Primary Care Primer

1. A 30 yo G2P2002 presents for routine care. She had gestational diabetes in her last pregnancy, and her delivery was complicated by a shoulder dystocia. She completed a 2 hr glucose tolerance test 6 weeks postpartum which was normal. She has heard that she’s at increased risk for type II diabetes. How often should she be screened for diabetes?

Every year for the next 5 years

Every 2 years for the rest of her life

Every 3 years for at least 10 years

Every 6 months for 1 year then every year for 3 years

She does not require screening until she reaches the age of 40

Show Explanation

The USPSTF recommends screening for abnormal blood glucose every 3 years in adults aged 40 to 70 years who are overweight and obese. Other risk factors for diabetes that may require early screening include history of PCOS and those with a family history of diabetes. The WPSI (Women’s Preventive Services Initiative) recommends screening non-pregnant women with a history of gestational diabetes every 3 years for at least 10 years after pregnancy.

2. A 52 yo female presents for routine GYN care. She cannot find a primary care provider. She would like to undergo any health screening that you would recommend. Specifically, she recalls that her mother had high cholesterol. How often would you recommend screening and what level of LDL would you consider to be consistent with dyslipidemia?

Show Explanation

The USPSTF recommend universal lipid screening in adults age 40 to 75 and calculation of a 10-year risk of a cardiovascular event. Measurement of lipid should occur every 5 years in 40-75 years. Lipid screening includes measurement of total cholesterol, LDL and HDL. USPSTF recommends starting a low- to moderate- dose statin in patients who have: age 40-75 and have one or more risk factors for CVD (diabetes, dyslipidemia, HTN, smoking) and have a calculated risk of CVD score of 10% or greater. Statins can be considered in those with a risk of 7.5% or greater as well. The 10-year risk can be determined using a calculator from the ACC/AHA.

3. Colorectal cancer screening begins at age 50. Many patients are reluctant to undergo colonoscopy. Which of the following is not an appropriate alternative to colonoscopy for colorectal cancer screening?

Guaiac-based fecal occult blood test every 1-2 years

CT Colongraphy every 5 years

Rectal exam every year

Fecal immunochemical test every 1-2 years

Flexible sigmoidoscopy every 5 years

Show Explanation

Colorectal cancer is most common among adults over the age of 50. Screening options between age 50 and 75 include guaiac-based fecal occult blood test, fecal immunochemical test or multitargeted stool DNA test every 1-2 years, flexible sigmoidoscopy or CT colongraphy every 5 years or colonoscopy every 10 years. Black women and those with a family history of colorectal cancer have increased risks and may consider screening at earlier ages.