PAP 540

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Author:
ckitejr
ID:
297606
Filename:
PAP 540
Updated:
2015-03-05 10:11:25
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Counseling Preventative Medicine
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Topics for mid-term exam on Counseling for Preventative Medicine
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  1. 10 most common "genetic" disorders
    • familial combined hyperlipidemia
    • familial hypercholesterolemia
    • dominant otosclerosis
    • adult polycystic kidney disease
    • multiple exostoses
    • Hunington disease
    • Fragile X
    • Neurofibromatosis
    • Cystic fibrosis
    • Duchenne muscular dystrophy
  2. Indications for genetic counseling referral
    • developmental delay
    • multiple café-au-lait spots
    • dysmorphic features
    • tall and thin
    • failure to thrive
    • multiple fractures
    • cyclic vomitting
    • seizures
    • hyperflexible joints
    • newborn screening follow up
  3. down syndrom
    • trisomy 21
    • mental retardation and atypical facial appearance
    • 40% have cardiac defects
    • risk for hypothyroidism, leukemia, early onset AD
  4. Turner syndrome
    • only affects females
    • congenital heart defects common, webbed neck, broad chest
    • risk for hypothyroidism, diabetes, juvenile arthritis, aneurysms, sensorineural hearing loss
  5. Klinefelter syndrome
    • only affects males
    • tall stature, hypogodnadism, decreased testosterone after puberty
    • risk for hypothyroidism, breast cancer, autoimmune disease
  6. DiGeorge syndrome
    • hypokalemic seizures in newborn, cardiac defect, cleft palate
    • risk for hypothyroidism, hypocalcaemia, schizophrenia
    • inherited dominant condition
  7. Cystic fibrosis
    • more common in northern European ancestry
    • risk for infertility in males and decreased fertility in females
  8. Achondroplasia
    • short-limbed dwarfism, large head, frontal bossing
    • risk for cord compression and foramen magnum stenosis
  9. Prader-Willi syndrome
    • infant with hypotonia and poor feeding
    • affects males and females
    • developmental delays and mild MR
    • risk for obsessive eating
    • skilled at jigsaws
  10. Angelman Syndrome
    severe MR, seizures, microcephaly, inappropriate laughter
  11. Duchene Muscular Dystrophy
    • x-linked
    • MR with autistic features
    • large jaw, long face, Parkinsonism
    • shows anticipation in pedigree
  12. Neurofibromatosis
    • café-au-lait spots, axillary freckling, inguinal freckeling
    • autosomal dominant
    • 50% new mutations
  13. Marfan syndrome
    • tall stature, long and thin limbs, pectus excavatum, flexible joints
    • Ghent criteria for diagnosis
  14. Osteogenesis imperfecta
    frequent fractures, blue scalera, poor dntition
  15. Warning signs for suicide
    Mental illness, major depression, male, >45, access to lethal means, drug EtOH use,
  16. Primary Prevention
    • prevention of Dz before onset
    • ex. STD prevention education, seatbelt use, sunscreen
  17. Secondary Prevention
    • Dz detection at an early stage
    • ex. colonoscopy, mammograms, PAP smears, PSA, hearing tests
  18. Tertiary prevention
    • prevention or delay of Dz progression
    • ex. medications for HTN, surgery
  19. World Health Organization Guidelines for Dz screening
    • condition is important health problem
    • Tx exists for the Dz
    • facilities for Tx are available
    • latent stage of Dz
    • there is a test for Dz
    • the test is acceptable to the population
    • the natural Hx of Dz should be understood
    • an agreed policy on who to Tx
    • cost of finding a case should be balanced to medical expenditure as a whole
    • case finding should be a continuous process
  20. Prevention vs Intervention
    • Prevention--stop Dz before it starts
    • Intervention-curative or palliative measures
  21. Most common causes of preventable death in US
    • Heart disease
    • cancer
    • chronic lower respiratory distress
    • stroke
    • unintentional injuries
    • AD
    • DM
    • Influenza
    • Suicide
  22. Goals of Healthy people 2020
    • reduce preventable diseases, disability, injury and premature death
    • eliminate disparities among demographics
    • create healthy social and physical environments
    • promote quality of life, healthy development, and healthy behaviors across all life stages
  23. Immunizations & Infectious Dz
    • by age 2 infants should have 25 doses to prevent 13 childhood diseases
    • influenza and pneumococcal for those older than 65
    • see CDC recomendations
  24. Health Maintenance Screening
    pediatric
    • child maltreatment
    • drug use
    • obesity
    • skin cancer
    • tobaccos use in school age
  25. Health Maintenance Screening
    adolescent
    • EtOH and drug abuse
    • STI screening for sexually active teens
    • depression screening
    • child maltreatment
    • obesity
    • skin cancer
    • tobacco use
  26. Health Maintenance Screening
    adult
    • EtOH misuse
    • BRCA risk assessment
    • Breast feeding
    • healthy diet
    • obesity
    • STI counseling
    • skin cancer
    • tobacco use
  27. Health Maintenance Screening
    elderly
    • EtOH misuse
    • Fall prevention conseling
  28. Sporadic cancer
    • average risk 70-80%
    • no family history
    • no other risk factors
  29. Familial cancer
    • 15-20%
    • a few family members with cancer
    • average age of onset for cancers
    • do not have more than one primary cancer
    • familial concern is a combination of inherited and environmental factors
  30. Inherited cancers
    • 5-10%
    • multiple family members with same or related cancers
    • earlier than average age of diagnosis
    • more than 1 primary cancer in a single individual
  31. BRCA 1 Cancer risks
    • breast cancer 60-85% risk
    • ovarian up to 60% risk
  32. BRCA 2 cancer risks
    • Breast 60-85%
    • ovarian up to 27%
    • prostate cancer
    • pancreatic cancer
    • melanoma
  33. Ancestry with increased risk fro BRCA
    • Ashkenazi jews
    • Dutch
    • Icelandic
  34. Breast Cancer Screening Recommendations with BRCA 1 and BRCA 2 mutations
    • annual mammogram
    • annual breast MRI starting age 25-30
    • clinical breast exams every 6mo
    • self breast exams
  35. Ovarian Cancer screening w/ BRCA 1 & 2
    • transvaginal US every 6mo starting at age 35
    • CA-125 blood test
  36. Male screening recommendations for patients with BRCA 1 & 2
    • monthly self breast exam
    • clinical exam every 6 mo
    • baseline mammogram
    • adhere to screening guidelines for prostate cancer
  37. HNPCC
    • Hereditary Non-Polyposis Colorectal Cancer (Lynch Syndrome)
    • Dx with Amsterdam criteria
    • Lynch related cancers: CRC, endometrial, gastric, small intestine, hepatobiliary, renal pelvis, ureteral
  38. Screening recommendations for HNPCC
    • colonoscopy 1-2 years
    • endometrial biopsy pelvi US
    • endoscopy 1-2 years
    • UA-cytology
  39. Adolescent Sex Facts
    • 1/4 self-declared virgins have had oral sex
    • CDC says 1/2 of high school students have had sex
    • 19 of 100 young women get pregnant using withdrawl as only birth control method
    • 40% of 3 million new cases of chlamydia are in Pt ages 15-19
    • teen pregnancy is at lowest rate in years
  40. SPIKES for delivering bad news
    • Set up the interview
    • Perception--obtain pt's perception
    • Invitation--be sure pt invites you to discuss
    • Knowledge and information--provided to pt
    • Emotions--empathy to pt's emotions
    • Set goals
  41. FEARED for delivering bad news
    • Facts--get all of them
    • Express empathy and educate
    • Anger--search for resources to address
    • Recite--have pt recite understanding of situation
    • Evaluate--the understanding of other family members
    • Documentation of the conversation
  42. Specific techniques for deliverying bad news
    • avoid apologizing
    • warning shot
    • active listening
    • body language
    • tone modulation
  43. Nicotine withdrawal symptoms
    • irritability frustration anger
    • anxiety
    • restlessness
    • frustration
    • cravings
    • insomnia
  44. Five A's for clinical practice
    • Ask--identify tobacco users at all visits
    • Advise--urge users to quit
    • Assess--willingness to quit
    • Assist--aid pt in quitting
    • Arrange--ensure follow-up care
  45. Smoking cessation strategies
    • Pharmacology (NRT) + counseling
    • Bx counseling
    • practitioner guidance
    • cold turkey
  46. Medications for smoking cessation
    • Bupropion--S/E dry mouth, rash, HA dopaminenergic C/I with seizure disorder
    • Chantix--S/E nausea, constipation C/I with renal failure
  47. Stages of behavioral change
    • Pre-contemplation--No
    • Contemplation--maybe
    • Preparation--yes
    • Action--doing it
    • Maintenance--living it
    • Relapse--opps
  48. Precontemplation intervention
    • ask permission
    • get Pt's thoughts
    • gently point out discrepancies
    • express concern
    • give pt homework between visits
  49. Contemplation strategies
    • elicit pt's perspective
    • identify pros and cons of change
    • ask what would promote commitment
    • suggest trials
  50. Preparation strategies
    • summarize pt's reasons for change
    • negotiate start date
    • encourage public announcement
    • arrange follow up shortly after start date
  51. Action strategies
    • show interest in plan specifics
    • discuss different between slip up and relapse
    • anticipate how to handle a slip
    • emphasize pros of changing
    • tweak action plan as needed
    • arrange for follow-up
  52. Maintenance strategies
    • show support and admiration
    • ask about feelings and support
    • assess waivering or slips
    • reflect on long term nature
    • address slips
  53. Relapse strategies
    • reframe as learning opportunities
    • ask about details of slips
    • remind of reasons for change
    • use when rather than if
    • relapse is common

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