Health maintenance Flashcards
Screening for hyperlipidemia
- healthy adults > 20 yrs: measure nonfasting total cholesterol and HDL cholesterol every 5 yrs
- if total cholesterol < 200 and HDL > 35 repeat in 5 yrs
- if total choesterol < 240 or bw 200-240 w multiple risk factors get complete lipoprotein profile (TG levels and calculation of LDL)
- calc LDL not nec for screening?
screen more freq if pt has inc risk CAD (smokers, diabetic, fam hx of cad, htn)
adults w CAD: complete lipoprotein profile
Screening for HTN
- screen all adults 18+ for htn
- recommended interval 2 yrs but not firm establishment
Colorectal cancer (CRC) screening/surveillance
- colonoscopy equivalent to flexible sigmoidoscopy + barium enema but is more $$$
CRC screening avg risk pts
- avg risk pts > 50 yrs of age w no GI symptoms: either of following:
- fecal occult blood test every yr, 1 flexible sigmoidoscopy every 5 yrs
- fecal occult blood test every yr, 1 colonoscopy every 10 yrs
Colonoscopy
- best of all colon cancer screening methods
- sigmoidoscopy will miss 40% of cancers
- fecal occult blood testing will detect cancer but if +, colonoscopy is needed
Prostate Cancer screening
- controversial
- evidence not sufficient to determine benefits of widespread screening (early detection) outweight harm (false +, unnecessary treatments, expenses)
Women’s health: breast cancer
montly self exam no longer
physical exam every 3 yrs until age 40, then yearly
mammorgram every 1-2 years for women >= 40 years of age (controversial whether 1 or 2) and yearly for women >= 50 yrs
There are no screening tests for the following:
- lung cancer
- prostate cancer
- hypertension
Miscellaneous preventive health
- screen all adults for depression, appropos treatment and followup
- no screen for dementia
- no routine screen of gen pop for glaucoma but refer high risk pts (fam hx) to eye care provider
- -> refer all diabetic pts to ophtho for annual fundoscopic exam
- informal test hearing on periodic basis in elderly; younger do not need to be screened unless at increased risk (high occupational noise levels) for hearing impairment
- elderly pts: asses risk factors for PVD, osteoporosis, stroke , CAD
- osteoporosis: DEXA scan starting age 65 in women
- abdominal aortic aneurysm (AAA) screening w ultrasound age 65 in all men w smoking hx; one test enough no repeat if normal
Functionally or Anatomically Asplenic indidividuals at increased risk for:
infection w encapsulated organisms
receive H.influenza type B (HIB) vaccine, meningococcal and pneumococcal vaccines
Influenza vaccine
Recommended recipients: adults > 50 yrs; adults < 50 yrs w chronic medical problems (chf, dm, lung dz, esrd); healthcare workers , pregnant women in 2nd or 3rd trimester during flu season; anyone wanting to reduce risk of getting flu
Schedule: annually; best time is october to november
Contraindications: standard; hx of severe anaphylaxis to eggs (pts can be tested w dilute vaccine but its generally not recommended)
Pneumococcal polysaccharide vaccine
Recommended recipients: adults > 65 yrs; pts with sickle cell dz (usually functionally asplenic) or asplenia;
adults w chronic medical problems or immunodeficiencies; women w high risk pregnancies
Schedule: administer as one time dose ; 2nd dose admin 5 yrs after first dose for pts at highest risk (asplenia, immunodeficiency, requiring dialysis)
Contraindications: standard
Tetanus/diphtheria (Td) vaccine
Recommended recipients: primary series for everyone; when indicated in wound mgmt ; ppl traveling to countries where risk of diphtheria is high
Schedule: primary series: 3 doses (1, 1-2, 6-12 months); after primary booster dose every 10 yrs; for unvaccinated ppl, 3 doses (0, 1-2 months, 6-12 months)
Contraindications:standard
Hepatitis B vaccine
Recommended recipients: primary series to infants; pts at risk for hbv; healthcare workers; chronic liver dz, MSM. IV drug users, household contacts w hep a or b
Schedule: 3 doses (0, 1, 6 months)
Contraindications: standard
ppl at risk: injectable drug users, MSM, heterosexuals w >1 sex partner in past 6 months, recent dx w STDs, sex partners with HB surface antigen +, patients on hemodialysis
Hepatitis A vaccine
Recommended recipients: travelers to developing countries’; pts w chronic liver dz, hcv; chronic liver dz, MSM. IV drug users, household contacts w hep a or b
Schedule: 2 doses; minimum time interval bw them at least 4 wks
Contraindications: safety during preg undetermined
Measles-Mumps-Rubella vaccine
Recommended recipients: primary series in children; adults born after 1957 who are older than 18 (before 1957 considered immune) if no proof of vaccination or immunity; all women of childbearing age without proof of rubella immunity or vaccination; health care workers
Schedule: 1 or 2 doses; give 2nd dose at least 4 wks after first dose
Contraindications: pregnancy; significant immunocomrpomised state (malignancy or cellular immunodeficiency due to HIV or AIDS); standard
HIV+ status not contraindication unless pt is severely immunocompromised
Varicella (live vaccine)
Recommended recipients: primary series in children; adults and adolescents who never had chickenpox (chickenpox confers immunity); susceptible, close contacts of immunocompromised pts; postexposure prophylaxis in susceptible ppl
Schedule: given as 2 doses w 2nd dose 4-8 wks after 1st date
Contraindications: pregnancy; immunocompromise due to malignancy or cellular immunodeficiency due to HIV/AIDS ; standard
immunosuppressive therapy per se not contraindication to varicella vaccine but dr should refer to acip guildines for delay of vaccine
Varicella (shingles) vaccine
Recommended recipients: adults > 60 yrs
Schedule: vaccinate (more data needed)
Contraindications:
Polio (inactivated) vaccine
Recommended recipients: given as primary series in kids; not routinely given to unvaccinated adults unless plan to travel to endemic areas
Schedule: refer to guildines
Contraindications: standard
Meningococcus serotypes A, C, W-135, and Y
Recommended recipients:asplenic ppl; travelers to areas where meningococcal dz is epidemic; military personnel; all college students; close contacts of pts w sporadic dz; ppl going to mecca or medina for hajj
Schedule: admin as single dose
Contraindications: standard
Rabies vaccine
Recommended recipients: post exposure prophylaxis; ppl at high risk for exposure to rabies
Schedule:
Contraindications:
HPV vaccine (human papilloma virus)
Recommended recipients: recommended for women 9-26
Schedule:
Contraindications:
Most important vaccines in adults
influenza and pneumococcus
CRC screening moderate risk pts
- single or multiple polyps, personal hx CRC: initial colonoscopy repeat 3 yrs if normal then colonoscopy every 5 yrs
- fam hx CRC or adenomatous polyps in 1st deg relatives: colonoscopy age 40 or 10 yrs younger than youngest case in fam; if normal repeat in 3-5 yrs
Colonoscopy high risk pts
- fam w familial adenomatous polyposis; genetic testing at age 10, consider colectomy if + genetic test or polyposis confirmed; if not colonoscopy every 1-2 yrs starting at puberty
- fam w hereditary nonpolyposis colorectal cancer : genetic testing at age 21; if + colonoscopy every 2 yrs until age 40 then every year thereafter
Women’s health: cervical cancer (Pap smear)
- start within 3 years of first sexual activity or age 21 (whichever comes first)
- if 2 consecutive smears (at ages 20 and 21) are negative then repeat every 3 yrs until age 35 then repeat every 5 years until age 65
more frequent screening in younger women due to increasing incidence of cervical cancer in this population (but controversial)
Women’s health: STDs
- all women at risk should be screened for chlamydia and gonorrhea (pelvic exam with cultures or enzyme immunoassay or DNA probe)
- recommends screening all sexually active women <=25 for chlamydia
- women and men w risk factors should be counseled and screened for HIV on periodic basis
Standard contraindications to vaccines
hx of anaphylactic rxn to vaccine + moderate to severe illness; mild illness not a contraindication
unless specified, breastfeeding not contraindication to vaccine
Misconceptions about contraindications to vaccination
- mild illness (common cold, low grade fever, mild diarrhea)
- convalescent phase of an illness
- recent exposure to a communicable dz
- breastfeeding
- current antibiotic therapy
- hx of nonspecific rxn to penicillin
