Colon Cancer
The USPSTF recommends screening for colon cancer starting at this age
Age 45 (Grade 1A)
These are the 3 most common cancers in men and together account for 43% of all cancer cases in men
Prostate, lung, and colorectal
How do you dose NRT?
21 mg - 1 PPD
14 mg - 1/2 PPD
7mg - 1/4 PPD
2-4mg gum/lozenge prn
The USPSTF recommendation for breast cancer screening in average risk women
Age 50-74, q2 years, individualize decision in women 40-49
The LDL goal in secondary prevention of ASCVD
<70mg/dL
Name 4 disease that are associated with increased risk of colon cancer
-Hereditary CRC syndromes (FAP, JP, Lynch)
-Prior CRC
-Inflammatory bowel disease
-Abdominopelvic radiation
-Cystic fibrosis (screening benefit less clear)
What is the recommended age to initiate discussion of PSA screening and shared decision making for average risk patient? High risk? Name 2 high risk groups.
Age 50 for average risk, 40-45 for high risk (family hx, black men), usually until age 75 or <10 year life expectancy
These are the 3 medication options to assist with smoking cessation
NRT (short & long acting), bupropion, varenicline
The USPSTF recommendation for cervical cancer screening
Pap smear q3 years for women aged 21-65, or cotesting with pap + HPV q5 years women 30-65
Age to begin screening for diabetes in obese/overweight patients
Age 35
Name 4 colorectal cancer screening options
1. Colonoscopy q10 years
2. High sensitivity FOBT or FIT q1 year
3. FIT-DNA (Cologuard) q1-3 years
4. Flexible sigmoidoscopy q5 years
5. CT colography q5 years
6. Flexible sigmoidoscopy q10 years + annual FIT
What two questions comprise the PHQ2 depression screen? What is considered a positive screen?
During the past two weeks:
-have you often been bothered by feeling down, depressed, or hopeless?
-have you often been bothered by having little interest or pleasure in doing things?
A single "yes" response indicates possible clinically significant depression
Annual low dose chest CT for lung cancer screening is indicated in this patient population per USPSTF guidelines
Age 50-80 with at least a 20 pack-year smoking history, and either current smokers or former smokers having quit within the past 15 years. Screening should be discontinued once the individual has not smoked for 15 years or has a limited life expectancy. Grade 2B
Give me 5 lifestyle recommendations for losing weight
-Eliminate sugar sweetened drinks
-Increase vegetable and protein intake to increase satiety
-Reduce processed carbs and refined sugars to reduce cravings
-Light walking, frequent movement (more intense exercise, while cardiovascular healthy, often leads to higher caloric intake
-Eat fruits in whole form (fiber), avoid juices
-Keto, IF are effective in some patients
(Calories In, Calories Out is misleading at best, most nutrition scientist now embrace a hormonal model of weight gain related to insulin response which trigger storage of calories as fat)
Risky drinking is defined as >14 drinks/week or 4 drinks in a day for men, >7 drinks/week or 3 drinks in a day for women and adults>65. What medication options exist for alcohol use disorder?
1st line: Naltrexone, acamprosate
2nd line: Disulfiram, topiramate, gabapentin
Recommended interval for surveillance colonoscopy for patient with sessile serrated or adenomatous polyp >10mm
3 years
Explain why PSA screening is controversial
For prostate cancer screening to be valuable, it must reduce disease-specific morbidity and/or mortality by detecting cancer at an early stage. However, detection at an early stage does not necessarily correlate with a clinically beneficial outcome (eg, decline in morbidity or mortality due to prostate cancer). Increased detection of prostate cancer subjects some patients to the risks associated with treatments that may not prolong life and that have risks of morbidity.
What is the recommended management of an incidentally detected 12mm pulmonary nodule, no prior imaging for comparison?
-Assess risk
-Low risk, repeat Chest CT in 3 months
-Intermediate/high risk, biopsy or resection
Name 5 factors that make a woman higher risk for breast cancer
-Personal history of breast, ovarian, tubal, or peritoneal cancer
-Family history of breast, ovarian, tubal, or peritoneal cancer
-Ancestry (eg, Ashkenazi Jewish) associated with BRCA 1/2 mutations
-Known BRCA 1/2 or other hereditary breast and ovarian cancer syndrome in self or relative
-Previous breast biopsy indicating high-risk lesion (eg, atypical hyperplasia)
-Early menarche, later first live birth, fewer pregnancies, late menopause
-Radiotherapy to the chest between age 10-30
AAA screening is indicated in this patient population
Men ages 65-75 with hx smoking or fam hx AAA needing repair
What is the most common cause of inherited colorectal cancer? What are the screening recommendations for this patient population?
-Lynch syndrome (hereditary nonpolyposis colorectal cancer, mutation of DNA mismatch repair genes)
-Screening colonoscopy q1-2 years beginning at age 20 to 25 years, or 2-5 years prior to the earliest age of CRC diagnosis in the family (whichever comes first)
-Also associated with endometrial, ovarian, and stomach cancer
All adults should get a one time HCV screening.
1) Adults born during this time period are at increased risk of Hepatitis C
2) Name 4 other high risk groups
1) 1945-1965 (before blood supply was screened)
2) HIV, past or present chronic hemodialysis, currently or previously incarcerated, MSM, or reside in a high-prevalence country
55M with no PMH comes to establish care after hospitalization for SBO. Incidentally discovered 3 cm solid, enhancing, exophytic mass of R kidney, pulmonary nodules, mediastinal adenopathy. Told to f/u with PCP. What's the best next step?
EBUS w/ biopsy of mesenteric adenopathy
Typical urology management of small kidney mass (likely RCC): thermal ablation, partial/complete nephrectomy, watch & wait
1) Age to begin screening for osteoporosis
2) Recommended treatment for postmenopausal woman with osteopenia (including dosage)
1) 65
2) 1200mg calcium (diet + supplement) & at least 800IU vitamin D. Caltrate 600-800 1-2 tabs depending on diet.
You have a 45M, white, current smoker, HTN controlled on lisinopril 5mg, physically active as roofer, A1c 6.2, total cholesterol 250, HDL 39. What is his ASCVD risk?
-11%, decreases to 4.2% after quitting smoking
-Discuss smoking cessation options and statin