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  #1  
Old 09-06-2012
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Arrow High-Yield Facts about Screening Tests

Age related screening tests:(please add any important concept).
1-Hypertension: all patient above the age of 18 year at every visit
2-Lipid screen:fasting cholesterol and LDL
*Men= above 35 year
*Women=above 45 year in both done every 5 years
*in high risk patient start at age of 20 year, done every year
3-Diabetes mellitus: fasting blood sugar
*at age >45 year at 3 year interval
* <45 year of age with risk factor (HTN, family Hx, over weight, PCOS, Hx of gestational diabetes, low HDL and high LDL )
4-Breast cancer: mammography (((lower mortality)))
*at age of 50—70 year, every 1—2 years
*Those are increase risk should screen at age of 40 year or 10 years before the age when a first-degree relative was diagnosed, whichever come first
5-Colon cancer:<A>- colonoscopy[COLOR="rgb(153, 50, 204)"](((lower mortality))) [/COLOR]
*start screening after age of 50 year= every 10 years
*if there is single family member with colon cancer= begin 10 years earlier than the family member developed their cancer or age 40, whichever is younger
* if there are 3 family member, 2 generation, or 1 premature before 50 year(HNPCC)= start screening at age of 25 with colonoscopy every 1—2 years
*if there is family Hx of FAP= start screening with sigmoidoscopy at age of 12 year every year
*if the patient has previous Hx of colon cancer= patient should have colonoscopy at 1 year after resection, then every 5 years
*All patient with confirmed colon adenomas, regardless of histological type should have full screening colonoscopy. If <2 tubular adenoma removed may followed up with colonoscopy every 5—10 years. If 3—10 tubular adenoma or villous adenoma or high grade dysplasia should have follow-up colonoscopy in 3 year
<B> fecal occult blood test(FOBT) + flexible sigmoidoscopy: every 5 years
<C> FOBT: every 5 years
6-Prostate cancer: DRE+PSA
* start at age of 50= every year
*before age of 40 if first degree diagnose before age of 65 year[COLOR="rgb(153, 50, 204)"](((not lower mortality)))[/COLOR]
7-Cervical cancer: Pap smear
*from 21—65 year
*after 3 years after being sexually active
Pap smear done every year until 3 consecutive –ve then every 2—3 years, and if HPV test is used perform every 3 year
8-AAA: U/S should do once in all male smoker older than 65 year
9-Osteoporosis: bone densitometry at age of 65 year
10-Barrett esophagus: endoscopy
*only metaplasia= every 2—3 years
*low grade dysplasia= every 6—12 months
11- Endometrial cancer : No proven screening test available
12- Ovarian cancer : No proven screening test available, but for postmenopausal women and those with high risk (family Hx, BRCA-1 mutation, Dermatomyositis, HNPCC) CA-125 assessment followed by transvaginal U/S if CA-125 IS >35 U/ml should be done

Last edited by heartbeat; 09-06-2012 at 01:53 PM.
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  #2  
Old 09-06-2012
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Cervical PAP smear starts at 21 yo regardless when patients start having sex
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Old 09-08-2012
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Quote:
Originally Posted by chienpolska View Post
Cervical PAP smear starts at 21 yo regardless when patients start having sex
Yes it's right, and there is mistake in KLN because guideline was changed
Quote:
In general, groups agree that you should have your first Pap smear at age 21:

The American Cancer Society (ACS) recommends having your first Pap smear at age 21.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends having your first Pap smear at age 21.
The U.S. Preventive Services Task Force (USPSTF) recommends that women begin Pap smear testing at age 21.
The Institute for Clinical Systems Improvement (ICSI) recommends that women begin Pap smear testing at age 21
Thanks friend
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Old 09-11-2012
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BREAST CANCER: use
Tamoxifen or Raloxifene: asymptomatic unproven cancer but family hx of 2 close relatives ( sister , mother)
Aromatase inhibs(anastrazole,letrazole)revent metastasis in proven cancer
Transtuzumab : use in her 2/neu +ve with proven cancer , not as prophylaxis
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Old 09-20-2012
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please help
which is true
Quote:
screening test of glaucoma: tonometry
*every year after age of 40 year in patient with risk factors present (increase IOP, family hx, black race, dm ).
*every 3--5 years between age of 40--60 year with no risk factors
*every 1--2 years after age of 60 years with no risk factors

OR
Quote:
there is no vidence to recommend for or against screening adults for glaucoma

Last edited by heartbeat; 09-20-2012 at 02:52 AM.
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Old 10-01-2012
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In September 2012, the U.S. Food and Drug Administration approved the first ultrasound system, the somo-v Automated Breast Ultrasound System (ABUS), for breast cancer screening specifically in women with dense breast tissue. ABUS is indicated as an adjunct to standard mammography for women with a negative mammogram, no breast cancer symptoms and no previous breast intervention such as surgery or biopsy.
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Old 10-01-2012
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In gestational Diabetes Mellitus, the best screening test is the 50 gram oral glucose tolerance test, not the fasting glucose, and the confirmatory test is the 3 hour 100 gram glucose tolerance test.

Source Uworld.
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  #8  
Old 12-23-2012
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Default Updated my previous thread

High-Yield Facts about Screening Tests

Screening for Breast Cancer
(((lower mortality))):
The USPSTF recommends biennial screening mammography for women aged 50 to 74 years every 1—2 years.
The USPSTF recommends against teaching breast self-examination (BSE).
The U.S. Preventive Services Task Force (USPSTF) recommends against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with an increased risk for deleterious mutations in breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2).
The USPSTF recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing.

*Those are increase risk should screen at age of 40 year or 10 years before the age when a first-degree relative was diagnosed, whichever come first.


Chemoprevention of Breast Cancer
The (USPSTF) recommends against routine use of tamoxifen or raloxifene for the primary prevention of breast cancer in women at low or average risk for breast cancer.
The USPSTF recommends that clinicians discuss chemoprevention with women at high risk for breast cancer and at low risk for adverse effects of chemoprevention. Clinicians should inform patients of the potential benefits and harms of chemoprevention.

Screening for Cervical Cancer (((lower mortality))) March 2012
The USPSTF recommends screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years or, for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5.
The USPSTF recommends against screening for cervical cancer in women younger than age 21 years.
The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.
The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion (i.e., cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer.

Colon cancer(((lower mortality)))
<A>- colonoscopy
*start screening after age of 50 year= every 10 years
*if there is single family member with colon cancer= begin 10 years earlier than the family member developed their cancer or age 40, whichever is younger
* if there are 3 family member, 2 generation, or 1 premature before 50 year(HNPCC)= start screening at age of 25 with colonoscopy every 1—2 years
*if there is family Hx of FAP= start screening with sigmoidoscopy at age of 12 year every year
*if the patient has previous Hx of colon cancer= patient should have colonoscopy at 1 year after resection, then every 5 years
*All patient with confirmed colon adenomas, regardless of histological type should have full screening colonoscopy. If <2 tubular adenoma removed may followed up with colonoscopy every 5—10 years. If 3—10 tubular adenoma or villous adenoma or high grade dysplasia should have follow-up colonoscopy in 3 year
<B> fecal occult blood test(FOBT) + flexible sigmoidoscopy: every 5 years
<C> FOBT: every 5 years

The USPSTF recommends against the routine use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent colorectal cancer in individuals at average risk for colorectal cancer.

Screening for Type 2 Diabetes Mellitus in Adults
fasting blood sugar
The USPSTF recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg.

*at age >45 year at 3 year interval
* <45 year of age with risk factor (HTN, family Hx, over weight, PCOS, Hx of gestational diabetes, low HDL and high LDL)
In gestational Diabetes Mellitus, the best screening test is the 50 gram oral glucose tolerance test, not the fasting glucose, and the confirmatory test is the 3 hour 100 gram glucose tolerance test.

Lipid screen:
fasting cholesterol and LDL
*Men= above 35 year
*Women=above 45 year in both done every 5 years
*in high risk patient start at age of 20 year, done every year

Screening for Carotid Artery Stenosis
The U.S. Preventive Services Task Force (USPSTF) recommends against screening for asymptomatic carotid artery stenosis (CAS) in the general adult population.


Aspirin for the Prevention of Cardiovascular Disease:

The USPSTF recommends the use of aspirin for men age 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage.
The USPSTF recommends the use of aspirin for women age 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage.


Screening for High Blood Pressure in Adults

The USPSTF recommends screening for high blood pressure in adults aged 18 and older.

AAA:
The USPSTF recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 who have ever smoked.
The USPSTF recommends against routine screening for AAA in women.


Screening for Coronary Heart Disease With Electrocardiography July 2012
The USPSTF recommends against screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate or high risk for CHD events.

Osteoporosis:
bone densitometry
The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men.

Barrett esophagus:
endoscopy
*only metaplasia= every 2—3 years
*low grade dysplasia= every 6—12 months

Screening for Asymptomatic Bacteriuria in Adults
The USPSTF recommends screening for asymptomatic bacteriuria with urine culture for pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit, if later.


Ovarian cancer September 2012
The USPSTF recommends against screening for ovarian cancer in women

Screening for Prostate Cancer May 2012
The USPSTF recommends against PSA-based screening for prostate cancer.

Behavioral Counseling to Prevent Skin Cancer May 2012
The USPSTF recommends counseling children, adolescents, and young adults aged 10 to 24 years who have fair skin about minimizing their exposure to ultraviolet radiation to reduce risk for skin cancer.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of counseling adults older than age 24 years about minimizing risks to prevent skin cancer.


Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions October 2012
The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women.
The USPSTF recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.


Screening for and Management of Obesity in Adults 2012
The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions.



In September 2012, the U.S. Food and Drug Administration approved the first ultrasound system, the somo-v Automated Breast Ultrasound System (ABUS), for breast cancer screening specifically in women with dense breast tissue. ABUS is indicated as an adjunct to standard mammography for women with a negative mammogram, no breast cancer symptoms and no previous breast intervention such as surgery or biopsy.


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  #9  
Old 01-19-2013
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Default Thanks so much for the useful post!

DM includes HbA1C as its screening tool

Aspirin can given as propylaxis for the diabetics whose age is > 30 yrs for stroke.
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Old 02-06-2013
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thank you for this post

The USPSTF recommends chlamydia and gonorrhea screening for all sexually active women younger than 25 years (including adolescents), even if they are not engaging in high-risk sexual behaviors.

The USPSTF found insufficient evidence to recommend for or against screening adults for glaucoma. A [draft] updated recommendation statement from April 2012 maintains this position (http://www.ncbi.nlm.nih.gov/books/NBK95371/)
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Old 02-19-2013
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Gestational Diabetes screening


Quote:
Originally Posted by neoeinstein View Post
First you need to do 50g OGTT, if >140 ➡ Proceed with FBS. What if >200? Proceed still

then FBS scenario#1 if >125 then STOP! it its OVERT DM
scenario#2 if >95, check previous 50g OGTT.
if previous 50g oGTT is >200 Stop! It is GDM
If previous 50g OGTT is <200 CONTINUE with 3h
I was reviewing this topic and this by far the best explanation.

So,

If 50g oGTT (Screening test) >200 + FBS >95 at the start of 100g OGTT-------> Gestational DM

If FBS >125 at the start of 100g OGTT --------------------------------> OVERT DM

In both cases DO NOT give 100g Glucose
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Old 02-20-2013
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Cool Aids meds side effects

zidovudine-- anemia

stavudine/daidenosine--pancreatitis/neuropathy

indinavir--kidney stones

all protease inhibitors--hyperglicemia/hyperlipidemia

no efavirenz on pregnancy


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