does the USPSTF give to promoting and supporting breastfeeding? A / B / C / D / I …. B The USPSTF recommends interventions during pregnancy and after birth to promote and support breastfeeding. Grade: B Recommendation.

Breastfeeding Which of the following is NOT a known benefit of breastfeeding for the infant? Less asthma Less obesity Less type 2 diabetes Less ADHD …. Less ADHD

Breastfeeding Which of the following is NOT a known benefit of breastfeeding for the mother? Less breast cancer Less ovarian cancer Less endometrial cancer …. Less endometrial cancer

COPD Given the prevalence of smoking and the cost of morbidity and mortality related to chronic lung disease, should we be screening asymptomatic high -risk patients, such as smokers, with spirometry? No Yes, if they still smoke and want to quit Yes, but only if they agree to use daily inhalers …. No

COPD The USPSTF recommends against screening adults for chronic obstructive pulmonary disease (COPD) using spirometry. Rating: "D" recommendation. Even in groups with the greatest prevalence of airflow obstruction, hundreds of patients would need to be screened with spirometry to defer 1 exacerbation. For example, under the best-case assumptions about response to therapy, an estimated 455 adults between 60 and 69 years of age would need to be screened to defer 1 exacerbation.