What is a periodic health encounter?
An opportunity for prevention or early detection of health-related problems.
What factors influence the nature of a periodic health examination?
Age, sex, occupation, and psychosocial background of the patient.
What is LMCC Objective #74?
Perform an appropriate history and physical examination based on patient's characteristics.
What should be included in the initial management plan?
Effective communication with the patient and recommending proven prevention strategies.
What is the age of Robin, the case study patient?
25 years old.
What is Robin due for?
A pap test.
What should be asked regarding Robin's gynecological history?
Previous pap tests, menstrual history, abnormal discharge, STIs, contraception, and sexual history.
At what age did Robin first become sexually active?
Age 17.
What contraceptive method has Robin been using?
The pill.
Is Robin due for a pap test?
Yes.
When should cervical cancer screening begin according to Saskatchewan guidelines?
At age 25 or 3 years after first intimate sexual activity, whichever is later.
What is the recommended frequency for cervical cancer screening?
Every 3 years.
At what age can cervical cancer screening be discontinued?
At age 70 if there are 3 normal paps in the last 10 years.
What should be done for individuals aged 70 and older who are under-screened?
Initiate or continue screening with three annual Pap tests.
What is the recommendation for patients with severe autoimmune disorders regarding screening?
Screen annually for 25 years, may require more frequent screening if on long-term immunosuppressants.
What is the screening recommendation for patients with a total hysterectomy and previous CIN II or III?
Suggest annual vault smears for 25 years after the last treatment for high-grade dysplasia.
What should be done for patients under 24 years with ASC-US?
Repeat Pap test every 12 months for two years; refer for colposcopy if high-grade lesions are found.
What is the follow-up for patients 25-29 years with ASC-US?
Repeat Pap test every 12 months for two years; refer for colposcopy if either result is ASC-US or greater.
What is the procedure for patients over 30 years with ASC-US?
The lab performs HPV reflex testing; HPV Negative: routine screening; HPV Positive: refer for colposcopy.
What is the follow-up for patients under 24 years with LSIL?
Repeat Pap test every 12 months for two years; refer for colposcopy if high-grade lesions are found.
What should patients aged 25-49 with LSIL do?
Repeat Pap test every 12 months for two years; routine screening if both results are negative.
What happens for patients over 50 years with LSIL?
The lab performs HPV reflex testing; HPV Negative: routine screening; HPV Positive: refer for colposcopy.
What is the recommendation for high-grade squamous lesions (ASC-H)?
Refer all ages for colposcopy.
What should be done for patients with atypical glandular cells (AGC)?
Refer all ages to a specialist.
What is the follow-up for patients with adenocarcinoma in situ?
Refer all ages to a specialist.
What is the procedure for patients with squamous carcinoma?
Refer all ages to a specialist.
What is the recommendation for patients under 21 years regarding screening?
Do NOT screen under 21 years.
What type of carcinoma is mentioned?
Squamous carcinoma
What should be done for all patients with adenocarcinoma?
Refer all ages to specialist
Is this patient due for a pap? Option a)
Yes
Is this patient due for a pap? Option b)
No
Is this patient due for a pap? Option c)
Unsure
When should the patient have her next pap?
3 years
What STI screenings should be done annually for sexually active individuals under 25?
Chlamydia, Gonorrhea, Hepatitis B and C, Syphilis
When should STI screening be done during pregnancy?
1st and 3rd trimester
How often should MSM have STI screenings?
At least annually; every 3-6 months if at increased risk
What age should HIV testing be offered?
Aged 15-65 years
What conditions should Tom be screened for?
Colorectal cancer, Diabetes, Dyslipidemia, Osteoporosis, Prostate cancer, STIs
What are risk factors for developing Type 2 Diabetes?
Age >40, 1st degree relative with T2DM, high-risk population, Hx of prediabetes, GDM, macrosomic infant, end organ damage
What are microvascular complications associated with diabetes?
Retinopathy, Neuropathy, Nephropathy
What are macrovascular complications associated with diabetes?
Coronary Artery Disease, Cerebrovascular Disease, Peripheral Vascular Disease
What are some vascular risk factors for diabetes?
Low HDL, elevated TG, HTN, overweight, abdominal obesity, smoking
What is the recommended dyslipidemia screening frequency for men aged 40-75?
Every 5 years
What is the method for dyslipidemia screening?
Lipid/lipoprotein screening (non-fasting)
What lifestyle changes are recommended for hyperlipidemia therapy?
Smoking cessation, physical activity, Mediterranean diet
What did Tom's grandfather have at age 80?
Prostate cancer
What does the Canadian Task Force on Preventative Health Care recommend regarding prostate cancer screening?
They do not recommend routine screening for prostate cancer.
When does the CUA suggest starting PSA screening?
At age 50, or age 45 for those who are high risk.
What is the recommended PSA level frequency for testing?
PSA <1 = q4yr, PSA 1 – 3 = q2yr, PSA >3 = more frequent.
At what age should men discontinue PSA screening if PSA <1?
At age 60.
When should all men discontinue PSA screening?
At age 70 or if life expectancy is <10 years.
What preventative health investigations should be checked for Susan?
HbA1c, lipid panel, Pap smear, STI screening, mammogram, FIT, bone mineral density.
What is the breast cancer screening recommendation for ages 50-74?
Screening every 2 years.
Who requires annual breast cancer screening?
Patients with significant family history, previous lobular carcinoma in-situ, or breast density >75%.
What is the colorectal cancer screening recommendation for ages 50-74?
Screening every 2 years using fecal immunochemical test (FIT).
What are the high-risk factors for colorectal cancer screening?
Family history of HNPCC, FAP, or personal history of inflammatory bowel disease.
What is the recommended screening test for >2 first-degree relatives with colorectal cancer?
Colonoscopy starting at age 40 or 10 years younger than the age of diagnosis of the first-degree relative.
What is the screening recommendation for 1 first-degree relative with colorectal cancer?
Colonoscopy starting at age 40-50 or 10 years younger than the age of diagnosis of the first-degree relative.
What is the recommended screening for colorectal cancer for someone with no family history?
FIT q2yr, starting at age 50
What is the screening recommendation for someone with a mother diagnosed with colon cancer at age 45?
Colonoscopy q5yrs, starting at age 35
What is the screening interval for someone diagnosed with Crohn’s at age 27?
Colonoscopy q1-2yrs, 8-10 years after diagnosis
What is the goal of osteoporosis screening?
To find patients at high risk of fracture, not just low bone mineral density
What tool is suggested for osteoporosis self-assessment?
Weight (kg) - age (years); if <10, do a BMD
What is the recommended vitamin D intake for individuals aged 19-50?
400-1000 Units
What is the recommended calcium intake for individuals over 50 years?
1200 mg
What should be done for low-risk individuals regarding osteoporosis?
Recommend prevention strategies
What pharmacological therapies are available for osteoporosis?
Anti-resorptive and bone-forming therapies
What should be considered when prescribing osteoporosis medications?
Renal function, esophageal disorders, bariatric surgery
What is the recommended interval for re-testing BMD after starting medication?
Do not re-test within the first 5 years
What is the recommendation for individuals with moderate to high fracture risk?
Recommend prevention strategies and offer medication
What is important to consider during patient encounters regarding preventative health?
Check if the patient is up to date on their preventative health screening
What should be considered during any patient encounter?
Whether the patient is up to date on their preventative health screening.
What is the purpose of the screening guidelines referenced?
To provide recommendations for cancer screening and early diagnosis.
Where can you find the cervical cancer screening guidelines?
At http://www.saskcancer.ca/images/pdfs/health_professionals/clinical_resources/cancer_screening_guidelines_and_resources/CervicalCancerScreeningGuidelines.pdf
What does CANRISK provide information on?
It provides a risk assessment tool for chronic disease.
What is the focus of the 2021 Canadian Cardiovascular Society Guidelines?
Management of dyslipidemia for the prevention of cardiovascular disease in adults.
What is the publication date of the Canadian journal of diabetes article on diabetes screening?
April 1, 2018.
What type of imaging does the Canadian Urological Association recommend for prostate cancer?
Multiparametric magnetic resonance imaging.
What is the focus of the clinical practice guideline for osteoporosis?
Management and fracture prevention in Canada.
Where can the 2023 update for osteoporosis management be found?
At https://www.cmaj.ca/content/195/39/E1333
What is a periodic health encounter?
An opportunity for prevention or early detection of health-related problems.
What factors influence the nature of a periodic health examination?
Age, sex, occupation, and psychosocial background of the patient.
What is LMCC Objective #74?
Perform an appropriate history and physical examination based on patient's characteristics.
What should be included in the initial management plan?
Effective communication with the patient and recommending proven prevention strategies.
What should be asked regarding Robin's gynecological history?
Previous pap tests, menstrual history, abnormal discharge, STIs, contraception, and sexual history.
When should cervical cancer screening begin according to Saskatchewan guidelines?
At age 25 or 3 years after first intimate sexual activity, whichever is later.
At what age can cervical cancer screening be discontinued?
At age 70 if there are 3 normal paps in the last 10 years.
What should be done for individuals aged 70 and older who are under-screened?
Initiate or continue screening with three annual Pap tests.
What is the recommendation for patients with severe autoimmune disorders regarding screening?
Screen annually for 25 years, may require more frequent screening if on long-term immunosuppressants.
What is the screening recommendation for patients with a total hysterectomy and previous CIN II or III?
Suggest annual vault smears for 25 years after the last treatment for high-grade dysplasia.
What should be done for patients under 24 years with ASC-US?
Repeat Pap test every 12 months for two years; refer for colposcopy if high-grade lesions are found.
What is the follow-up for patients 25-29 years with ASC-US?
Repeat Pap test every 12 months for two years; refer for colposcopy if either result is ASC-US or greater.
What is the procedure for patients over 30 years with ASC-US?
The lab performs HPV reflex testing; HPV Negative: routine screening; HPV Positive: refer for colposcopy.
What is the follow-up for patients under 24 years with LSIL?
Repeat Pap test every 12 months for two years; refer for colposcopy if high-grade lesions are found.
What should patients aged 25-49 with LSIL do?
Repeat Pap test every 12 months for two years; routine screening if both results are negative.
What happens for patients over 50 years with LSIL?
The lab performs HPV reflex testing; HPV Negative: routine screening; HPV Positive: refer for colposcopy.
What should be done for patients with atypical glandular cells (AGC)?
Refer all ages to a specialist.
What is the recommendation for patients under 21 years regarding screening?
Do NOT screen under 21 years.
What STI screenings should be done annually for sexually active individuals under 25?
Chlamydia, Gonorrhea, Hepatitis B and C, Syphilis
What conditions should Tom be screened for?
Colorectal cancer, Diabetes, Dyslipidemia, Osteoporosis, Prostate cancer, STIs
What are risk factors for developing Type 2 Diabetes?
Age >40, 1st degree relative with T2DM, high-risk population, Hx of prediabetes, GDM, macrosomic infant, end organ damage
What are macrovascular complications associated with diabetes?
Coronary Artery Disease, Cerebrovascular Disease, Peripheral Vascular Disease
What are some vascular risk factors for diabetes?
Low HDL, elevated TG, HTN, overweight, abdominal obesity, smoking
What lifestyle changes are recommended for hyperlipidemia therapy?
Smoking cessation, physical activity, Mediterranean diet
What does the Canadian Task Force on Preventative Health Care recommend regarding prostate cancer screening?
They do not recommend routine screening for prostate cancer.
What is the recommended PSA level frequency for testing?
PSA <1 = q4yr, PSA 1 – 3 = q2yr, PSA >3 = more frequent.
What preventative health investigations should be checked for Susan?
HbA1c, lipid panel, Pap smear, STI screening, mammogram, FIT, bone mineral density.
Who requires annual breast cancer screening?
Patients with significant family history, previous lobular carcinoma in-situ, or breast density >75%.
What is the colorectal cancer screening recommendation for ages 50-74?
Screening every 2 years using fecal immunochemical test (FIT).
What are the high-risk factors for colorectal cancer screening?
Family history of HNPCC, FAP, or personal history of inflammatory bowel disease.
What is the recommended screening test for >2 first-degree relatives with colorectal cancer?
Colonoscopy starting at age 40 or 10 years younger than the age of diagnosis of the first-degree relative.
What is the screening recommendation for 1 first-degree relative with colorectal cancer?
Colonoscopy starting at age 40-50 or 10 years younger than the age of diagnosis of the first-degree relative.
What is the recommended screening for colorectal cancer for someone with no family history?
FIT q2yr, starting at age 50
What is the screening recommendation for someone with a mother diagnosed with colon cancer at age 45?
Colonoscopy q5yrs, starting at age 35
What is the screening interval for someone diagnosed with Crohn’s at age 27?
Colonoscopy q1-2yrs, 8-10 years after diagnosis
What is the goal of osteoporosis screening?
To find patients at high risk of fracture, not just low bone mineral density
What tool is suggested for osteoporosis self-assessment?
Weight (kg) - age (years); if <10, do a BMD
What should be done for low-risk individuals regarding osteoporosis?
Recommend prevention strategies
What pharmacological therapies are available for osteoporosis?
Anti-resorptive and bone-forming therapies
What should be considered when prescribing osteoporosis medications?
Renal function, esophageal disorders, bariatric surgery
What is the recommended interval for re-testing BMD after starting medication?
Do not re-test within the first 5 years
What is the recommendation for individuals with moderate to high fracture risk?
Recommend prevention strategies and offer medication
What is important to consider during patient encounters regarding preventative health?
Check if the patient is up to date on their preventative health screening
What should be considered during any patient encounter?
Whether the patient is up to date on their preventative health screening.
What is the purpose of the screening guidelines referenced?
To provide recommendations for cancer screening and early diagnosis.
Where can you find the cervical cancer screening guidelines?
At http://www.saskcancer.ca/images/pdfs/health_professionals/clinical_resources/cancer_screening_guidelines_and_resources/CervicalCancerScreeningGuidelines.pdf
What is the focus of the 2021 Canadian Cardiovascular Society Guidelines?
Management of dyslipidemia for the prevention of cardiovascular disease in adults.
What is the publication date of the Canadian journal of diabetes article on diabetes screening?
April 1, 2018.
What type of imaging does the Canadian Urological Association recommend for prostate cancer?
Multiparametric magnetic resonance imaging.
What is the focus of the clinical practice guideline for osteoporosis?
Management and fracture prevention in Canada.
Where can the 2023 update for osteoporosis management be found?
At https://www.cmaj.ca/content/195/39/E1333
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