Cervical cancer screening guidelines? o 21-29: Pap smear Q3yr o 30 – 65: Cytology Q3yr or with HPV test Q5yr Ovarian cancer screening? o Not recommended Endometrial cancer screening? o Those with HNPCC may be offered annual screening starting at the age of 35 Lung cancer screening? o 55 – 65 low dose CT for 30 pack year history Mammograms? o Q 1 yr starting at 40 (earlier if BRCA in family) o UPSTF says after 50 with below that up to the pt Ca recommendations for women for osteoporosis o 1000mg for pre and 1500mg / day for post menopausal women. o However USPTF is not recommending this or vitamin D currently do to lack of evidence So what is osteoporosis screening then? o DEXA scan at 65 years or less if a reason provides Osteoporosis: o Risk factors: low estrogen states (early menopause, low body weight), FHx of osteoporotic fracture, previous fracture as an adult, dementia, smoking, white race, and others. When is zoster vaccine recommended? 60 (one time) What pt. population gets one time screen for Hep C? o Adults born b/t 1945 and 1965. Diameter concern with a possible melanoma? o 6mm ASCVD and lipid/chol panel ought to be checked minimum ___ o Q 4-6 years Which SSRI is known for its long ½ life? o Fluoxetine (prozac) 2-4 day long ½ life Which is the most used in pregnancy? o Sertraline (zoloft); main SE? GI upset (more than others) Which is best in children? o Paroxetine (paxil); 1/2 life? Very short; most likely to cause discontinuation syndrome Which is good for OCD? o Fluvoxamine What is escitalopram best used for? o GAD ADA recommendation for dyslipidemia in DM pts. o Mod. Intensity stating for those 45-70 with DM o High intensity statin if the ASCVD RF is > 7.5% When does the ADA recommend aspirin therapy? o Secondary therapy in those with CVD history o Primary therapy in those with ASCVD risk > 10% Includes men > 50 and women > 60 (most) Do not take if these are not met as risk > benefit. Note that USPTF recommends age 45 – 79 for men and 55 – 79 for women. Ankle Brachial Index for PAD? < 0.9 When in the pregnancy is Rho Gam given? o 50mcg at first trimester or 300mcg at 28 weeks (either is fine) Ottawa knee rules…any one of the following o Age > 55 o Tenderness at head of fibular or isolated at patella o Inability to flex to 90 degrees o Cannot bear weight for 4 steps (immediately or in ER) USPSTF recommendation for abdominal aortic aneurysm? o Men 65-75 with hx. of smoking Catching or locking of the knee can indicate what knee injury? o Meiscal tear Recommendation regarding folic acid? o All women “capable of pregnancy” take a daily supplement containing 400 – 800 mcg of folic acid. Higher: 1mg with DM or epilepsy 4mg with child with previous NTD When do we screen for endometrial cancer? o Those > 35 with abnormal uterine bleeding o Note: that RF increases at age 35 McIsaac Decision rule for strep throat: o Fever > 38 o Absence of cough o Tonsillar exudates o Anterior cervical lymphadenopathy o Age less than 15 < 1pt = sx. Treatment 2-3 rapid strep test: treat if positive 4: throat culture and empiric abx. When is it recommended to start screening for obesity? At age 6 Describe the appearance of posterior vs anterior shoulder disloc o Anterior: fullness at anterior shoulder with posterior dimple o Posterior: arm is adducted and internally rotated Most common type of testicular tumor? o Germ cell tumors (95%); which of these is most common Semninomas, which occur around ____ (age) (high ALP) 3rd decade of life; which is much different from ___ Yolk sac tumors: occur in kids < 3 (high AFP) What test has a better SN vs doppler US for testicular torsion? o Radionuclitide scintigraphy: radioisotope to visualize testicular blood flow (decreased in torsion) When does age become a RF for CAD? o Men at 45 and women at 55 Components of metabolic syndrome? o 3 of 5 of: Waist > 35M and 40F TG > 150 HDL < 40 BP > 130/85 (half way) Fasting glucose > 110 Screening for DM: o Every 3 years starting at 45 or earlier if BMI > 25 with 1 additional risk factor (inactivity, race, etc.). o Asymptomatic adults with sustained BP (treated or untreated) > 135/80. Who do we recommend high intensity statins for? o 75 years old with clinical ASCVD o LDL > 190 o DM > 45Y with 10 year ASCVD > 7.5% Good Na goals: o Less than 2400mg or less than 1500 for further BP loss Estimating BMR? o 10 X pounds: there are factors to increase it based on lifestile Ex: sedentary = X 1.3 Avg calorie defecit to loose 1lb in a week? o 3500/week Children who we should screen for DM? o 85% of BMI o Weight:height > 85%ile o Weight > 120% ideal for height plus any two of: Family hx. of DMII Ethnic race Signs of insulin resistance (acanthosis/PCOS/HTN/HLD) We typically start screening at ___ years old every ___ years o 10; 2 Dx. of bacterial sinusitis in children? o Signs of bilateral nasal dx. + cough lating >10 days o Worsening after getting better or o High fever + nasal dx X 3 days Dentist recommendation for children? o Should be seen within 6 mos from first tooth eruption or by one year of age. After ___ years or after outgrowing height restriction for car seats, kids can ___ o 2 years; sit in fwdd facing car seat in back seat: booster seat should be kept until child is 4’9’ What women do we screen who are younger than 65 with DEXA? o Those with FRAX score > 9.3% What kids do we screen diabetes in? o BMI > 85% with RF or 95% with no RF o Every two years; these ages are also the same for steatosis screening! What kids do we treat high cholesterol? o Age 10 or greater and are either Tanner 2 or menarche if… LDL > 160 with RF or > 190 period. When do we typically start anemia screening? o At 12 mos; then at preschool/kindergarden Hearing and vision ought to be checked early on, but objective screening should be done when for each? o Hearing at 3 years; vision at 4 years Why use aspirin? What is recommendation? o Men: 45 – 75 reduce MI o Women: 55 – 75 reduce ischemic stroke!!!! o GLP-1 agonist: Exenatide, increase insulin, decrease glucagon, SE = weight loss. o DPP-4 inhibitors: “gliptin,” prolong GLP-1 action. o SGLT-2 inhibitors: “flozin,” block reabsorption of glucose in PCT, SE = UTIs, yeast infections. o α-glucoside inhibitors: decrease glucose absorption in gut, used postprandially. Frequent visits every 3-6 months to check glucose and eye/foot exams and UA yearly (foot exam ● LMWH > UFH: ○ Longer half-life so it can be administered sub Q qd or BID. ○ Lab monitoring is not required and dosing is fixed. ○ HIT is less likely. ○ May be used in outpatient setting, whereas UFH is not. ● IV UFH is not cleared by kidneys so better for CKD patients. UFH requires hospitalization as it is given IV with dosage based on body weight and titrated based on the PTT. ○ Meniscal tears and ligamentous tears are both associated with “popping” sensation, however rapid joint swelling due to hemarthrosis is seen with ligamentous injuries (ligaments have much greater vascular supply). Think meniscal injury if twisting injury or have positive provocative tests → (+) McMurray test. See catching and locking. ■ Diagnose: MRI. RhoGAM: ● Prevent HDN (severe fetal anemia → fetal hydrops). ● Find O-negative → 50 mcg dose of Rho(D) Immune Globulin in 1st trimester. ● Administration: given to Rh-, unsensitized woman at 28 weeks, and if baby Rh +, given another dose after delivery or within 72 hours of any procedure in which there is possibility of blood mixing (delivery, amnio, CVS) → now sensitized. ● Types of abortion: ○ Inevitable abortion - dilated cervical os. ○ Incomplete abortion - some but not all POC have been expelled. ○ Missed abortion - fetal demise without cervical dilatation and/or uterine activity (often found incidentally on US without a presentation of bleeding). ○ Septic abortion - with intrauterine infection (abdominal tenderness and fever usually present). ○ Complete abortion - the products of conception have been completely expelled from the uterus. Follow hCG until 0 to confirm no more chorionic villi are present. ● Appendicitis: ○ Psoas sign: passive extension of patient‘'s hip as he lies on his side with knees extended, or ○ asking the patient to actively flex his/her hip (psoas is a hip flexor). Obturator sign: examiner has patient supine with right hip flexed to 90 degrees- takes patient‘s right ankle in his right hand as he uses his left hand to externally/internally rotate patient‘s hip by moving the knee back and forth.