Intro to Well-Patient Exam Flashcards
What is the purpose of the Well-Patient Exam?
- Screen for Disease
- Assess risk of future medical problems
- Encourage a healthy lifestyle
- Update vaccinations
- Maintain a relationship with a health care provider in case of illness
What is a good way to ask about Sexual History?
Do you have any concerns about your sex life?
Where can you find the Review of Systems list?
Maxwell’s System Complaints
What is the Basic approach to a Well-Patient Exam?
Head-to-Toe Screening exam
If you find something that is abnormal, you should do additional exams so that you know how to proceed with the workup
Where in the SOAP note does the Review of Symptoms go?
SUBJECTIVE
Where do you put immunizations in your SOAP note?
PLAN
What some sources to get recommendations for vaccines?
- CDC Recommendations (For vaccine recommendations)
- United States Preventive Services Task Force Recommendations (For screening recommendations)
- American Cancer Society
What are the guidelines for the Influenza Vaccine?
- All people age 6 months or older should have an annual vaccine
- Forms: Intramuscular, Intradermal, Inhaled
- Age 65 or older may opt for the high-dose vaccine
Should pregnant women get the flu vaccine?
People with egg allergies?
What about people who are going to be around newborns or very sick people?
Will getting the flu shot give me the flu?
YES
Depends on what their allergy is… If anaphylaxis, probably NO.
YES
NO
What are the guidelines for the Tdap Vaccine?
- One dose of Tdap, then every 10 years thereafter give Td booster
- Give Tdap once per pregnancy, usually around 27-36 weeks Gestation, regardless when the last Td or Tday vaccine was recieved
What are the guidelines for the Varicella Vaccine?
- CONTRADICTED in pregnancy, immune-compromised conditions and HIV with CD4 count <200
- TWO doses for anybody who doesn’t have documentation of 2 varicella vaccines in lifetime or who hasn’t had chicken pox
What are the guidelines for Human Papilloma Virus (HPV) Vaccine?
- 3 doses up to age 26 for women, up to age 21 for most men, up to age 26 for men who have sex with men or who have other risk factors
- Recommended for ALL boys and girls starting at age 11
What are the guidelines for the Varicella Zoster Vaccine (Shingles Shot)?
- Starting at age 60, all adults should get one, whether or not they have had a previous case of shingles
- CONTRAINDICATED in pregnancy, immune-compromised conditions and HIV with CD4 count <200
What are the guidelines for the MMR Vaccine?
- Adults born before 1957 are considered immune
- Certain adults need a second booster
- CONTRAINDICATED in pregnancy, immune-compromising conditions and HIV with CD4 count <200
What are the guidelines for the Pneumococcal Vaccines?
- All adults age 65 or older
- All adults who smoke
- Residents of nursing home
- All adults who are diabetic or have chronic lung disease
- 5 years after first dose, re-dose people with chronic renal failure, nephrotic syndrome, functional or anatomic asplenia
- Everybody who has a dose before age 65 gets ANOTHER dose at or after age 65
Who needs to get Hepatitis A? Hepatitis B?
Hep A: Men who have sex with men, people traveling to or adopting from areas where Hep A is endemic
Hep B: HEALTH CARE WORKERS, Diabetics
What are the guidelines for the Meningococcal Vaccine?
- Upper teen as they approach communal living areas like dorms
- Revaccination every 5 years if continue to be at high risk
Differentiate between screening and testing patients.
Screening: Testing an ASYMPTOMATIC patient for a specific disease that is recommended by a national service
Testing: Testing a SYMPTOMATIC patient for a specific disease
When should you screen for an Abdominal Aortic Aneurysm?
Men who have ever smoked at ages 64-75 for AAA with ultrasonography
When should you screen for Alcohol misuse?
Screen adults age 18 and older for misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling
When should you screen with Mammograms?
Begin at age 50, then do every 2 years until age 75 (AAFP)
Start at age 40 then do it yearly (American Cancer Society)
When should you give a Pap Smear?
- Not necessary before the age of 21
- Every 3 years until age 65
When do you screen for Colon Cancer?
- Begin at age 50 and continue until age 75
- Recommend AGAINST screen age 76-85, unless patient is in good shape
When should you screen for HIV?
AAFP say screening adults ages 15-65 and ALL Pregnant women
When should you start with statins in patients that might be at risk for lipid disorders?
AAFP recommends treating with a low to moderate dose of statin to adults aged 40-75 with no symptoms or history of cardiovascular disease and a calculated 10-year CVD risk of 10% or greater
When should you screen for Obesity?
Adults with a BMI > 30 kg/m2
When should you screen for Osteoporosis?
AAFP recommends screening women age 65 and older and younger women whose fracture risk is equal to or above that of a 65 year-old woman
