Intro to Well-Patient Exam

Question 1

What is the purpose of the Well-Patient Exam?

Answer 1

• 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

Question 2

What is a good way to ask about Sexual History?

Answer 2

Do you have any concerns about your sex life?

Question 3

Where can you find the Review of Systems list?

Answer 3

Maxwell’s System Complaints

Question 4

What is the Basic approach to a Well-Patient Exam?

Answer 4

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

Question 5

Where in the SOAP note does the Review of Symptoms go?

Answer 5

SUBJECTIVE

Question 6

Where do you put immunizations in your SOAP note?

Answer 6

PLAN

Question 7

What some sources to get recommendations for vaccines?

Answer 7

• CDC Recommendations (For vaccine recommendations)
• United States Preventive Services Task Force Recommendations (For screening recommendations)
• American Cancer Society

Question 8

What are the guidelines for the Influenza Vaccine?

Answer 8

• 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

Question 9

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?

Answer 9

YES

Depends on what their allergy is… If anaphylaxis, probably NO.

YES

NO

Question 10

What are the guidelines for the Tdap Vaccine?

Answer 10

• 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

Question 11

What are the guidelines for the Varicella Vaccine?

Answer 11

• 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

Question 12

What are the guidelines for Human Papilloma Virus (HPV) Vaccine?

Answer 12

• 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

Question 13

What are the guidelines for the Varicella Zoster Vaccine (Shingles Shot)?

Answer 13

• 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

Question 14

What are the guidelines for the MMR Vaccine?

Answer 14

• 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

Question 15

What are the guidelines for the Pneumococcal Vaccines?

Answer 15

• 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

Question 16

Who needs to get Hepatitis A? Hepatitis B?

Answer 16

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

Question 17

What are the guidelines for the Meningococcal Vaccine?

Answer 17

• Upper teen as they approach communal living areas like dorms
• Revaccination every 5 years if continue to be at high risk

Question 18

Differentiate between screening and testing patients.

Answer 18

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

Question 19

When should you screen for an Abdominal Aortic Aneurysm?

Answer 19

Men who have ever smoked at ages 64-75 for AAA with ultrasonography

Question 20

When should you screen for Alcohol misuse?

Answer 20

Screen adults age 18 and older for misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling

Question 21

When should you screen with Mammograms?

Answer 21

Begin at age 50, then do every 2 years until age 75 (AAFP)

Start at age 40 then do it yearly (American Cancer Society)

Question 22

When should you give a Pap Smear?

Answer 22

• Not necessary before the age of 21

- Every 3 years until age 65

Question 23

When do you screen for Colon Cancer?

Answer 23

• Begin at age 50 and continue until age 75

- Recommend AGAINST screen age 76-85, unless patient is in good shape

Question 24

When should you screen for HIV?

Answer 24

AAFP say screening adults ages 15-65 and ALL Pregnant women

Question 25

When should you start with statins in patients that might be at risk for lipid disorders?

Answer 25

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

Question 26

When should you screen for Obesity?

Answer 26

Adults with a BMI > 30 kg/m2

Question 27

When should you screen for Osteoporosis?

Answer 27

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