Adult Screening Tests

Men between 65-75 years with a smoking history

Which population should receive an abdominal ultrasound? How often?

Women >65 years of age or post-menopausal women with one of the following (parental history of hip fracture, BMI<21, excessive alcohol use, smoking history, history of fragility fractures). A T-score <2.5 is positive for osteoporosis. A T-score between -1.0 and -2.4 is indicative of osteopenia

Who should receive a DEXA scan for osteoporosis screening? What T-score is positive for osteoporosis? Osteopenia

A CDT (carbohydrate-deficient transferrin) test for binge drinking (>5 drinks/day) over the past two weeks. A ethyl glucoride test is a urine test for alcohol exposure within the last three days. A PEth (phosphotidylethanol) test checks for alcohol consumption within the last month.

What test is used to determine if an individual has been binge drinking? Test for alcohol exposure within the last three days? Test for alcohol consumption within the last month?

Pap smear cytology for women between 21-29, every 3 years. hrHPV test for women >30 years of age. hrHPV every five years (can co-test with pap smear. Does not change screeing interval)

Who should receive a pap smear? How often? Who can receive an hrHPV (high-risk HPV) test instead? How frequently?

A pap smear returns with ACS-US. What is the next step?

If a woman with LSIL is under 25, a follow up pap at 1 year is sufficient. If she is 25 or older, a colposcopy is recommended

A pap smear returns with LSIL? What is the next step in a 22 year old woman? In a 29 year old woman?

CIN 1 should be followed within 12 months with a repeat pap or hrHPV test. Only treat with colposcopy if not cleared in 2 years. For CIN 2, LEEP is recommended, but can be conservatively managed, if a patient desires pregnancy, with colposcopy every 6 months for 2 years

A cervical biopsy of HSIL returns with a CIN diagnosis. What is the next step if it is CIN 1? If it is CIN 2?

A woman with a CIN 3 diagnosis requires an in-office LEEP (loop electrosurgical excision procedure), laser therapy, or cryotherapy. Surgeries under general anesthesia are cold knife conization or hysterectomy

What are next steps for a woman whose cervical biopsy returns with CIN 3?

ASC-H (atypical squamous cells-HSIL cannot be excluded) or HSIL

Which two cervical biopsy findings require an immediate colposcopy with biopsy?

Mammogram every year starting at 40, and every two years starting at 55

What are the current mammography guidelines according to the American Cancer Society?

Starting at 25, an annual breast MRI. Starting at 30, an annual breast MRI and mammogram until 75 years of age

What are the screening guidelines for women with the Brca1/Brca2 mutation?

Screening begins at age 45. For colonoscopy, every 10 years. For FIT testing, every year. For Fecal immunochemical-DNA stool test like Cologuard, every 3 years. Pathogenesis is commonly due to chromosomal instability due to APC (wnt signalling) or Kras (cell cycle “on” signal) mutations

For colorectal cancer screening, at what age should screening begin? What is the screening interval for colonoscopy? For FIT testing? For fecal-immunochemical DNA testing? Bonus question: what mutation accounts for 70% of colorectal cancer cases?

Each year starting in their 20s because lifetime CRC risk is >50%. Pathogenesis: mismatch repair DNA mutation leading to microsatellite instability (repetitive DNA sequences are known as microsatellites)

How often should patients with Lynch Syndrome receives colonoscopies? Starting at what age? What mutation type results in cancer within this population?

HbA1c every 3 years in all adults 35 years or older, or any adult with one of the following: PCOS, BMI>25, POC, 1st degree family hx, HTN, HLD

What are the guidelines for T2D screening?

All individuals under 26 should receive the HPV vaccine, with ages 11-12 being the most effective ages. For individuals above 27, the decision to be vaccinated depends upon risk for new virus exposure

Which age group should receive HPV vaccines? For which age group is the decision to receive the HPV vaccine dependent upon risk of new exposure (new or multiple sexual partners in the future)?

Adults 50 or older should receive the pneumococcal vaccine. If they received PCV15, they will need a booster of PCV23 at one year. If they received PCV20 or PCV21, one dose alone is fine

Which adults should receive the pneumococcal vaccine? Which vaccine requires a booster with PCV23 after one year?

Shingrix (herpes zoster vaccine) is recommended for adults 50 and older. A second dose must be administered 2 to 6 months later

At what age should an individual receive the Herpes Zoster vaccine? How many doses?

4 oz (or half of a cup) of prune juice in the morning on an empty stomach can resolve mild constipation within a month. For moderate constipation, increase to BID, with 4 oz in the morning and 4 oz before bed. Side effects are gas and diarrhea. It works because prune juice is a stimulant laxative high in sorbitol, which draws water into the gut through high osmolarity to soften stools and aid the movement of stool through the GI tract. Works within 6-12 hours.

What dose of prune juice is indicated for mild chronic constipation? For moderate constipation? What are the side effects? How does it work? How quickly?

Lifestyle changes: Increase water intake to at least 8 cups a day. Increase fiber intake with broccoli, leafy greens, beans, lentils, or with supplements like oat husk fiber, psyllium husk (Metamucil), or methylcellulose. Reduce amount of time sitting on toilet. Medications: Stool softener like docusate: 300-600 mg/day. Treat hemorrhoidal pain and bleeding: MPFF (micronized purified flavonoid fraction). Acute: 3000 mg/day for 4 days then 2000 mg/day for 3 days. Maintainence dose: 1000 mg/day. Sitz baths 10-20 minutes a day, up to 3xdaily

A patient with hemorrhoids, or suspected hemorrhoids, presents with a history of straining constipation. What do we recommend?

First line supplement: psyllium (metamucil) First line med for acute constipation: osmotic laxative like 17 g/dose Miralax (polyethylene glycol). If this fails, add stimulant laxative: bisacodyl (5-15 mg) works within 10 hours. If this fails, and stool is in the rectal vault, bisacodyl suppository. If stool is not visualized in the rectal vault, try adding pyridostigmine

What is the first line medication for acute constipation? What if these methods are unsuccessful? What if this new medication is unsuccessful (assuming we do not suspect a defecation disorder)?

Motion-sickness induced nausea: meclizine, an antihistamine

Chemotherapy-induced nausea:

What medications do we recommend for motion sickness-induced nausea? Chemotherapy-induced nausea? Delayed gastric motility-associated nausea?