Health Maintenance/Preventative Health

Question 1

At what age is colon cancer screening recommended?

Answer 1

50 years old

Question 2

When should the Tdap (tetanus, diphtheria, and pertussis) booster be given?

Answer 2

Every 10 years

Question 3

What are the main screening tests for cardiovascular disease?

Answer 3

• Blood pressure measurement
• Lipid panel
• Abdominal aortic aneurysm for men 65-75yo who have ever smoked

Question 4

Which group of individuals should be screened fro abdominal aortic aneurysm?

Answer 4

• Men who have ever smoked, ages 65-75

Question 5

What are the various methods of screening for colon cancer and at what intervals should they be done (if previous normal tests are found)?

Answer 5

• Fecal occult blood testing (FIT card) annually
• Sigmoidoscopy with or without occult blood testing, 3-5 yrs
• Double barium enema, 3-5yrs
• Colonoscopy, 10 yrs

Question 6

For what men might prostate cancer screening be suggested?

Answer 6

• symptomatic men >75yrs (via digital rectal exam or PSA)

Question 7

Adults with which other co-morbidities should be screened for diabetes mellitus?

Answer 7

• Adults with hypertension and/or hyperlipidemia should be screened for DM

Question 8

When should depression screening be done?

Answer 8

• Depression screening should only be done if there are mechanisms in place for assuring accurate diagnosis, treatment, and follow up

Question 9

What adults may need increased protection against pertussis with a Tdap booster?

Answer 9

• Adults who may need increased protection against pertussis are those who work in health care, childcare, or those who are having close contact with infants younger than 1 year.

Question 10

At what age is influenza vaccine recommended?

Answer 10

Adults >50 should receive the influenza vaccine as well as younger adults who are high risk

Question 11

At what age is the pneumococcal polysaccharide vaccine recommended?

Answer 11

Pneumonia 23 and 13 are each recommended as a one time vaccination for individuals >65 and who are high risk.

Question 12

For which populations is the Hep B vaccination recommended?

Answer 12

• Health care workers
• Those exposed to blood/blood products
• Dialysis patients
• IV drug users
• Those with multiple sex partners
• MSM

Question 13

For which populations is the Hep A vaccination recommended?

Answer 13

• Chronic liver disease
• Those who use clotting factors
• Occupational exposure to Hep A
• IV drug users
• MSM
• Travellers

Question 14

For whom is varicella vaccination recommended?

Answer 14

• Varicella vaccination should be given to those with no reliable history of immunization or disease, who are seronegative on testing AND who are at risk for exposure

Question 15

For whom is the meningococcal vaccine recommended?

Answer 15

• Persons with certain complement deficiencies
• Functional/anatomic asplenia
• Travel to endemic nations

Question 16

What are the major pharmacologic methods that aid with smoking cessation?

Answer 16

• Bupropion (zyban) => blocks norepinephrine/dopamine
• Varenicline (chantix) => Nicotine partial agonist; reduces cravings
• Nicotine replacement

Question 17

What are common nicotine replacement products?

Answer 17

• gum, patch, inhaler, nasal spray and lozenge

Question 18

Which smoking cessation products are contraindicated in pregnancy?

Answer 18

• Nicotine inhaler, nasal spray, and gum

Question 19

In what group of patients can pap smears (cervical cancer screening) be discontinued?

Answer 19

• Patients who have had a hysterectomy

- Patients who are older than 65yo

Question 20

How frequently should pap smears be administered?

Answer 20

• From ages 21-65 => every 3 years

- From ages 30-65 => every 5 years IF done in conjunction with HPV testing

Question 21

At what age is mammography indicated in breast cancer screening?

Answer 21

• Age 50-74

Question 22

How often should women ages 50-74 be screened for breast cancer?

Answer 22

• Every 2 years

Question 23

When should adults be screened for lipid disorders?

Answer 23

• Age 45

Question 24

What is the risk of HRT use in post menopausal women?

Answer 24

• Increased risk of coronary heart disease, stroke, and venous thromboembolic disease
• Lowest effect dose should then be used

Question 25

What medications are used as migraine prophylaxis?

Answer 25

• Amitriptyline
• Propanolol
• Timolol
• Divalproex sodium (valproate)

Question 26

What drugs can cause fever, especially in a post operative setting?

Answer 26

• beta lactams
• sulfa derivatives
• heparin
• amphotericin B

Question 27

What is malignant hyperthermia?

Answer 27

• Autosomal dominant disorder ( rare) characterized by fever >104F, tachycardia metabolic acidosis, and calcium accumulation in skeletal muscle leading to rigidity
• Can occur up to 24 hours after exposure to anesthetic agents such as halothane and succinylcholine

Question 28

How is malignant hyperthermia treated?

Answer 28

• Antipyretics
• Oxygen
• Cooling blankets
• Dantrolene IV

Question 29

What are the 5 most common causes of postoperative fever?

Answer 29

• Wind: pneumonia
• Water: UTI
• Wound: surgical site infection
• Walk: DVT
• Wonder drugs: drug fever

Question 30

What are the two main organisms to cause fever within 36 hours of post-laparotomy?

Answer 30

• Bowel injury with leakage of GI contents into the peritoneum
• invasive soft tissue wound infection
• both caused by beta hemolytic streptococci or clostridium species

Question 31

What type of pneumonia needs to have gram negative coverage?

Answer 31

• aspiration pneumonia