DIP Episode 37 - Risk Factors, Preventive Medicine, and Screening Guidelines

Okay, welcome. My name is Divine. I am a PGOI1 about to start residency. Welcome to the 37th episode of the Divine Intervention Podcasts. This is kind of a grab back podcast, but I decided to name it the Preventive Medicine Podcast. I would say that with this podcast, you will probably get many, many questions right on many exams you take across your 30 year, or even for step one, and definitely for step two, seeking an almost certainly for step three. Because for this podcast, there are three big things I'm going to focus on. I'm going to focus on risk factors across the different specialties. I am going to focus on the most common causes of death across the different specialties, and then I'm also going to focus on just some other weird, high-yoda grab back pieces of information. I will highly encourage you to listen to this like the night before an exam or something. You will almost certainly get many questions right from this. Let's begin. I also mix and match everything. The most important risk factor for suicide is actually a prior history of committing suicide. If you have previously attempted suicide, that's the biggest risk factor for having a new suicide. Now, what is the biggest risk factor for A-fib? What is the biggest risk factor for A-fib? I hope you are thinking about mitro stenosis. Okay? Mitro stenosis is the biggest risk factor for A-fib. Although a fairly related question is to ask about the most common erythmia in a patient with hyperthyroidism.

The most common erythmia in patients with hyperthyroidism is A-fib as well. Next question. What is the most important risk factor for a mitro stenosis? What is the most important risk factor for mitro stenosis? Well, the answer to that is rheumatic fever. Okay? Rheumatic fever very commonly torches the mitral valve and usually causes mitro stenosis. Okay? So most common risk factor for A-fib is mitro stenosis, but for mitro stenosis is rheumatic fever. Now, what is the most common risk factor for an abdominal erythmia in a patient with hyperthyroidism? That is smoking. Okay? They will try to trip you up with hypertension. Don't be dinged by that on a test. The biggest risk factor for a triple-lase smoking. Now, what is the most important, more defiable risk factor for coronary artery disease? That's smoking as well. Okay? That's smoking as well. In fact, if they mention a patient with an MRI and they ask for risk factors, the big thing you want to think about is smoking. But if you don't see smoking as an answer choice, then go with unstable angina. Unstable angina is actually one of the most important risk factors for a myocardial infarction, but the biggest risk factor for coronary artery disease and it's actually a modified one is smoking. Now, for stroke and eiotic dissection, what is the biggest risk factor? That will be hypertension. Hypertension is the biggest risk factor for stroke and eiotic dissection.

And if you get an usual example question about a patient that has iron deficiency anemia and they say, or this patient has a history of H by lorry infection and they ask for the biggest risk factor, well, I hope you think about peptic ulcer disease, right? So H by lorry can cause PUD and that PUD can then trigger an iron deficiency anemia because you're basically bleeding into your GI tract. Now, what is the most important risk factor for a sofogil adnocarcinoma? That is Barrett's esophagus. Okay? They will try to trip you up by putting Barrett's esophagus as an answer choice and GERD as an answer choice. Do not bigger it. Big Barrett's esophagus. That's the biggest risk factor for a sofogil adnocarcinoma. Now, what's the most common cause of community acquired pneumonia? That is strep pneumo. Okay? What's the most common cause of UT Is overall? That will be equal line. Now, what is a commonly tested exam risk factor for osteoporosis? That's a low BMI, right? So they classically test this in the context of patient and anorexia nervosa or a patient that is a postmenopausal but has a low BMI, usually it's like 19 or 18. If you see that, that's the biggest predisposinerous factor for osteoporosis in those populations. And another bizarre thing you want to keep in mind, this is just something I'm just going to go ahead and say out loud, but when you control blood glucose in a diabetic, it actually does not decrease the risk of stroke or a myocardial infarction.

So controlling blood glucose does not decrease the risk of stroke or a myocardial infarction in a patient with diabetes. Those are macrovascular complications. The macrovascular complications of diabetes are not prevented with control of blood glucose. The only things that controlling blood glucose helps with microvascular complications, right? So like an apropathy, retinopathy or an neuropathy. Those things you can decrease those risks by controlling blood glucose. Now, for triple A, remember, you screen for triple A in men, not women, okay? You screen only in men and you basically screen in a man that has ever smoked and is between the ages of 65 to 75. Usually you do that with a one-time screening ultrasound. If the aneurysm is greater than 5.5 centimeters, you go ahead, you proceed to surgery. If it's less than 5.5 centimeters, you'll watch. If it grows by more than 0.5 centimeters in a six-month period, you also proceed to surgery. If it's symptomatic at any point, you also proceed to surgery. And again, remember, the biggest risk factor for a triple A is smoking. But the greatest risk factor that predisposes a triple A to rupture is the damage of the aneurysm. The damage of the aneurysm is the greatest predisposing risk factor to rupture of the triple A. Now, what is the most important risk factor for squamous cell carcinoma of the skin? It's a skin cancer, so what should it be? It should be cumulative sun exposure.

Now, what's the most important risk factor for a variant cancer? It's actually having a family history of a variant cancer. What is the most important risk factor for prostate cancer? That's age. Age is the most important risk factor for prostate cancer and for breast cancer. Okay? Basically, the older person gets the higher the risk of prostate cancer or breast cancer. Now, what is the most important risk factor for bladder cancer? That will be smoking. Smoking is the biggest risk factor for bladder cancer. The most common cause of death in patients with getting a kidney transplant is cardiovascular disease. What's the most common cause of death in patients with acromagaly? That's heart failure. Okay? Now, what's the most common cause of death in patients with chronic kidney disease? That's cardiovascular disease as well. And actually, if you want to be like a little more specific, the most common cause of death in patients with end-stitch kidney disease is like arrhythmias, like sudden cardiac death from an arrhythmia. Okay? The second most common cause of death in patients with end-stitch kidney disease is infection. Okay. Now, moving on. What is the most important risk factor for obstructive sleep apnea? That's obesity. Okay? What is the most important, modifiable risk factor for knee osteoarthritis? That's obesity as well. What's the most common cause of death in patients with autosomodominant polycystic kidney disease? It's cardiovascular disease.

So here's what they will try to do to you on an example. They will try to trick you by putting subarachnoid hemorrhage as an answer choice. That is not the most common cause of death in ADP-KD. It's actually cardiovascular disease. Okay? What's the most common cause of death in patients with lupus? That's a schemic heart disease, right? So like a myocardial infraction. And what's the commonly tested risk factor on many exams for pancreatic cancer? That's smoking. Okay? Now, what's the most common pomenary malignancy in patients with a history of asbestos exposure? That's a bronchogenic carcinoma. Okay? Not a misothelium, it's a bronchogenic carcinoma. And remember, smoking is very high to know. The smoking is not a risk factor for misothelium. And don't forget that misothelium is the acarctin positive. So C-A-L-R-E-T-I-N-I-N. The acarctin positive and you can also see someoma bodies, which are laminated calcifications on microscopy. And don't forget, since we're talking about the lungs, don't forget that silicosis increases a patient's risk for TB. Now, what is the most common cause of acupuncturitis in the US? That's gallstones. Okay? Not alcoholism. They are roughly equal, to be honest. But at least there's a study I read that said that gallstones are the most common cause of acute, not chronic, acute pancreatitis in the US. However, the most important risk factor for chronic pancreatitis in the US is alcoholism. Okay? Because think about it, right?

People drink, it's like a habit, right? People drink over time. Now, I'll just mention this, but there's a classically tested risk factor for papillary thyroid cancer, dude. Know what it is? Well, I hope you're thinking about like a history of like chest or like neck radiation for lymphoma. Okay? And for breast cancer, right? You want to know your screening guidelines as per the USPSTF. You want to screen every two years from the age of 50 to 74. For the American Cancer Society, they say screen every year studying at 40. And I've actually seen this American Cancer Society recommendation, be what's like most correct on most of the exams I've taken in the past. So it's just something to keep in mind, but I would definitely know both if I were you. American Cancer Society started 40 every year. USPSTF, which is supposed to be the most correct, every two years studying at the age of 50. Now, for cervical cancer screening, right? You want to do a pap smear every three years between the ages of 21 to 30. Okay? Basically, if a patient is more than 30 years old, you can also do the same thing. You can do a pap every three years. But an alternative, only if you're greater than 30, is to do a pap smear plus HPV co-testing every five years. It's definitely higher to know that. And basically, you screen between the ages of 21 to 65. If a patient has a history of HIV, you actually screen a little more frequently. So you don't screen every three years.

You screen like every like one or two years. And basically, you stop, you can stop screening before the age of 65. If a lady has a history of HIV, but here's the kicker. You can only stop screening before the age of 65 if the history of HIV was done for benign reasons. So let's say like a lyoma, for example, if the history of HIV was done for a non-benign cause like endometrial cancer or something like that, you want to keep doing pap smears. And the buzzword you want to recognize on exams is a pap sme of the vaginal cough. Okay, it's a very common exam question. Now, with regards to chlamydia screening in general, if a patient has like some high-yodorous factors, I'll say like the big one, they tend to put a lot on the exams is like inconsistent use of condoms. And yeah, those patients are less than 25. You can go ahead and screen them for chlamydia. And then with regards to screening for hyperlipidemia, in men, you screen men that are over the age of 35. For women, you screen studying at the age of 45. And I believe you do that every five years thereafter. Not sure about that last part though, but I'm almost certain you screen every five years, but I'll encourage you to look that up. And it is mega, mega, mega high, you know, know that you can actually start before the age of 35 in men or before the age of 45 in women, if they have, if they're like high risk for coronary artery disease.

So you may see exam questions where the suspicion is 22 and the answer is to screen for lipids. Don't be surprised by that if they have a lot of risk factors for coronary artery disease, you go ahead and screen them earlier than 35. Now, for colon cancer, colon cancer screening is super high-yod. In general, you want to screen with colonoscopy. That's the preferred method every 10 years between the ages of 50 to 75. Alternatively, you can do like a flexig, right? So flexible sigmoidoscopy every five years. Alternatively, you can also do an anal, fecal, occult, or blood test. I imagine in the future that the CT colonography, it's not yet approved, but CT colonography may become a thin in a few years, because it has a very high sensitivity. And basically, like I said, colonoscopy is preferred, but if you say, okay, let me go the FOB tear out or the flexible sigmoidoscopy are out. If any of those tests are positive, the next step in management is to do a colonoscopy. And for patients with all straight-up colitis, you definitely want to know that colon cancer screening actually starts at eight years after the initial diagnosis of UC has been made. Eight years after the initial diagnosis. If a patient has like a family history of colon cancer, the also classically test is you want to start screening at the age of 40, or you want to start screening 10 years before the age where the family member with colon cancer was diagnosed.

So say for example, the family member was diagnosed at the age of 49. If you're backtrack 10 years, that's 39. If you compare 39 and 40, 39 is earlier, so you start screening at 39. But if the patient's family member had cancer at like 52, and you're like, oh, when do I start screening? You start screening at the age of 40. Because if you backtrack 10 years from 52, that's 42 years. But if you compare 40 and 42, 40 is earlier, it's an earlier age, so it's not screening at the age of 40. Now, if a patient has a history of familial adenomatosis polyposis, you actually want to start like anewal colonoscopies or like sigmoidoscopies every year, starting between the age of like 10 to 15 years. So once the child hits like anywhere from 10 to 15, start an anocolonoscopy or like a sigmoidoscopy. Basically, the recommendations are roughly the same for HNPCC, but I think that's a little low yield, so I'm not going to say too much about that. But basically it's like, oh, the youngest age that the family member had colon cancer, start screening like five to 10 years before that. In general, I'll say the big thing should probably remember is for HNPCC, start screening for colon cancer before the age of 21. Now, for all pregnant women, right, that the first prenatal visit, you want to definitely screen for syphilis, right? And you also want to screen for asymptomatic bacteria and HIV.

And if you detect bacteria in an asymptomatic pregnant woman in her urine, you go ahead and treat, but that recommendation does not extend to a non-pregnant female, non-pregnant females with asymptomatic bacteria and not treated. And if a lady, if a pregnant woman has asymptomatic bacteria, right, after you treat, usually you treat with like mitrofyrantoin, for example, you go ahead and perform a test of cure. But if a pregnant woman has pylon and fritis, after treatment, she actually has to be on chronic prophylaxis against the UT Is for the rest of the pregnancy. And then for RHD immunoglobulin, right, you want to give that around 28 weeks. And you also probably want to give that 70, like within 72 hours of delivery. If you want to determine how, like the dose of RHD immunoglobulin that you want to give to mom, you try to perform this, like this quantitative test, where you determine how much of the, like how much of the fetus's blood has mixed with mom's blood. It's a test known as the Klyhawabetki test. Klyhawabetki test. That's a test you can use to quantitatively determine, okay, this is how much RHD immunoglobulin should give to mom, postpartum. And then a melanoma. What's the most important prognostic factor that indicates the likelihood of spread? Well, I hope you're seeing the depth of the lesion, the depth of the lesion, the breast load depth, determines the, is like the biggest prognostic factor that indicates how likely the melanoma will spread.

Now, what is the most important preventive measure in hepatocellular carcinoma? That's actually hep B-vaccination, okay, remember hep B can cause HCC and it's a vaccine preventable illness. So the most important preventive measure in HCC is hep B-vaccination. Now remember if you vaccinate against hep B, you've basically prevented hep D. Now, what is the most important risk factor for erectile dysfunction? That's cardiovascular disease, okay? What is the most common cause of death in patients with cervical cancer? That's actually renal failure from genital urinary spread. Classically, it's the ureters that the cancer spreads to. And just as a general rule, in general, in general, the most common, most important prognostic factor in patients with like cancer is like the stage of the tumor. And for lung cancer, right, there's actually screening for lung cancer. The USPSTF recommends like a low-dose CT scan for men and women between the ages of like 55 to 80, if they have a greater than 30-pack year smoking history. And you need to remember some addendums though, these people, they either have to still be smoking or quit within the past 15 years. If the patient has quit more than 15 years ago, this recommendation does not apply to them anymore, okay? So lung cancer, low-dose CT scan, men and women, 55 to 80, who have a greater than 30-pack year smoking history and currently smoke or have quit within the last 15 years.

So if it's 15 years or less since the last quit, you go ahead and do the screen. And again, 30-pack year smoking history. Now, what's the most important risk factor for endometritis? That's a C section, okay? What's the most important risk factor for preeclampsia? It's actually a prior history of preeclampsia, okay? What's the highest, what's like a high-yield exam risk factor for uterine inversion? It's actually a prior history of inversion, okay? Now, what's the high-yield exam risk factor for core amnionitis? We love this one. It's actually a history of prolonged rupture of membranes. And this I'll just say out loud, having a bicone weight uterus actually increases risk for preterm delivery. What is the biggest risk factor for placenta-previa? It's a history of C section, okay? And this is something I guess I'll say out loud, bacterial vaginosis, right? Remember, gunnarella vaginalis vaginal pH is at 4.5, clusels on microscopy. Bacterovaginosis, which is treated with metronides, is actually a high-yield risk factor for preterm labor. That's a very common exam question. Now, what is the biggest risk factor for endometrial cancer? That's actually exposure to unopposed estrogen, okay? Exposure to unopposed estrogen is the biggest risk factor for endometrial cancer. If you don't see exposure to unopposed estrogen as an answer choice, go with endometrial hyperplegia, okay? Go with endometrial hyperplegia, but the biggest risk factor is exposure to unopposed estrogen.

So, a little like PCOS or a lady taking like tamoxifen, they have a high risk of endometrial cancer. Now, what is the biggest risk factor for cervical cancer? That'll be exposure to HPV, okay? Especially the high risk types like HPV 16, 18 and those in the 30s. And actually, they may give you a peripheral answer instead of giving like, oh, exposure to HPV, they could give you an answer choice that is something where if you participated in that behavior, you have an increased risk of exposure to HPV. For example, they could say like a person that has like multiple sexual partners or like an early age of sexual intercourse. Those things increase risk of HPV acquisition, right? So, that actually increases a patient's risk of a cervical cancer. And remember, HPV causes squamous cell cancer of the cervix, not adnocarsinoma, squamous cell cancer. And just one bizarre thing that I came across recently that you, I guess you want to keep in mind is, the reason why young females have an increased risk of like vaginal infections, especially like cervical infections, is because they have more cervical activity. So, the cervix has two parts, right? There's an endoservix that's made of like columnar epithelium and there's an ectoservix that's made of squamous epithelium. The thing is, that squamous epithelium is sort of like hardcore, it's more resistant to infection in comparison with the endoservix. But the thing is, the endoservix tends to bulge out more in younger females.

And that columnar epithelium is not very good at guiding against infection. So, infection is like vaginal infections are pretty common in young females because they have more cervical activity. So, the cervical epithelium has increased susceptibility to infection. So, some of those bizarre things you want to keep in mind. But as you get older, the endoservix sort of like stays where it's supposed to be, so you don't get many of those problems. Now, one of the strongest examrace factors I would say for a topic pregnancy is a prior history actually of a topic pregnancy. But the other things you want to keep in mind like smoking because smoking messes with the mortality of like the, I believe, the like serious, or serious, serious, that line of allocyan tubes. One high-yield risk factor I would say in terms of exams for cervical incompetence is actually a history of like a lip procedure, like the LEEP procedure, or like a cervical colonization procedure. So, those are things to keep in mind. A high-yield risk factor for shoulder distortion, what do you think that would be? That's macrosomia, that's macrosomia. And what is the high-yield examrace factor for phyto macrosomia? That would be a pre-existing or gestational diabetes in the month. And for your exam, you want to remember certain high-yield risk factors for developing pylonofritus and pregnancy. For that, you want to think about like asymptomatic bacteria, and prior pylonofritus.

Okay, now, some just other weird things I'll mention, you definitely want to avoid combined OC Ps, right? Another Bosnian disease like trifisic contraception, trifisic contraceptives contain estrogen. You want to avoid combined OC Ps in smokers, or patients that have like history of strokes, or patients that have a history of like migraines with like neurological symptoms. So like super complex migraines. If a patient has a history of like thrombogenic disease, you'll like factor five lighting, for example, you want to avoid an estrogen containing a contraceptive option. Another high-yield one that they love to test is a history of hepatic adenomas. That's definitely a contraindication to the administration of an estrogen-containing contraceptive. And a super bizarre question, a person may get an exam. Let me just throw many people off, is avoiding the copper IUD in a patient that has a history of well-sensed disease. Okay, it kind of makes sense, right? Because well-sensed disease is a copper overload disorder. Now, for urinary incontinence, I will say that age is probably good, high-yield, and important risk factor you want to keep in mind. Although also like having like multiple vaginal deliveries, that's also like a big risk factor, especially like stressing continents. MS multiple sclerosis, classic lion exams, is associated with like urgent continents, and then diabetes, classic lion exams is associated with overflowing continents.

And in general, the most significant risk factor for placental abruption is what? That's trauma, okay? If you don't see this, go with cocaine on the only exams. And for preeclampsia, like I said, the biggest risk factor is a prior history of preeclampsia, although nulliparity. If you don't see like a prior history of preeclampsia as an answer choice, probably go ahead and choose nulliparity. That's a very high-yield important risk factor for preeclampsia. And then like I mentioned earlier, the biggest risk factor for breast cancer is age. That's also the biggest risk factor for prostate cancer, okay? Age. And the final thing I'll mention here is relatively high-yield risk factor for ashyman syndrome. So that's like intra-yudarin adhesions, that's more ubigain territory, is actually having a history of like a uterine curatache, okay? So that's something you want to keep in mind. So I know this is kind of a lot, but I promise you, I promise you, this is super, super high-yield for exams. So spend the time, go over it, take notes, make flashcards, whatever you do to keep it straight in your mind, and I wish you all the best on your tests. The workup started today, obviously I'm supporting Nigeria, but I feel like this workup will be filled with a lot of shocking upsets, but I'll go for my soapbox for now. I'll keep you updated on how things are going for my favorite teams for the workup. So have a wonderful day, all the best on your exams, and God bless. Thank you.

Mitral stenosis.

Bacterial vaginosis.

Squamous cell carcinoma; exposure to high-risk types (e.g., HPV 16/18).

Exposure to unopposed estrogen.

Colonoscopy; every 10 years.

Cardiovascular disease.

Smoking.

Uterine curettage.

Gallstones.

Klyehbaum test.

Cervical cancer (Pap smear/HPV testing).

E. coli (or urinary tract bacteria).

Smoking.

Uterine curettage.

Gallstones.

Klyehbaum test.

Cervical cancer (Pap smear/HPV testing).

E. coli (or urinary tract bacteria).