Divine Intervention | Ep. 37 | Risk Factors, Preventive Medicine, and Screening Guidelines

smoking screening has changed as well : The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

For those wanting a typed out version, this is everything (edited a few based on updates on most recent recommendations as of July 2025):
- Biggest risk factor for suicide: Prior history of previously attempting suicide

- Biggest risk factor for A-Fib: Mitral Stenosis

- MC Arrhythmia in a pt with Hyperthyroidism: A-Fib

- Biggest risk factor for Mitral Stenosis: Rheumatic Fever

- Biggest risk factor for Abdominal Aortic Aneurysm (AAA): Smoking

o NOT HTN

- Biggest modifiable risk factor for CAD: Smoking

o If smoking is NOT an answer choice, go with Unstable Angina

- Biggest risk factor for Stroke and Aortic Dissection: HTN

- If a pt has Fe Deficiency Anemia and has a history of H Pylori infection and ask for the biggest risk factor for the anemia: Peptic Ulcer Disease (bleeding into GI tract)

- Biggest risk factor for Esophageal Adenocarcinoma: Barret Esophagus

o NOT GERD

- MCC of CAP: Strep Pneumo

- MCC of UTI overall: E Coli

- Biggest risk factor for Osteoporosis: Low BMI (esp. for anorexic or postpartum pts)

- When you control blood Glucose in a diabetic, it doesn’t decrease the risk of stroke or MI (macrovascular complications of DM are not prevented with control of blood Glucose – controlling blood Glucose only helps decrease the risk of Microvascular complications such as Nephropathy, Neuropathy and Retinopathy)

- You only screen for AAA in men (not women); you only screen in men who has ever smoked and between the ages of 65-75 with a one-time screening US

o If aneurysm is >5.5cm, proceed to surgery

o If aneurysm is <5.5cm, observe

o If aneurysm grows by >0.5cm in a 6mon period, proceed to surgery

o If aneurysm is symptomatic at any point, proceed to surgery

- Biggest risk factor for rupture of an AAA is the diameter of the aneurysm

- Biggest risk factor for SCC of skin: Cumulative sun exposure

- Biggest risk factor for Ovarian Cancer: Family history of Ovarian Cancer

- Biggest risk factor for Prostate and Breast Cancer: Age

- Biggest risk factor for Bladder Cancer: Smoking

- MCC of death in those getting a Kidney Transplant: Cardiovascular Disease

- MCC of death in those with Acromegaly: Heart Failure

- MCC of death in those with CKD/ESRD: Cardiovascular Disease (Sudden Cardiac Death from Arrhythmias)

o 2nd MC is Infection

- Biggest risk factor for Obstructive Sleep Apnea: Obesity

- Biggest modifiable risk factor for Knee Osteoarthritis: Obesity

- MCC of death in those with ADPKD: Cardiovascular Disease

o NOT SUBARACHNOID HEMORRHAGE

- MCC of death in those with Lupus: Ischemic Heart Disease (ex. MI)

- Biggest risk factor for Pancreatic Cancer: Smoking

- MC Pulmonary Malignancy in pts with hx of Asbestos exposure: Bronchogenic Carcinoma

o NOT MESOTHELIOMA

o Smoking is NOT a risk factor for Mesothelioma

o Mesothelioma is Calretinin positive and you can also see Psammoma Bodies (Laminated calcifications on Microscopy)

- Silicosis increases a person’s risk for TB

- MCC of Acute Pancreatitis in US: Gallstones

o NOT ALCOHOL

- Biggest risk factor for Chronic Pancreatitis in US: Alcoholism

- Biggest risk factor for Papillary Thyroid Cancer: History of chest/neck radiation for Lymphoma

- For Breast Cancer, screen every 2 years from ages 40-74 (USPSTF); Screen every year starting at age 40 (ACS)

- For Cervical Cancer, screen using PAP smear every 3 years between ages of 21-30; If >30 years old, you can do a PAP every 3 years OR if > 30 years old you can do PAP + HPV co-test every 5 years

o Screen between ages of 21-65

o If pt has history of HIV, you screen every 1-2 years

o You can stop screening before 65 years old if pt has hysterectomy ONLY IF the hysterectomy was done for benign reasons (ex. Leiomyoma); If Hysterectomy was done for something like an Endometrial Cancer, you keep doing PAP smears of Vaginal Cuff (aka Vault Smear: Checks for abnormal cells in vaginal area after a Hysterectomy)

- For Chlamydia, if pt has risk factors (ex. inconsistent condom use or <25 years old), screen for Chlamydia

- For Hyperlipidemia, screen in men >35 years old and women starting at 45 every 5 years thereafter

o You can start earlier in both M/F if they have high risk for CAD

- For Colon Cancer, screen with Colonoscopy every 10 years from ages of 45-75; Alternatively you can do Flexible Sigmoidoscopy every 5 years; Alternatively you can do an annual Fecal Occult Blood Test

o If EITHER of the alternative methods (Flexible Sigmoidoscopy or FOBT) tests are positive, the next step is to do a Colonoscopy

- For pts with UC, Colon Cancer screening starts 8 years after an initial diagnosis of UC

- For pts with family history of Colon Cancer, start screening at age of 40 or 10 years before family member with Colon Cancer was diagnosed - Do the option that is earlier!

- For pts with hx of FAP, do annual Colonoscopy or Sigmoidoscopy every year starting at age of 10-15

- For HNPCC, start screening for Colon Cancer before the age of 21

- For all pregnant women, at first prenatal visit you want to screen for Syphilis, asymptomatic bacteriuria, and HIV

o ALWAYS treat asymptomatic bacteriuria in pregnant pts - this does not apply to non-pregnant F (not treated)

o For pregnant pts with asymptomatic bacteriuria, you usually treat (with Nitrofurantoin), you perform a Test of Cure BUT if she has pyelonephritis, she must be on chronic prophylaxis for UTIs for rest of pregnancy

- For RhD IG, give around 28 weeks and give within 72 hrs of delivery

o If trying to determine the dosage, perform a quantitative test to see how much of the fetal blood has been mixed with mom’s blood known as the Kleihauer Betke Test (determines how much Rhogam to give)

- Biggest prognostic factor for likelihood of Melanoma spread: Breslow Depth

- Most important preventative measure in HCC: Hep B Vaccine

- Biggest risk factor for Erectile Dysfunction: Cardiovascular Disease

- MCC of death in those with Cervical Cancer: Renal Failure from Genitourinary spread (classically, Ureters that cancer spreads to)

- Biggest prognostic factor for cancer: Stage of tumor

- For Lung Cancer, screen with low dose CT scan for M/F between ages 50-80 if they have a >20 pack year smoking history and currently smoke or have quit within the past 15 years

o These people have to either be still smoking or have quit within the past 15 years; If pt has quit >15 years ago, this recommendation doesn’t apply anymore

- Biggest risk factor for Endometritis: C-Section

- Biggest risk factor for Preeclampsia: Prior history of Preeclampsia

o If not an option, go with Nulliparity

- Biggest risk factor for Uterine Inversion: Prior history of Inversion

- Biggest risk factor for Chorioamnionitis: History of Prolonged Rupture of Membranes

- Having a Bicornuate Uterus increases risk for Pre-term delivery

- Biggest risk factor for Placenta Previa: History of C-Section

- Bacterial Vaginosis is a HY risk factor for Pre-term Labor

- Biggest risk factor for Endometrial Cancer: Exposure to Unopposed Estrogen

o If that isn’t a choice, go with Endometrial Hyperplasia

- Biggest risk factor for Cervical Cancer: Exposure to HPV (especially high risk types); HPV causes SCC of Cervix (NOT Adenocarcinoma)

o They may give a risk factor that increases risk of HPV rather than flat out saying HPV (ex. multiple sexual partners or early age of sexual intercourse)

- The reason why young F have increased risk of vaginal infections (ex. cervical infections) is because they have Cervical Ectopy (Cervical epithelium has increased risk of infections)

o Endocervix tends to bulge out more in younger F and the columnar epithelium of the Endocervix isn’t as good for guarding against infections

- Biggest risk factor for Ectopic Pregnancy: Prior hx of Ectopic Pregnancy

o Other things: Smoking (affects motility of Stereocilia lining Fallopian Tubes)

- HY risk factor for Cervical Incompetence: History of LEEP (procedure to remove abnormal/precancerous cells from cervix) or Cervical Conization procedure (cone-shape piece of cervix is removed to diagnose/tx CIN)

- HY risk factor for Shoulder Dystocia: Macrosomia

- Biggest risk factor for Fetal Macrosomia: Pre-existing or Gestational DM in mom

- HY risk factors for developing Pyelonephritis in pregnancy: Asymptomatic Bacteriuria and prior Pyelonephritis

- Avoid combined OCPs (Triphasics) in smokers, pt with hx of stroke/migraines/neurologic symptoms/thrombotic diseases (Factor V Leiden)

- History of Hepatic Adenomas is an absolute contraindication to Estrogen containing OCP

- Avoid Copper IUD in person with history of Wilson Disease

- For Urinary Incontinence, age is an important risk factor as well as multiple vaginal deliveries (esp for Stress Incontinence)

- MS is classically associated with Urge Incontinence

- DM is classically associated with Overflow Incontinence

- Biggest risk factor for Placental Abruption: Trauma

o If not an option, go with Cocaine

- Biggest risk factor for Asherman Syndrome (Intrauterine adhesions/scar tissue forms inside uterine cavity): History of Uterine D&C

Has anybody written down all this info or is it available in a pdf form ?

Breast cancer screening every 2 years age 40-74, as per April 2024 USPSTF.

How did i even end up here, all i was doing is looking for ultrakill soundtrack

what is he saying at 18:40 "most important prognostic factor in pations with ??? cancer is stage of the tumor"

Couldn’t understand the word 18:09 please write it for me below 😅

Thanks a lot!

Thank you for this!

Update: USPSTF now says breast cancer screening age 40-74

You are the goat. Tomorrow my day 2 step 3 and you did the best review in 28:17 minutes only

Thank you for making this hy podcast video God bless you too

Is this for step 3?

Colon cancer screening starts at 45 now

hidemyacc

Epic. Thank you

hello sir, first of all your podcasts are superb. Just a slight correction for screening of lung cancer it is age 50-80 with more than 20 pack yr smoking history and those who quit smoking with 15 yrs.

Macrosomia for shoulder dystocia not microsomia

@6:12 when you say damage of the aneurysm, could be be anything? like HTN? iatrogenic? Trauma?

How can I get your videos on social sciences/ethics?

Amazing as always thank you

😍🤸🏾‍♀️ thank you!

Lung cancer is 50-80 years, 20 pack year hx.