Family Medicine Shelf (USPSTF + Blueprints + AAFP Questions)

Screening for AAA

Men 65-75 who have ever smoked (A)

Test used to screen for AAA

Abdominal duplex ultrasonography

Treatment for AAA

>5.5 cm --> surgery

3.0-5.4 cm --> repeated surveillance Q3-12 months

Growth >1.0 cm/yr --> surgery

Screening for Alcohol Misuse

Persons older than 18 years

Screening Tests for Alcohol Misuse

AUDIT, AUDIT-C, or number of times person drank >5 (4 if woman or older than 65) drinks in the past year

Treatment for Alcohol Misuse

Behavioral Counseling interventions

Recommendation for Aspirin Usage

Men 45-79 years old (MI protection)

Women 55-79 (Stroke protection)

*Benefit of MI reduction must outweigh the risk of GI hemorrhage

Risk Factors For GI Hemorrhage

Men

Other NSAID usage

Hx of GI ulcer

Uncontrolled HTN

Anticoagulation

Screening for Asymptomatic Bacteriuria

Women at 12-16 weeks of pregnancy or first prenatal visit if farther along

Screening Test for Asymptomatic Bacteriuria

Urine culture

Dipstick and microscopy have poor PPV and NPV

Treatment for Asymptomatic Bacteriuria

Nitrofurantoin

Prophylactic Aspirin for the Prevention of Colon Cancer

The USPSTF DOES NOT recommend this due to risk of GI hemorrhage

Bacterial Vaginosis Screening in Pregnant Women

The USPSTF DOES NOT recommend this due to lack of evidence that it reduces mortality or morbidity

Amsel Criteria

Need 3/4:

1. Fishy odor with addition of KOH

2. Vaginal pH >4.7

3. Clue cells on wet mount

4. Thin, homogenous discharge

Treatment of BV

Oral Metronidazole or oral Clindamycin

or

Vaginal Metronidazole or Vaginal Clindamycin creams

Screening for Bladder Cancer

The USPSTF DOES NOT recommend this due to lack of accurate screening methods

Screening for HTN

Adults > 18 years

Diagnosis of HTN

>140 systolic or >90 diastolic

Must have 2 different BP readings that are elevated over a period of 1-several weeks

Categories of BP

Normal = <120/<80

PreHTN = 120-129/80-89

Stage 1 HTN = 140-159/90-99

Stage 2 HTN = 160+/100+

Major CV Risk Factors

HTN

Obesity

Dyslipidemia

DM

Cigarette smoking

Inactivity

Age >55 (men) or >65 (women

Family History of premature CVD: <55 (men) and <65 (women)

Causes of HTN

Sleep Apnea

Drug-induced (diuretics, cyclosporine, glucocorticoids, amiodarone)

Chronic kidney disease

Primary Aldosteronism (Conn's Syndrome)

Cushing's Syndrome

Pheochromocytoma (MEN II and III)

Coarctation of aorta (Turner's)

Thyroid/Parathyroid disease

Goal BPs for Treatment (JNC8)

<140/90 for adults <60 years without CKD

<150/90 for adults >60 years without CKD

<140/90 for all ages with DM, but no CKD

<140/90 for all ages with CKD +/- DM

Treatment of HTN for Non-Black without CKD

Thiazide Diuretic

ACE-I

ARB

CCB

Treatment of HTN for Black without CKD

Thiazide Diuretic

CCB

Treatment of HTN for All Races with CKD +/- DM

ACE-I

ARB

BRCA-Related Cancer Screening

All women with family members who had breast, ovarian, tubal, and/or peritoneal cancers

Medications for Breast Cancer Risk Reduction

Offer tamoxifen or raloxifene to women at high risk with low risk for adverse side effects

Mammography Screening

Women 50-74: biennial (every other year)

Women under 50: Take the patient's factors into context and weigh benefits and risks

Women >75: not recommended to get screening

Breastfeeding recommendations

Interventions to educate and encourage women during pregnancy and postnatal period to breastfeed

Carotid Artery Stenosis Screening

USPSTF DOES NOT recommend screening for the general population for asymptomatic carotid stenosis

Diagnostic Test for Carotid Artery Stenosis

Ultrasonography of Carotid Artery with Doppler flow

High Intensity Statin

Lowers LDL-C by >/=50%

Atorvostatin 40-80 mg

Rosuvostatin 20-40 mg

Medium Intensity Statin

Lowers LDL-C by 30-50%

Atorvostatin 10-20 mg

Rosuvostatin 5-10 mg

Simvastatin 20-40 mg

Provastatin 40-80 mg

Lovastatin 40 mg

Fluvastatin 40 mg BID

Low Intensity Statin

Lowers LDL-C by

Cervical Cancer Screening

Women 21-65 Pap smear with cytology Q3 years

Women 30-65 Pap smear with HPV testing Q5 years

Cervical Cancer Screening Exemptions

Women >65 years with previously normal screenings

Women who had a hysterectomy with removal of the cervix and no history of precancerous lesion

High Grade Intraepithelial Lesion Treatments

Cryotherapy, laser therapy, loop excision and cold knife excision

Early Stage Cervical Cancer Treatment

Surgery or chemoradiation

Ottawa Rules for Ankle

XR required if 1/3:

Tenderness at posterior edge of lateral malleolus

Tenderness at posterior edge of medial malleolus

Inability to bear weight both immediately after injury or in the ED

Ottawa Rules for Foot

XR required if 1/3:

Tenderness at base of 5th metatarsal

Tenderness at navicular

Inability to bear weight both immediately after injury or in the ED

Exceptions to the Ottawa Rules

Inebriation/uncooperative patient

Other distracting painful injuries that cloud the perception of pain in the regions listed in rules

Diminished sensation in legs

Gross swelling which prevents palpating of medial malleolus

**Patient is under 18 years old***

Ottawa Rules for Knee

Age >55

Isolated tenderness of patella

Tenderness at head of fibula

Inability to flex 90 degrees

Inability to bear weight both immediately and in the ED

Chlamydia and Gonorrhea Screening for Women

Women <24 who are sexually active

Women >24 with risk factors identified

Risk Factors for Gonorrhea/Chlamydial Infection in Women

Age 20-24

New sex partner

More than 1 sex partner

Sex partner with concurrent sex partners

Sex partner with an STI

Inconsistent condom usage

Previous or coexisting STI

Exchange of sex for money or drugs

Incarceration

Military recruits

Black and Hispanic

Screening Test for Gonorrhea/Chlamydia

Nucleic Acid Amplification Test (NAAT)

Screening for Chronic Kidney Disease

USPSTF has insufficient information to recommend screening for CKD in asymptomatic adults

Screening for COPD

The USPSTF DOES NOT recommend screening for COPD in asymptomatic adults using spirometry

Diagnosis of COPD

FEV1:FVC ratio of <70% with less than 12% reversibility

Colorectal Cancer Screening

Start screening at 50 years and continue until the age of 75 years

Screening Tests for Colorectal Cancer

Fecal Occult Blood Testing (annually)

Sigmoidoscopy (Q5 years)

Screening Colonoscopy (Q10 years)

Screening for Colon Cancer in Adults >75 years

76-85: recommendation against screening unless patient has risk factors

>85: do not screen as there is no net benefit

Screening for Congenital Hypothyroidism

All infants should be screened for T4 and TSH

Timing of Congenital Hypothyroidism Screening

Between 2-4 days of age

Treatment for Congenital Hypothyroidism

Confirmatory testing and thyroid hormone replacement within 2 weeks after birth

Dental Carries Prevention in Children Under 5 years

USPSTF recommends that fluoride should be prescribed for children 6 months to 5 years old if water is deficient in fluoride

Screening for Depression in Adults

Screen all adults 18+ when staff-assisted depression care supports are in place

Screening for Depression in Adolescents

Screen adolescents 12-18 years old for MDD when staff-assisted depression care supports are in place

Screening for DM Type 2 in Adults

Screen adults with sustained high blood pressure (treated or untreated) >135/80

Screening Tests for DM II

Fasting plasma glucose

2 hour post-load plasma glucose

HgbA1C

Fall Prevention in Older Adults

Exercise or physical therapy and Vit D supplementation to prevent falls in adults >65 years

Risk Factors for Falls

Age

Hx of falls

Hx of mobility problems

Poor performance on Get-Up-and-Go Test

Get-Up-and-Go Test

Time it takes for a person to rise from an armchair, walk 10 feet, turn, walk back and sit down

(Average healthy adult >60 years can do it in 10 seconds)

Folic Acid Supplementation in Pregnant Women

Take supplements with 0.4 to 0.8 mg of folic acid to reduce risk of NTDs

4.0 mg in women with a Hx of NTDs in prior pregnancies

**All women who are capable of pregnancy should take it**

Screening for HSV

USPSTF DOES NOT recommend screening asymptomatic pregnant women nor routine screening for asymptomatic adolescents and adults

Gestational Diabetes Mellitus Screening

Screen all pregnant women after 24 weeks of gestation

GDM Screening Test

50 g oral glucose challenge test (OGCT)

Positive OGCT?

(>130 mg/dL)

Do the 100 g oral glucose tolerance test (OGTT)

Interventions for Overweight/Obese Patients With Additional CVD Risk Factors

Behavioral counseling, with intense focus on healthful diet and physical activity, over an extended period of time

**Refer at a BMI of 30 + CVD risk factors**

Screening for Hearing Loss in Newborns

Screen all newborns

Screening Test for Newborns' Hearing

Otoaccoustic Emissions Test (OAE)

If failed OAE test, then follow up with Auditory Brainstem Response (ABR)

When to Screen Newborns for Hearing Loss

Before 1 month of age

Confirmatory testing before 3 months of age if failed first test

Screening for Hearing Loss in Adults

USPSTF has insufficient evidence to determine the benefits of screening for hearing loss in asymptomatic adults over the age of 50

Screening for Hepatitis B in Pregnant Women

Screen all pregnant women

Screening Test for Hepatitis B in Pregnant Women

HBsAg detection, regardless of previous negative HBsAg results

Timing of Screening for HBV in Pregnant Women

At first prenatal visit

At hospital for birth in women with unknown status or continuing risk factors for HBV infection

Treatment for HBV infection of pregnant women

Infants should receive HBV vaccine and HBIG within 12 hours of birth

Screening for HBV Infection in General Population

Screen all person at high risk for infection

Risk Factors for HBV Infection

Country of origin

Lack of immunization in persons with parents from a country/region with high prevalence

HIV infection

Injection Drug Users

Household or sexual contacts of HBV-infected persons

Male homosexuals

Hemodialysis

Immunosuppressive therapy

Treatment for HBV

Pegylated Interferon-Alpha-2a

entecavir

Tenofovir

Screening for Hepatitis C Infection in General Population

Screen all persons at high risk for infection

Screen adults born between 1945 and 1965

Screening Test for HCV Infection

Anti-HCV antibody testing, with confirmatory PCR testing

Risk Factors for HCV Infection

Past/present injection drug use

Sex with an injection drug user

Blood transfusion before 1992

Long term hemodialysis

Born to HCV-infected mother

Incarceration

Treatment for HCV Infection

Pegylated Interferon

plus

Ribavirin for 48 weeks

Screening for HIV

Screen in adolescents and adults aged 15-65 years

Screen younger adolescents and older adults at increased risk

Screen all pregnant women for HIV

Risk Factors for HIV Infection

Male Homosexuals

Active Injection Drug Users

Exchanging Drugs for Sex or Money

Sexual contact with a known HIV-positive individual

Screening Tests for HIV

Rapid screening test (positive results requires work up)

Serum testing: ELISA, followed by confirmatory Western Blot Immunofluorescent assay

Hyperbilirubinemia Screening in Infants

USPSTF has insufficient evidence to recommend screening for hyperbilirubinemia

Screening for Idiopathic Scoliosis in Asymptomatic Adolescents

USPSTF DOES NOT recommend screening for idiopathic scoliosis in asymptomatic adolescents

Screening for Intimate Partner Violence

Screen women of childbearing age for intimate partner violence and provide or refer women who screen positive to intervention services

Screening for Abuse of Elderly and Vulnerable Adults

USPSTF has insufficient evidence to recommend screening

Screening Test for Intimate Partner Violence

HITS (Hurt, Insult, Threaten, or Scream)

Screening for Iron Deficiency Anemia

USPSTF has insufficient evidence to recommend screening asymptomatic infants 6-12 months for Iron Deficiency Anemia

Screen all asymptomatic pregnant women

Iron Supplementation Recommendations

Routine iron supplementation for children aged 6-12 months at increased risk of developing Iron Deficiency Anemia

Routine supplementation for pregnant women with Iron Deficiency Anemia

Risk Factors for Developing Iron Deficiency Anemia

Rapid growth

Inadequate dietary intake

Blood loss

Decreased absorption

Prematurity

Screening For Lead Levels

USPSTF has insufficient evidence to recommend screening symptomatic children 1-5 years at increased risk

USPSTF DOES NOT recommend screening children 1-5 years with average risk

USPSTF DOES NOT recommend screening asymptomatic pregnant women

Screening for Lipid Disorders in Adults

Men >35: Screen them

Men 20-35: Screen if they have increased CVD risk

Women 20+: Screen them if they have increased CVD risk

Screening Test for Lipid Disorders

Lipid Panel: Total Cholesterol, LDL-C, HDL-C, Triglycerides

Screening for Lipid Disorders in Children 1-20

USPSTF has insufficient evidence to recommend screening children aged 1-20

Prophylactic Use of Aspirin in Pregnant Women

Low dose aspirin (81 mg) after 12 weeks in women at high risk for preeclampsia

Risk Factors for Preeclampsia

Hx of Preeclampsia

Multifetal gestation

Chronic HTN

DM

Renal disease

Autoimmune disease