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Preventive Medicine Guidelines for the Physician Assistant Exam

As a healthcare professional, you may be evaluated on how well you adhere to preventive medicine guidelines. The Physician Assistant Exam (PANCE) will certainly expect you to know about preventive medicine.

Benjamin Franklin said it best when he said, “An ounce of prevention is worth a pound of cure.” Health maintenance involves different types of prevention, namely primary, secondary, and tertiary prevention.

  • Primary prevention: The goal of primary prevention is to use measures that prevent disease or illness from occurring in the first place.

  • Secondary prevention: Secondary prevention means a medical condition may be present, but screening catches the condition early, before the person develops symptoms.

  • Tertiary prevention: Tertiary prevention focuses on limiting further progression of a disease process or on rehabilitation to help improve a significantly disabling condition (in other words, restoring a person’s functioning).

As an example in primary prevention, suppose a person does not have a diagnosis of coronary artery disease (CAD) but takes steps to reduce risk factors for developing CAD. These steps can include exercising; adhering to an eating plan low in saturated fat and high in fruits, vegetables, and whole grains; keeping cholesterol levels and blood pressure low; and never starting smoking.

Secondary prevention includes lowering the cholesterol to goal and adhering to strict blood pressure guidelines. Aspirin therapy is also indicated, as the person has documented CAD. Tertiary prevention is treating someone who has CAD as diagnosed by a cardiac catheterization. Steps to reduce further progression could include the use of beta blockers, ACE inhibitors, statin therapy, and exercise therapy.

Note the overlap between secondary and tertiary prevention as it relates to CAD; the difference is that with secondary prevention, you’re trying to intervene before the person develops the symptoms of CAD. With tertiary prevention, the person has established CAD (with a catheter and multiple stents placed), and you’re trying to prevent the condition from getting any worse.

Broadly, primary prevention can include the following:

  • Lifestyle choices: Physical exercise reduces the risk for many conditions and is good for total body health. Stopping smoking, limiting alcohol use, and following a healthy diet are all examples of primary prevention.

  • Vaccines: A vaccine prevents a disease from occurring in the first place. Examples include vaccines intended to prevent measles, mumps, smallpox, and influenza.

  • Condoms and safe sexual practices: The goal is to prevent the spread of sexually transmitted disease (STI), especially HIV/AIDS. Some practices can prevent pregnancy as well.

  • Safety gear: Other examples of primary prevention include using a helmet when riding a bike and wearing a seatbelt.

Examples of secondary prevention can include cancer screening and prophylaxis of deep venous thrombosis (DVT) in a hospital setting. Some medical conditions are prevalent in the population, and screening for them reduces the risk of acquiring them. Also, if a cancer is caught early, you’ve reduced the risk of potential complications.

The same goes for DVT prophylaxis. Someone who’s bedridden and not moving is at high risk for developing of a deep venous thrombosis. The goal is to minimize the risk with prophylaxis, such as anti-coagulation therapy.

Examples of tertiary prevention include aggressive rehabilitation to restore functionality in a person who has suffered a stroke. In someone diagnosed with diabetes, tertiary prevention includes screening for eye and renal problems.

You’re evaluating a 55-year-old male with a history of asthma, which has been well controlled on his current asthma regimen. He notes that recently at work he’s been having “asthma flares.” Your goal is to identify potential allergens at his workplace that are worsening his asthma. Which of the following would this be an example of?

(A) Primary prevention
(B) Secondary prevention
(C) Tertiary prevention
(D) Occupational health prevention
(E) Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria

The correct answer is Choice (C). This man’s asthma was stable before an exposure at work that has caused an exacerbation. Looking for potential allergens to prevent worsening of his condition is an example of tertiary prevention. An example of secondary prevention, Choice (B), is the use of a steroid inhaler in someone who’s been having asthma exacerbations and for whom an as-needed albuterol inhaler isn’t enough.

Primary prevention, Choice (A), would be eliminating risk factors that could foster the development of asthma and/or lung disease, including not smoking in the house and reducing exposure to second-hand smoke and other lung irritants.

Given that this issue is taking place at work, occupational health may be called in, but there is no such concept as occupational health prevention, Choice (D). The GOLD criteria, Choice (E), refers to the Global Initiative for Chronic Obstructive Lung Disease and is a way of staging and raising awareness about COPD, not asthma.

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