Transcription
Hi everyone, welcome back to our YouTube channel. Today we'll be talking about a really high yield topic tested on all the USMLE exams. We'll go over the USPSTF guidelines for screening and vaccines. We'll start off the video by going over a rapid review of the guidelines and then we'll follow that up with high yield vignettes to ensure that we really know how these are going to be tested on exam day. Let's get started.
If you need some extra practice with questions, I've partnered with Truelearn to give you $25 off of the question bank. You can use the discount code success25 and I'll have the link in the description box below.
So, some general tips for this part of the exam. You need to know the USPSTF grades. So, grades A and B means that we recommend the guideline. C is based on an individualized risk and D is we don't routinely recommend this. Now when you look at a vignette, the age range and intervals are very important because that can help guide which answer to pick and be ready to apply the guidelines to the clinical vignettes like what's the best next step for management.
With that being said, we'll go over some of the high yield guidelines now. So, first we're going to talk about some of the cancer screening starting with breast cancer. So, women between ages 40 to 74 years old get a mammogram every 2 years. For cervical cancer, women between the ages of 21 to 29 get a pap smear every 3 years. Women from 30 to 65 get either a pap smear every three years or you can do HPV co-testing every five years or you can do both every 5 years. Never test anybody below the age of 21 for cervical cancer. For colorectal cancer, we do a colonoscopy every 10 years in adults 45 to 75 years. We repeat it in three years if there's an adenomatous polyp with villous or tubulovillous histology, high-grade dysplasia, or if the polyp size is 10 millimeters and greater. And in patients with inflammatory bowel disease, they need a colonoscopy 8 to 10 years after the diagnosis and then we repeat it every 1 to three years. For lung cancer, patients get an annual low-dose CT scan if they're between the ages of 50 to 80 years old with a 20 pack-year smoking history or more. Either they can be currently smoking or quit less than 15 years ago. And for prostate cancer, we don't routinely recommend it, but it can be a shared discussion in men ages 55 to 69. And we do a PSA screening if wanted. And in over 70 years old, we usually do not recommend a PSA screen.
Now, we'll talk about some infectious disease stuff. So, for HIV, we screen everyone ages 15 to 65 years old and all pregnant patients. For HEPC, it's a one-time screening for all adults ages 18 to 79, especially in IV drug users. For hepatitis B, we do a high-risk population screen. So high-risk means any immigrants from high prevalence areas, IV drug users, and males who have sex with males. For syphilis, we screen high-risk adults and all pregnant women. For chlamydia and gonorrhea, we screen sexually active women below the age of 25. And if they're 25 and older, we screen them there if they're at increased risk. And for TB, we screen high-risk populations like immigrants, prisoners, and immunocompromised patients. And of course, if they have symptoms, then you'd obviously want to test them for TB as well.
Next, we'll do some cardiovascular risk assessments. So for abdominal aortic aneurysm, we screen males smokers with a one-time abdominal ultrasound between the age of 65 to 75 years old. For hypertension, all adults above 18, we want to check their blood pressures at least annually. For diabetes and pre-diabetes, we check an A1C between the ages of 35 to 70 years old. And it's especially important in overweight and obese patients.
Now, next we'll be talking about statin use for primary prevention. So, this is recommended if your LDL is over 190 or in adults 40 to 75 years old with one or more cardiovascular risk factors like diabetes, hypertension, hyperlipidemia, and smoking who have a 10-year ASCVD risk of at least 10%. So for these patients, we'd prescribe a statin. Aspirin for primary prevention. However, it's grade C. So you can consider low-dose aspirin for adults between the ages of 40 to 59 at higher cardiovascular risk.
Next, we'll be talking about tobacco and alcohol use. So you want to screen all adults and provide cessation intervention and resources for these substances. For obesity, we want to screen all adults for obesity and offer weight loss counseling. Depression, you want to screen all adults and adolescents 12 years and older. Intimate partner violence is also really important. You want to screen all women of reproductive age. And folic acid supplementation is suggested for all women planning to become pregnant. And for osteoporosis, we screen women 65 years and older or if you're younger than this with risk factors like steroid use, smokers, and we do a DEXA or bone density scan to screen for osteoporosis.
Okay. So now we'll be talking about high yield vaccines. So herpes zoster, the shingles vaccine is recommended for patients 50 years and above. The pneumococcal vaccine is recommended for patients 65 years and above or younger if they're immunocompromised or have any kind of chronic disease. Influenza, we give every year in season. Tetanus, you give the Tdap once and then Td every 10 years. For asplenic and sickle cell patients, we want to give the pneumococcal, meningococcal, and the Haemophilus influenza type B vaccine. Now, other important things is that live vaccines such as MMR, Varicella, and Rotavirus, we want to avoid in pregnancy and immunocompromised states. And in pregnancy, Tdap, influenza, and COVID are really important vaccines to give.
Okay, so that summarizes all of the high yield screening and vaccine guidelines that we will commonly see tested on the exams. Now, what we'll do is we'll go over some high yield vignettes. So, I'll talk about a patient presentation. Go ahead, think about the answer, pause the video, and then resume when you feel ready. So, let's get started with the first one.
So, we have a 52-year-old woman who presents for a routine exam. She's asymptomatic and her last mammogram was 2 years ago. So this lady needs a mammogram. So remember, we do a mammogram every 2 years for females between the ages of 40 to 74. So she falls in this range. So we'll do a screening mammogram for her.
Next, we have a 24-year-old sexually active woman who presents for a wellness exam. So, this girl's going to need a pap smear. So, remember, she falls between the ages of 21 to 29. So, we'll do a pap smear now and every 3 years.
Next, we have a 46-year-old male who presents for his annual physical. He's a non-smoker, has no family history, and a normal BMI. So this guy needs a colonoscopy. So remember, we now start colonoscopy screening at 45 years old and we do it every 10 years if it's normal. Um, you can also do the FIT testing every year, but on exams, they mostly like to test us on colonoscopy. So, look out for that.
Next, we have a 77-year-old female with a 30 pack-year smoking history who quit smoking 5 years ago and she has no symptoms. So, this patient needs a low-dose chest CT. Remember, we do a low-dose chest CT every year between the ages of 50 to 80 with a 20 or more pack-year smoking history. And if they've quit less than 15 years ago, they also need this CT done.
Next, we have a patient who's a 25-year-old healthy male, sexually active with women, and uses condoms inconsistently. So, this patient should be screened for HIV and HEPC. Remember, HIV, we screen everyone 15 to 65 years old. And then for HEPC, it's a one-time screening for all adults 18 to 79. So, he falls in that range.
Next, we have a patient who's 22 years old. She's a woman who presents for contraception, no symptoms, and has one sexual partner. So for her, we want to test chlamydia and gonorrhea. Remember, in sexually active women less than 25 years old, we do the chlamydia and gonorrhea screen. So she fits in that category.
Next, we have a 60-year-old female with hypertension and hyperlipidemia and her ASCVD risk is 12%. What would you want to do for this patient today? So, we'd want to prescribe a statin for her. Remember, she falls in the age range of 40 to 75 and has that higher than 10% risk of cardiovascular events. So, she would benefit from a statin.
Next, we have a patient who's 26 years old. She's a female planning to conceive. She's up to date on all vaccines and screening tests, but she asks you about vitamins. So, what would you want to tell her today? So for this patient, we want to prescribe a folic acid supplement. You want to tell her to take folic acid daily to prevent neural tube defects if she gets pregnant.
Next, we have a 67-year-old female. She's up to date on her mammogram, pap smear, screening lab tests, and vaccines. What would you want to do for her today? So, this patient, you want to order a DEXA bone density scan. Remember, for women 65 years and older, need this DEXA scan to screen for osteoporosis. And if they mention somebody younger than 65, but maybe they were on steroid use, maybe they had a history of smoking or falls with fractures, um, these patients are also at higher risk of osteoporosis and we would also order this scan for them as well.
Next, we have a 66-year-old male with a 40 pack-year smoking history who quit 5 years ago. He has no symptoms. He had a negative low-dose CT test one month ago and he's up to date on all screening lab tests. What would you like to order for him today? So this patient needs the one-time abdominal ultrasound because he falls in the age range and he was a smoker at one point. So you know for anyone who's ever smoked, get a one-time abdominal ultrasound to assess for abdominal aortic aneurysm.
Next, we have a 28-year-old female who presents for an annual well-woman exam. She lives with her long-term partner. She's up to date on all screening labs and vaccines. When you ask her about stress or safety at home, she hesitates briefly, but then says everything is fine. What would you want to screen her for today? So, you want to screen this patient for intimate partner violence. And oftentimes in the vignette, they'll kind of mention, you know, things like she's going to hesitate. She might not make good eye contact. It might be really like subtle hints in the vignette. And, you know, when you're reading through the other answer choices, you can rule out all the other ones that don't really fit. Um, but otherwise, you know, all females should get screened for IPV. And you want to make sure they're safe, they have an escape plan in case something was to happen, and they have a safe place to go to. So, remember to look for that as other options in the answer choices.
Thank you so much for watching. I hope you found this really helpful. Like always, please feel free to reach out if you have any other questions. I wish you the best of luck with all of your studying and good luck with the exam.