Deck 1 Flashcards
When in doubt about whether to immunize someone,
Better to give an extra vaccine dose than to give none. Risk of reaction with re-immunization is minimal.
When should you defer an immunization and when should you not defer?
Immunization should only be deferred if there’s a moderate to severe illness (with or without fever). For minor illness, you should still immunize.
What is the onset and duration of most immunizations (active immunity)
Onset is about a month, it lasts for years
What is passive immunity and when is it used
It’s when you directly give someone antibodies. It’s used post-exposure for certain infections (so the patient has to have a recent risk of exposure)
What is the onset and duration of passive immunity
Onset is a few hours, usually lasts 6 to 9 months
What are some infections we can treat with passive immunity
Varicella, Hep A, Hep B, tetanus, rabies
Herpes Zoster Vaccine (4 things)
Prevents herpes zoster (shingles) in adults aged 50 years and older.
Give 1 dose, then 2 to 6 months later, give another dose.
Can be given to immunosuppressed people.
If they have already received the live zoster vaccine, still give this one.
How to calculate packs per day years
2 packs per day for 30 years
2 PPD x 30 years = 60 pack year history
CAGE for other substances
Change the “E” to an “N”
Have you ever needed heroine to feel normal (not be in withdrawal)
CAGE scoring
2 or more “Yes’ “ means they almost definitely have substance abuse disorder
For all ages, what is the leading cause of death, and what is the 10th leading cause
Heart disease, suicide
Prostate screening recommendations
55 to 69 years old: Should be a case by case decision.
70 and older: Do not screen
Breast cancer Genetic Counseling recommendations
If they have certain risk factors, especially the BRCA 1 and 2 gene, screen them with the assessment tool. Based on the tool, you may need to do genetic testing.
If they don’t have the BRCA 1 and 2, do not screen routinely
Colorectal cancer
Screen from 45 to 75.
From 76 to 85 the decision is case by case.
Fecal Occult- yearly
DNA test- 1 to 3 years
Sigmoidoscopy- 5 years
CT colonoscopy- 5 years
Colonoscopy- 10 years
Lung cancer screening
CT scan for people 55 to 80 years old with a 30 pack-year history, who currently smoke or quit within the past 15 years.
Stop screening if they quit for more than 15 years or if they have another illness that limits their life expectancy anyway
Breast Cancer Screening
Age 40 to 45: Woman’s choice
45 to 54: Annual mammogram
54 to whenever they still have a life expectancy of 10 years: Biennially
Or
50 to 74: Biennially
BSE is not encouraged nor discouraged
Cervical Cancer
Do not screen before 21
Sensitivity
Likelihood of being sensitive enough to find a true positive
Specificity
Specific enough to know which is a true negative
Aspartate aminotransferase (AST) measures
damage to the liver
Aspartate aminotransferase (AST) findings
Can be elevated in valproate therapy, hepatitis, cirrhosis
Decreased in chronic alcoholic liver disease
Alanine aminotransferase (ALT) measures
liver damage
Alanine aminotransferase (ALT) findings
Can be elevated in valproate therapy, hepatitis, cirrhosis.
Deceased in chronic alcoholic liver disease.
y-Glutamyl transferase (GGT) measures
Cholestasis (flow of bile from the liver, either extrahepatic or intraheptatic)