DIP Episode 325 - The Extremely HY Screening Guidelines Podcast

Okay, welcome. My name is Divine. This is another episode of the Divine Intervention Podcast and this is going to be episode 325 and this podcast is going to be a super super super super high-yout podcast. I imagine that this is probably going to be a podcast kind of like episode 37. So this is an updated screening guidelines podcast. It's going to cover pretty much all the screening guidelines you need to know for your exams. I'll be really surprised if you got a screening guideline question wrong if you master this podcast. I'm basically going to talk about every category that the MBME cares about. And then two quick announcements. The first one is many of us know that, you know, many of you listen to this podcast you know the Christian. You know I put these life lessons podcasts at the end of you know some of my podcasts and you know I've got in tons and tons of emails from people that have said that they found those life lessons to be beneficial. So I did actually start another website divininginterventionlifelessons.com and basically you know it's a lot of Bible-based teaching. Just very short podcasts they're basically like a bunch of life lessons. Pretty much all of them are going to be 10 minutes or less. Right now I actually have six episodes and I plan to keep adding more and more as time goes on.

Although you know every now and then I'll also slot in a few life lessons at the end of these podcasts but again I've kind of studied another website for that and even those podcasts that divine intervention life lessons podcasts. You can actually find them on Apple podcasts as well. They actually right now on Apple podcasts. That's one. And then the second announcement I want to make is if you're studying for a state of duty, state three or complex level two and three. I do have a course starting next week. I have a testing and strategy course next week Wednesday from two to four thirty p.m. Pacific Standard Time and then I have a very comprehensive review course taking place on Thursday Friday and Saturday next week. And basically we're going to be covering Pied's surgery, OBE Guy and I am Neural Psych, FX, Bio Stats, Healthcare Systems, Professionalism, Communications basically like the things covered on the USMLA exams. I am going to cover them in in that course. Again the course I kind of like where it is right now. It's very comprehensive to these parts of the exam. And in addition to that I try to keep the course updated very frequently so that because sometimes it's almost like you're in an arms race with the MBM and just want to make sure that you're up to date on everything. So we'll basically cover about 1700 scenarios across those three days that buttress those facts. They are multiple kinds of questions we use.

We use multiple choice, audience response, freestanding questions, vignettes, scenarios. By the end you'll feel very prepared. And again hundreds of people have taken these courses and I've had people do really well. I've had people get 250's, 260's, 270's from people doing these courses. I've seen many people have very good score improvements between when they before when they like comparing their scores before they took the course and after they took the course. So let's go ahead and get right into this screening guidelines. So the thing is these screening guidelines. So the next question I'm going to put them in seven categories. I think it's better to group them like this. If you're able to group them like this, then it's much easier to memorize. So unfortunately this podcast is something that will be good on key material. So listen to the podcast because the thing is I'll try to make some integrations along the way. They'll make it a little easier to remember. I'll give you some context. But again I'll encourage you to either take your notes and go over it over and over and over again or make your own on key cards and then go over it over and over again. The thing is this stuff is very important. Just you don't have to believe me but just check pretty much people that have taken the exam recently. They have tons and tons of questions on these screening guidelines. Like they've started putting just more questions on these screening guidelines.

So I'm really going to hit those hard. So the first category of people I would discuss are people that are pregnant. Right? People that are pregnant. So there are some high-eal things your friends at the MVM need you to know about screening guidelines in people that are pregnant. Right? So the first one for people that are pregnant are gestational diabetes. Right? Gestational diabetes is something we're about in pregnant women. You're going to start screening at around 24 weeks. Okay? You're going to start screening at around 24 weeks. And for the most part you're going to do that with a one hour oral glucose tolerance test. And then if that is positive you'll follow it up with a three hour oral glucose tolerance test. Now another thing you check pregnant women for is HIV. Right? So remember HIV is something you check actually at the first prenatal visit. You you check every pregnant woman for HIV at the first prenatal visit. Now one thing that's actually high you to know is that in addition to checking at the first prenatal visit you have to retest for HIV in the third trimester. Again because if you know woman has HIV you want to take certain measures. So she doesn't transmit it to the fetus. You don't have vertical transmission to the fetus. And then he be is also the third thing you test for you screen for in pregnant women is also he be right you test pregnant women for he be and usually for the most part start that at the first prenatal visit on in being exempts.

And usually you're going to do that with a he be surface antigen. And then you also check for syphilis right you also check for syphilis at the first prenatal visit. That's important to know. And then I'm definitely also screen women for at the first prenatal visit is a asymptomatic bacteria area right. So if you're a woman that has ever been pregnant and you go to the OB-GYN doctor they're going to tell you to pee in a cup at your first prenatal visit right. So they are checking you for your symptomatic bacteria area because remember if you have a symptomatic bacteria area it increases your risk of pretermly brain delivery. So you're checked for that right because remember normal women that are not pregnant non- pregnant women if they have no symptoms both the auring contains bacteria we don't treat but for pregnant women we make an exception. So if you don't have pretermly brain delivery so we treat. So we screen up that first prenatal visit if they have bacteria in the auring we're going to treat it we're going to treat it usually with nitrofure and towing. We're going to treat it with nitrofure and towing or you know one of those lorginarygenic cell phyllosporins and then after you treat it you need to actually do a test of cure. You need to do a test of cure. And then another thing you also screen pregnant women for. So this is the sixth thing is group E strep. You're going to screen for a group E strep. Remember that strep in galactia.

You're going to do that right between 35 to 37 weeks. You're going to figure out the woman's group E strep status. And then remember a woman's aurex status so determining if she's aurex positive or aurex negative and also determining her antibody status. Remember the antibody status is oh if you is obviously woman you check the aurex status right if it's positive or negative. And then the next thing you do if a woman is aurex negative right she will potentially make antibodies. So you check her antibody status by doing the indirect that's very high yield. The indirect comb test right that's something you gain you also do at the first prenatal visit. And remember women get a rogam if a woman is aurex negative she gets a rogam at around 28 weeks gestation and then she gets it within the first three days postpartum the second dose of rogam. So again in pregnant women don't forget to check for gestational diabetes don't forget to check for HIV don't forget to check for her B don't forget to check for syphilis don't forget to check for asymptomatic bacteria aurea don't forget to check for gruby strep and don't forget to check for the aurex status. I remember HIV is kind of unique you're going to test for that twice during pregnancy you're going to test for it at the first prenatal visit and then you're going to repeat it in the third trimester. Okay so that's category number one that's category A pregnant people.

Now category B are smokers right again these are just high risk populations that you can just pretty much tell well I'm going to get a question on the stuff on my exam.

So smokers the first thing I want you to keep in mind with screening these people for first is a triple A right and abdominal eortic aneurysm remember these people the the smokers that we screen for triple A right first you you need to be between the ages of 65 to 75 that's very high you to not need to be between the ages of 65 to 75 and we only screen men I'll just say this right now you should never screen women for triple A's on MB exams you only screen men for triple A's on MB exams right so it has to be a man has to be between the ages of 65 to 75 and it must be a guy that has smoked in the past right he must be a guy that has smoked if you've ever smoked as a guy or if you're a non-smoker as a guy but you have a family history of an abdominal eortic aneurysm then yes you do need to screen again between the ages of 65 to 75 and remember if you and you do that with an ultrasound and if you notice that the the persons the abdominal the abdominal eortic that diameter is you know more than 5 and a half centimeters so 5 and a half centimeters or higher then those people need intervention right you need endovascular repair of some sort and then one other thing you also screen for in smokers that's kind of unique is osteoporosis again remember we screen in women right so if a woman is on because normally for osteoporosis we screen study in a age of 65 with a dexter scan but in smokers in smokers you can actually start screening for osteoporosis if they are less than 65 right again with a dexter scan and you also do this early you know less than 65 years old osteoporosis screening if people are just high risk right in general those are people that are very thin right so let's say for example a man has an or X-ion or Vosa you're gonna screen a osteoporosis or let's say a man has premature variant failure that's another very good candidate for less than 65 years old osteop

orosis a screen and then the third thing you screen for in smokers is lung cancer right I'll say that again you screen smokers for lung cancer so what are the guidelines right for smokers with lung cancer the big big one I want you to keep in mind is if you need to first be between the ages of 55 to 80 that's a very important one between the ages of 55 to 80 and you must have you must meet certain conditions right so the first again condition is the is the again you must be between 55 to 80 and then you must have more than you know 30 or more pack years in terms of smoking history right 30 or more pack years in terms of smoking history and you either have to currently be smoking or have quit like less than 15 years ago right so let's say for example you have like a 30 pack year smoke a more than 30 pack year smoking history when you quit 30 years ago you're and you're between 55 to 80 you're not only eligible for lung cancer screen right as a smoker so you can remember you must have had more than a 30 pack or more year smoking history that's one two you must either still be currently smoking or quit less than 15 years ago and then three you need to be between the ages of 55 to 80 and how do you screen those people you're going to screen those people with a low dose CT scan I'll say that again you're going to screen those people with a low dose CT scan right again between the ages of 55 to 80 and guess what you only do that low dose CT scan three times if you notice that oh and you do it every year obviously that's the screening interval so if you do it every year three times and you notice that it's negative then you can stop those low dose CT scans in those people after that interval so again very very high you also know these screening guidelines again in smokers those are populations they love to test on exams now so that's category number two right so for smokers

we said again we're screening for triple lease we screened them for we talked about their screening for osteoporosis and then we also talked about their screening for lung cancer now let's jump on to the next category the next category of people are people that have special genetic diseases right so they're certain high old screening guidelines to know if you have a certain genetic disease right so the first one is if a person has familial hypercholesterolemia right these are people that get M Is at 20 like very early M Is in life remember most times when people have familial hypercholesterolemia they really have it because they have an LDL receptor mutation right they really have an LDL receptor mutation so they're not able to clear LDL from the circulation basically those people the easy way to remember the screening guidelines or obviously you're going to be checking the LDL cholesterol the key thing I want you to remember is just remember the rule of release that to three the rule of related to three what do I mean by that basically those people you start at the age of three you check their LDL cholesterol at the age of three years you check the LDL cholesterol at the age of nine years and then check the LDL cholesterol at the age of 18 years so you check it at three you check it at nine and check it at 18 and for the most part you even after the age of 18 you're gonna keep screening screening screening but again the MB means they're not gonna go into those murky orders on on exams now the second group of people would like again like a special disease that you need to screen for right is inflammatory bowel disease so we're pressing as inflammatory bowel disease it doesn't matter which type all sort of collides, curse disease literally doesn't matter those people need to be screened for colon cancer right they need to be screened for colon cancer in years after you m

ake the initial diagnosis of IBD so once you're diagnosed let's say you're diagnosed with inflammatory bowel disease in the year 2022 either or clinicalitis or current disease and hopefully you will not get that diagnosis God willing but let's say you get the person gets diagnosed in 2022 and you need to start screening them for colon cancer at in the year 2030 right in the year 2030 but there's a small exception to this rule right where you actually need to start screening a little earlier and this is actually if a person is diagnosed with primary sclerosis in colonitis for person is diagnosed with primary sclerosis in colonitis you need to actually screen them for colon cancer at the time of diagnosis that's very high yield you need to start screening them for colon cancer at the time of diagnosis and then you're gonna start screening or continue screening them for colon cancer every one to two years afterwards that's very important to know so a person has PSC at the time not eight years later at the time of diagnosis you need to start screening them for colon cancer and they need to do it for you know every one to two years afterwards now the next special genetic disease is a linch syndrome right HMPCC here are the three non polyposis are colorectal cancer remember these people tend to have like micro satellite instability problems so how do we screen these people for colon cancer well remember you're gonna start screening these people for colon cancer at the age of 20 right you need to start screening them at the age of 20 I need to do it every one to two years and many times these high risk colon cancer populations you're just gonna go straight to a colonoscopy I know that'll be messing around with fits test blah blah blah blah blah no just go straight to colonoscopy for these people but the thing is unfortunately linch syndrome causes many other problems besides

colon cancer right and your friends at the MbMe kind of care that you know some of these things so the thing is people that have linch syndrome again heritage and on polyposis colorectal cancer those people need to be screened for endometrial cancer studying that around the age of 30 and you need to do it every one to two years many times you're gonna do this screening with either an endometrial biopsy or endometrial sampling against studying at the age of 30 and you do it every one to two years right so an easy way to remember which one comes first remember C comes before in the alphabet so the C the colon cancer is that at age 20 right and again you do it every one to two years and many times those people you also give them like prophylactic aspirin aspirin actually lowers the presence risk of getting colorectal cancer especially in these people and then again the endometrial cancer the E starts at each 30 and again is every one to two years as well and one thing I will just encourage you to keep in mind because sometimes your friends at the MbMe they like you to know some prophylactic like surgeries and stuff you can bring people that have genetic disease right many of us have heard of how like if a person has MEN2 of MEN sort be it MEN2 or 2 B right you're gonna offer them a prophylactic thyroid dichotomy because it's not a matter of if they'll develop uh medallary thyroid cancer it's just a matter of when if they live long enough they will develop medallary thyroid cancer well that's same advice in a sense applies to people that have HNPCC those people you actually need to offer them a prophylactic hysterectomy after child bearing because again their risk of endometrial cancer is astronomically high their risk of ovarian cancer is also astronomically high so many times we offer these people a THBSO right so THBSO means a total abdominal hysterectomy and bilateral

salpingo upherectomy right so it's a surgery where you take out of them and ovaries have fallopian tubes and her uterus so we offer these to these people after child bearing that's very high to know for exams now the next special genetic disease I want to talk is familial adenomatos polyposis right so FAP right FAP remember FAP is an autosomodominant disorder right it's a problem with the APC gene right so many times those people have an APC gene mutation and that will give them all these polyps and then after that APC gene mutation they'll have a keras mutation and then after that keras mutation they'll have a p53 mutation and then that will drive them towards colorectal cancer so for those people you need to start screening them for colon cancer at the age of 10 years I need to do it every year I'll say it again you need to screen them for colon cancer starting at the age of 10 I need to do it every year and then the final genetic group that I'm going to talk about are people that have brachamutations right people that have brachamutations so the big thing I want to talk about with brachamutations is breast cancer so how to what are the breast cancer screening guidelines for people with brachamutations remember those people between the ages of 25 to 29 they deserve anual breast MRI so I'll say it again between the ages of 25 to 29 you deserve an anual breast MRI if you have a brachamutation but if you're over the age of 30 then you deserve anual breast MR Is plus mammograms so every year if you're over the age of 30 you have a brachamutation you did an anual breast MRI and an anual mammogram okay so that's the third category of people that I wanted to discuss right so again just to summarize we talked about the screening guidelines for people that have familial hypercholesterolemia for the people that have inflammatory bowel disease for the people that have primary

sclerosis colangitis for the people that have kidney trinom polyposis colorectal cancer for the people that have brachamutations and for the people that have APC gene mutations aka familial adenomatos polyposis now the fourth category of people I want to discuss are people that are I call them the risky sexual group right the risky sexual group the risky sexual group right so what do I mean by who when the risky sexual group well the risky sexual group are people that have HIV men that have sex with men i.v drug users sex workers people in that group right those are the risky sexual people that's category D right so for those people what are the screening guidelines for these people well the first thing you want to people to screen these people for is HIV right basically if you end up that's higher category area between the ages of 15 to 64 you deserve annual HIV screening that's very important to know for exams now the second thing here is these people if they have syphilis I mean you you need to screen them for syphilis every three months again these higher sexual individuals need to screen them for syphilis every every three months and then the third thing you want to screen these people for are chlamydia and gonorrhea because the thing is for the most part if you're less than 24 every female that is less than 24 years old is recommended that you screen them for chlamydia and gonorrhea but the thing is if you're over 24 and you're not high risk sexually you don't need to be screened for chlamydia and gonorrhea right so the thing is these people because they are high risk even over the age of 24 you're still going to screen them for chlamydia and gonorrhea remember the only people who screen you should screen on nbm exams for chlamydia and gonorrhea women don't screen men for chlamydia or gonorrhea on nbm exams and then the fourth thing you screen these people for i

s hebi right because again remember you can get hebi through sexual intercourse right so these people you screen them with the hebi surface antigen every year every year every year and also this will also applies to like an anti-vaxer let's say a person is like I don't want the hebi vaccine you can screen them with the hebi surface antigen every year so those are the people that fall into the high risk sexual category right this category number 4 category D right so again we talked about the hebi guidelines in these people the chlamydia gonorrhea guidelines in these people the syphilis guidelines in these people and the hebi guidelines in these people right now the next group of people I'll talk about the next category this category number five right so these are metabolic diseases right metabolic diseases these ones are floridly high autonofere exams right so the first one I'm going to talk about is hypertension right hypertension remember if a person is you need to screen high for hypertension it's like very very important on nbm's right and you screen for hypertension studying at the age of 18 right so between the ages of 18 to 40 you screen for hypertension every three to five years but once you get over the age of 40 you screen for hypertension every one to two years the reason we have a more frequent screening guideline if you get over the age of 40 is because obviously the incidence and the prevalence of hypertension is way higher over the age of 40 compared to the 18 to 40 age group all the life suspect that this guideline will change in the future because just again with the burden of metabolic disease in this country more and more people are getting like super high-pertensive very early in life because and those things you know obviously will destroy a person's kidneys now the third the next thing I want to discuss about in terms of screening diabetes right

so diabetes right so what do we how do we screen for diabetes basically the two groups of people who screen for diabetes just in general first things first are people that are obese on nbm exams if a person is obese and they're between the ages of 40 to 70 years old you need to screen them for diabetes every six months I remember there are many ways you can screen for diabetes you can do the fasting blood glucose which is 126 or higher or you can do and again I talked about this extensively my diabetes podcasts you can do the oral glucose tolerance test you can do the hemoglobin A1 C right there are many ways you can screen for diabetes right and then so first group if you're obese between the ages of 40 to 70 second group if you have hypertension if you have hypertension right basically if your blood pressure is over 135 systolic and 80 systolic then you and you're over the age of 45 you're 45 or higher you also need diabetes screening again every six months right so for the most part these higher age groups that I just mentioned again obese person between the ages of 40 to 70 high-pertensive person so blood pressure over 135 over 80 over the age of 45 you need to be screened this bill for diabetes every every six months right and then osteoporosis right I kind of talked about it already but you know smokers they have their special recommendation but if you're over the age of 65 and you're a woman we don't scream man for osteoporosis you're a woman we're gonna scream you at a dexascan right and we're gonna do remember we're looking for that t-score if your t-score is less than negative 2.5 then that's that you know if it's negative 2.5 or less that's that tells us you have osteoporosis you need to be placed on some kind of a disfossin it and then the final metabolic disease I think I'll talk is hyperlipidemia right so like LDL cholesterol right so the big thing I want

to keep in mind here is just really try to divide these people into three groups right there's the screening guidelines for men there's screening guidelines for women and the screening guidelines for diabetics that's very important to know so what's the screening guideline for men or for men basically the three tiers of men you can be between the ages of 2045 for those people we screen them every five years for hyperlipidemia basically everyone gets screened for hyperlipidemia studying at 20 if that if that's an easy athlete to remember right but for men again between the ages of 20 to 45 we screen every five years now if you're between the ages of 45 to 65 we're gonna screen you every one to two years we're gonna screen you every one to two years now if you go over the age of 40 over the age of 65 then we need to screen you hyperlipidemia every single year again just as a general concept for metabolic disease the screening guidelines get more frequent that order you become simple as that so again for men from 2045 every five years from 45 to 65 every one to two years over the age of 65 every year now for women the guidelines are similar but the thing is that study that each 20 will expand the range a bit more because women the risk of cardiovascular disease is not that high until they go past men or both right around the age of 55 so the thing is for women between the ages of 20 to 55 was screened for hyperlipidemia every five years but from 55 to 65 we do it every one to two years and then over the age of 65 we're gonna do it every year okay we're gonna do it every year now if you're a diabetic basically I'll just tell you this do you have diabetes is your LDL cholesterol over let me put it this way with screened diabetics for hyperlipidemia every year the end we're screened them for hyperlipidemia every year and remember if you notice that their LDL cholesterol is

70 or higher that's in milligrams per deciliter those people are going to be placed on a high intensity starting like a tuber starting or a zoova starting that's very important to know right so again kiki metabolic diseases we talked about screening for right we talked about hypertension we talked about osteoporosis we talked about diabetes and we talked about hyperlipidemia right so we should all know the screening guidelines for that now we're almost done with this podcast but the next report to talk about are cancers right cancers cancers cancers cancers cancers very very important to know right so the first one is colon cancer again I've kind of talked about colon cancer in some genetic diseases but let's talk about just like most you know pretty much everyone else right so the thing is colon cancer you start screening at the age of 50 now let me tell you this on an in-beaming exam you can see a person that is 45 or higher that needs colon cancer screening right the thing is the guidelines have changed relatively recently to where we can start screening people at age of 45 so that's something to keep in mind right so I will probably say that colon cancer screening should be done between the ages of 45 to 75 I'll say that again it should probably be done between the ages of 45 to 75 on in-beaming exams that's the screening interval now the thing is there are many different ways you can screen for colon cancer unfortunately all these different ways are very high you to know for exams right so you can do a colonoscopy every 10 years that's perfectly fine you can do flexible sigmoidoscopy every five years that's perfectly fine you can do flexible sigmoidoscopy every 10 years but the thing is if you're doing every 10 years you need to be doing a fit test like a fickle immuno test you're supposed to do that every year if you're doing the flexig every 10 years you can a

lso do the that FIT test again that fickle immuno test or the FOBT right the fickle or called blood test you know those hemocards you you can do those every year as well right and then another a new kid on the block that I suspect will gain wider spread acceptance in the future is CT colonography you can do CT colonography right basically is a CT scan that looks at your colon but it has like certain protocols that make it very highly sensitive for detecting colon cancer and you're going to do that every five years right so again just in summary you screen people for colon cancer and envy in exams you know outside of those genetic diseases I've talked about earlier between the ages of 45 to 75 and you're going to do that with colonoscopy every 10 years or you can do flexible sigmoidoscopy every five years or you can do flexible sigmoidoscopy every 10 years but you need to do a fit test a fickle immuno test every every year or you can do an FOBT or that again fickle immuno test every year or you can do CT colonography every five years now let me tell you this for all these other tests I've mentioned besides colonoscopy if any of those things are positive for malignancy or show you something that looks like malignancy your next best step in management on envy in exams is always going to be a colonoscopy with a biopsy is always always always going to be a colonoscopy with a biopsy right so that's the first one now the second cancer I'll talk about is breast cancer right remember breast cancer there are two guidelines that I used right there is the American Cancer Society guidelines that say started 40 and screened every year in women USPSTF says start at 50 do it between the ages of 50 to 75 and then do it every every two years every two years right so the thing is many people use the USPSTF guidelines but the thing is our friends at the mb me also use the ECS guidelines

so I would know both if I read you many times they will give you enough context in the exam question that will help you pick out the right answer ECS says pretty much start at 40 screen every year for as long as the woman has a decent life expectancy USPSTF says between 50 to 75 do it every two years that's obviously going to be with a with a mammogram and then cervical cancer right so what is the screening guidelines for cervical cancer this is actually like hot kicks for our friends at the mb me's right so this one you definitely want to make sure you know you know well but basically HPV I mean cervical cancer you're going to screen between the ages of 21 to 29 right and you're going to do that with a pap smear every three years between the ages of 21 to 29 you do it a pap smear every three years now if you're over the age of 30 right so if you're between 30 and 65 years old there's one of three modalities you can go with there is a preferred modality of the three but the other two are perfectly acceptable on mb me exams so the preferred modality is that you do a pap smear and HPV Quotesting every five years so a pap smear plus HPV Quotesting every five years that is the preferred modality for people between the ages of 30 to 65 for cervical cancer but between the ages of 30 to 65 some other options that are available to use you can do a pap smear every three years just like you did from 21 to 29 but again it's not preferred alternatively you can also do that HPV testing you can test for the hires HP Vs every five years if you're between the ages of 30 and 65 that's pretty much it right that's pretty much it in terms of those people but then there also unfortunately some other people that have again special cervical cancer screening guidelines one is if you have HIV if you have HIV or let's say you've had if you have some kind of immunodeficiency disease of some sort

those people that actually get pap smears every year that's very important to know so if you have HIV or some kind of immunodeficiency disease especially those T-cell immunodeficiency diseases like the George for example you need pap smears every year that's very important now another thing that's also helpful to know is his directemies and pap smears right so the thing is if a woman gets a hysterectomy for a b9 reason so let's say for a lyoma for example after that hysterectomy you still need to do pap smears the answer to that is no in those people you don't have to do pap smears but if a woman had a hysterectomy for a malignant reason cervical cancer or endometrial cancer or endometrial hyperplasia then those people they still need pap smears and you need to do those pap smears of the vaginal cough that's very high to know you need to do those pap smears of the vaginal cough in those people on an embankment exams and many times if you do a hysterectomy because of cervical cancer many times you're gonna keep doing those pap smears in those people for at least 20 years after the surgery was done 20 years after the hysterectomy was done and then one of the things that I think is important because again I want to be very thorough with the screening guidelines I essentially want you to listen to the podcast know all the screening guidelines and crush all these questions on exams so who remember I said that you can stop you know pap smears at the age of 65 or you know most women right now what are some things you want to keep in mind with stopping at 65 you stop at 65 when you meet two criteria one the person has no history of cervical cancer right or they have no history of like a very severe pap smears like like oh like HSIL or CIN3 or you know like really bad dysplasia right and they must have had three negative pap smears in a row right and must have had three negat

ive pap smears in a row or they may have they must have had like you know three negative I mean two negative like paps plus HPV Quotesten right so if you just doing straight-up pap smears you must have had three negatives in a row or if you're doing pap smears and the HPV Quotesten which is the preferred method over the age of 30 then if you have two of those negative in a row and you're again you're at 65 you can go ahead and stop you can go ahead and stop our pap smears in these people you can go ahead and stop pap smears in these people now the final category category number seven right so again just I guess to summarize what I've talked about already right for cancers I talked about colon cancer screening guidelines I talk about breast cancer screening guidelines I talked about cervical cancer screening guidelines again are there other guidelines beyond these yes they are what are they high you to know for the exam that's what our question is pretty much no right but the screening guidelines you see me discussing this podcast they are important for you to know for you to know for exams and then the final group of people category number seven just again just some grab bag once here there's not much here but basically remembering kids I guess the first thing I'll talk about here kids remember kids if you notice that they're having any language difficulties you need to screen they're hearing you need to check their hearing many times you're gonna do that with audiometry that's very important to know and remember for all kids between the ages of three to five years old you're gonna screen them from Bliopia basically like Lisia right you're gonna screen them from Bliopia once between the ages of three to five years old right and then remember many times we if you're less than 24 years old everyone that is female will screen them for gonorrhea and chlamydia right if you

're less than 24 years old remember if you're over 24 years old we only do that gonorrhea chlamydia screening if you're if you're high risk and then some weird ones because the thing is remember most times when people get hit being so that's the third one I'm gonna discuss most people that get hit be many times they get it from blood transfusions but remember you don't only get it from blood transfusions again if you are intimately working with blood you can get hit be right so if a person is doing a lot of dialysis remember dialysis you're literally like circulating these people's blood through like many different machines right those people they actually need hit be screening every year right or let's say a person is immunosuppress let's say they're on like chemotherapy or though like long-term chemotherapy or long-term immunosuppressive therapy because they are you know like post transplant patients those people again need hit be screening every year they need hit be screening every year with the head be surface antigen and then remember again as I said for gonorrhea chlamydia we don't screen men for that on MMM exams we screen only women right and remember hep C you deserve a one-time hep C screening usually if you're between everybody between the ages of 18 to 79 between the ages of 18 to 79 you deserve a one-time hep C screening right and then don't forget that we also screen people for depression with you know these fancy questionnaires like the actually not fancy they are easy questionnaires like the PHQ9 or the BECS depression inventory right so those are the things you can you can use right so again to summarize the seven categories of people we talked about in terms of screening today category number one where people that were pregnant we talked about gestational diabetes HIV, hebi, syphilis, asymptomatic bacteria, group B strap, right, arach status right a

nd then category number two we talked about where smokers for smokers we talked about the triple E screening we talked about osteoporosis screening especially with them being less than 65 and then we talked about the lung cancer screening guidelines for smokers and then for specialty genetic diseases we talked about those category number three we talked about familial hypercholesterolemia we talked about inflammatory bowel disease talked about primary sclerosin colangitis talked about a hereditry non polyposis correctoc cancer that's a high yield group to know for exams we talked about the APC gene mutation familial at the number of polyposis and then we talked about brachamutations and then category number four we talked about the risky sexual folks right so there we categorized like screening for HIV screening for chlamydia gonorrhea screening for syphilis screening for hep B we talked about those those people and then category number five we talked about metabolic diseases we talked about hypertension we talked about osteoporosis we talked about diabetes and we talked about hyperlipidemia and then for cancers right that was category number six we talked about colon cancer screening guidelines breast cancer screening guidelines we talked about cervical cancer screening guidelines and we said quite a bit about cervical cancer screening guidelines and when you go to stop and then category number seven we talked about just a grab bag right for the most part we talked about like a B and C talked about kids talked about chlamydia gonorrhea right and then we talked about depression so again please listen to this podcast over and over again if you need to find some way on for to commit the stuff to memory but I feel like the way I've grouped it for you probably makes it a lot easier to remember you just need to remember that oh there are seven categories right and if you c

an kind of put these you know little things on on their each one then I think it will be much much easier to to remember so as I do at the end of every podcast I do offer one on one tutoring for step one step to seek is step three so if you're interested in that should be an email through the website and also and also you know if you need tutoring for pre-clean cubits school exams 30-click shift shelf exams I do also offer one on one tutoring for those and then I have a the review courses for step to seek is step three complex level two and three as well and then I also work with people on their era's applications right again I've been on an admissions committee before I've worked with tons of people that have matched into very competitive specialties anesthesia dermatology ENT neurosurgery orthopedic surgery I've worked with tons of people that have matched into these categories so if you have a tricky application and you need help with like personal statements reclators and stuff or editing your era's application just again should give me an email through the website I'll be able to give you some more information and then I have this podcast on Apple podcasts on Google podcasts and on Spotify so if you subscribe to those podcasts apps you'll see the most recent 150 podcasts I'm the key thing I'll just say there is um it's the most recent 150 so since this episode 325 you'll see everything after episode 175 right if you want everything from episode one all the way to 325 go to the website it's a Word Press role that is really know it to circumvent that role and then I do also have a You Tube channel Divine Intervention USMD podcast and videos that's where I put the videos that I make for the website although if you want the slides that are associated with those videos again go on the website itself you'll find the slides that are associated with with those videos and t

hen as I also say there's this notes feature if you go on the website there's this thing called a episode notes right so the website by the way is Divine Intervention Podcasts with an s.com so if you go there there's an episode notes feature at the top basically a lot of my step one material a lot of my step 2ck material has been transcribed again I would encourage you to still listen to the podcast to give you understanding and most times it just makes more sense to make your own notes it makes it a lot easier to remember but if you can't again there are many many of my podcasts especially for step 2ck step 3 they have been transcribed on the on the website broken up by sections almost like a mini textbook in a sense and then by the way I'll put an plugin for the DIP deck is the Divine Intervention Podcast deck if you're studying out your third year rotations that DIP deck contains again it's basically like a very awesome on key deck made of a ton of my high-eal step 2ck material so it does something you're interested in again it's on Reddit just look for the DIP deck find the most recent thread on it and you should be able to download it a very awesome medical student pretty much made that made that deck it wasn't made that made it and then finally in terms of organization if you're trying to figure out oh for this subject what podcast should I study on the website go to the part that says exam topic lists is at the top it's a header go to exam topic lists if you click on it it will take you to a Google spreadsheet that breaks things down by step 1 step 2ck slash step 3 and it tells you all for internal medicine these are the podcasts that are relevant for the rapid review series these are the podcasts that are relevant just stuff like that so that's just for me what I found to be the easiest organization tool right now so you know if you subscribe to the website Di

vine Intervention Podcast dot com whenever I make a new podcast you will get an email notification so please please listen to this podcast commit the stuff to memory I can pretty much promise you this podcast will make positive benefit for those that are taking step 2ck or step 3 or complex level 2 or complex level 3 even if you're studying for an internal medicine board exam this podcast will be helpful again pretty much every screening guideline you need to know I have disgusting in this podcast and also if you're taking the internal medicine shelf or the family medicine shelf this is definitely a podcast also no and also the early part of this podcast on pregnant women will be helpful for people that are taking an OB-GYN shelf so thank you for listening I wish you all the best God bless you thank you

Start screening at around 24 weeks gestation using a one-hour oral glucose tolerance test (OGTT), followed by a three-hour OGTT if positive.

Screened at the first prenatal visit, AND retested in the third trimester to check for vertical transmission risk.

Must be male, between 65–75 years old, and must have a history of smoking. Screening is done with an ultrasound.

The "risky sexual group," including men who have sex with men (MSM), IV drug users, and sex workers.

Pap smear combined with HPV co-testing every five years.

Continued Pap smears of the vaginal cuff, often for at least 20 years post-surgery.

Age 3, Age 9, and Age 18.

Age 20 years old.

Treat it usually with nitrofurantoin/TMP-SMX; this prevents increased risk of preterm premature delivery.

Annual breast MRI.

Hepatitis B (HEB).

Every five years.

No, she does not need routine Pap smears.

Age 3, Age 9, and Age 18.

Age 20 years old.

Treat it usually with nitrofurantoin/TMP-SMX; this prevents increased risk of preterm premature delivery.

Annual breast MRI.

Hepatitis B (HEB).

Every five years.

No, she does not need routine Pap smears.