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Ambulatory Medicine > Health maintenance > Flashcards

Health maintenance Flashcards

0
Q

Screening for hyperlipidemia

A
  • 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

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1
Q

Screening for HTN

A
  • screen all adults 18+ for htn

- recommended interval 2 yrs but not firm establishment

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2
Q

Colorectal cancer (CRC) screening/surveillance

A
  • colonoscopy equivalent to flexible sigmoidoscopy + barium enema but is more $$$
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3
Q

CRC screening avg risk pts

A
  • avg risk pts > 50 yrs of age w no GI symptoms: either of following:
  1. fecal occult blood test every yr, 1 flexible sigmoidoscopy every 5 yrs
  2. fecal occult blood test every yr, 1 colonoscopy every 10 yrs
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4
Q

Colonoscopy

A
  • 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
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5
Q

Prostate Cancer screening

A
  • controversial
  • evidence not sufficient to determine benefits of widespread screening (early detection) outweight harm (false +, unnecessary treatments, expenses)
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6
Q

Women’s health: breast cancer

A

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

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7
Q

There are no screening tests for the following:

A
  1. lung cancer
  2. prostate cancer
  3. hypertension
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8
Q

Miscellaneous preventive health

A
  • 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
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9
Q

Functionally or Anatomically Asplenic indidividuals at increased risk for:

A

infection w encapsulated organisms

receive H.influenza type B (HIB) vaccine, meningococcal and pneumococcal vaccines

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10
Q

Influenza vaccine

A

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)

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11
Q

Pneumococcal polysaccharide vaccine

A

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

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12
Q

Tetanus/diphtheria (Td) vaccine

A

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

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13
Q

Hepatitis B vaccine

A

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

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14
Q

Hepatitis A vaccine

A

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

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15
Q

Measles-Mumps-Rubella vaccine

A

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

16
Q

Varicella (live vaccine)

A

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

17
Q

Varicella (shingles) vaccine

A

Recommended recipients: adults > 60 yrs
Schedule: vaccinate (more data needed)
Contraindications:

18
Q

Polio (inactivated) vaccine

A

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

19
Q

Meningococcus serotypes A, C, W-135, and Y

A

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

20
Q

Rabies vaccine

A

Recommended recipients: post exposure prophylaxis; ppl at high risk for exposure to rabies
Schedule:
Contraindications:

21
Q

HPV vaccine (human papilloma virus)

A

Recommended recipients: recommended for women 9-26
Schedule:
Contraindications:

22
Q

Most important vaccines in adults

A

influenza and pneumococcus

23
Q

CRC screening moderate risk pts

A
  • 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
24
Q

Colonoscopy high risk pts

A
  • 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
25
Q

Women’s health: cervical cancer (Pap smear)

A
  • 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)

26
Q

Women’s health: STDs

A
  • 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
27
Q

Standard contraindications to vaccines

A

hx of anaphylactic rxn to vaccine + moderate to severe illness; mild illness not a contraindication

unless specified, breastfeeding not contraindication to vaccine

28
Q

Misconceptions about contraindications to vaccination

A
  • 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

Ambulatory Medicine (19 decks)

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