Preventative Med

Question 1

protocol for infant if mother is positive for HepB surface antigen

Answer 1

• Vaccine and immunoglobulin w/in 12 hrs of birth
• 2nd dose of vaccine at 1-2 mo
• 3rd dose of vaccine at 6 mo

NB: if status of mother unknown, give vaccine at birth and test mother; if found to be pos give Ig w/in 7 days

Question 2

Hib vaccine - effectiveness against

• invasive disease
• otitis media

Answer 2

invasive disease: 95-100%

otitis media: none (usually caused by non-typable)

Question 3

Hib vaccine timing

Answer 3

AFTER 6 weeks

early than 6 wks - immune tolerance to antigen may be induced

Question 4

pregnant woman who has not had chicken pox and has not had the varicella vaccine - her? household contacts?

Answer 4

• vaccinate mother after delivery

- household contacts do not need to delay (if mother is immunocompetent)

Question 5

infection following varicella vaccine

Answer 5

1% of people vaccinated

does not appear to be contageious

Question 6

homosexual male who has had all the “typical childhood vaccines” - what vaccine is indicated

Answer 6

Hep A

Behavioral risk categories:

• more than one sexual partner in last 6 months
• seeking tx for another sexually transmitted disease
• current or recent injection-drug user
• MSM

Occupational risk categories:

• health care
• public safety

Medical risk categories:

• chronic liver disease
• HIV
• end-stage renal disease

Question 7

rubella vaccine and pregnancy

Answer 7

• contraindicated if pregnant or planning to be pregnant in the next 4 weeks
• vaccinate postpartum

Question 8

influenza vaccine recomendations (children)

Answer 8

• annually for children 6mo and older
• minimum age for live vaccine is 2 y/o
• 2 doses at least 4 wks apart for children between 6mo and 8yrs who are receiving vaccine for the first time or who were vaccinated for the first time last year but only received 1 dose

Question 9

PCV7 (7 valent pneumococcal) recommendation for children under 5

Answer 9

• healthy 24-59 m/o who have not completed primary immunization –> give 1 dose PCV7
• if they received less than 3 doses of PCV7 during primary immunization, give 2 doses at least 8 wks apart
• usual schedule: 2,4,6,12,15 months

Question 10

HPV quadrivalent vaccine

Answer 10

• females 9-26
• best before sexually active
• ok in brest feeding, h/o abnormal pap, immunocompromised
• not recommended during pregnancy
• males 9-26

Question 11

Tdap in pts over 65

Answer 11

• pts over 65 who have close contact with an infant less that 12 m/o regardless of interval of most recent Td vaccine

Question 12

influenza live vaccine (intranasal)

Answer 12

healthy adults younger than 50

Question 13

Year considered immune to:

• MMR
• Varicella

Answer 13

• MMR: 1957

- Varicella: 1980

Question 14

varicella zoster vaccine

Answer 14

• adults 60 yrs or older regardless of h/o prior episode(s) of zoster

(NOT currently approved for persons younger than 60)

Question 15

screening for lipids in men w/o other risk factors

• age?
• what are the risk factors (examples)

Answer 15

men - 35

RFs:

• diabetic pt
• FamHx of heart disease by age 50
• (others)

Question 16

(? lung cancer screening)

Answer 16

?

Question 17

colon cancer screening (age)

Answer 17

either:

50 y/o or 10 yrs before cancer was found in family member (whichever is EARLIER) to age 75

Question 18

age to begin routine mammogram screening w/ no fam hx

Answer 18

• 50 y/o
• prior to age 50, should be individualized
• 50-75 y/o every 2 yrs

Question 19

USPSTF and AAFP recommendation re: self breast exams (#19)

Answer 19

both recommend AGAINST BSE for women at average risk for breast cancer

Question 20

AAFP recomendation re: prostate cancer screenings

Answer 20

• evidence insufficient to recommend for or against routine prostate cancer screening in men younger than 75 yrs

Question 21

Cervical cancer screening begins at what age

Answer 21

21 or 3 yrs after sexually active

Question 22

discontinuation of paps

Answer 22

USPSTF
- age 65

American Cancer Society
- age 70
or
- has had 3 or more documented normal, technically satisfactory pap tests, and has had no abnormal pap tests in the last 10 yrs

Question 23

referral for genetic counseling for breast cancer

Answer 23

must meet specific high-risk criteria

non-Ashkenazi Jewish women

• 2 first degree relatives, one who was dx before 50
• 2 or more first or second degree relatives with breast cancer
• first degree relative w/ bilateral breast cancer
• 2 or more first or second degree with ovarian cancer
• first or second degree with both breast and ovarian cancer
• male relative with breast cancer

Aschkenazi Jewish women
- any first or 2 second degree relatives on same side of family w/ breast or ovarian cancer

Question 24

Surgeries:

• low risk
• moderate risk
• low risk

Answer 24

low ( 5%; high anticipated blood loss)

• aortic
• peripheral vascular

Question 25

pre-op cardiac evaluation

Answer 25

(see flow sheet and #29/30)

Question 26

MCC of death while traveling

Answer 26

heart disease

2nd is accidents - 25%

Question 27

high BP on combination oral contraceptives… next steps?

Answer 27

discontinue oral contraceptives and BP should return to normal w/in 3 months

NB: both E and P can increase BP; risk increases with age

Question 28

MC side effect cited as the reason for discontinuing COCs

Answer 28

irregular bleeding
(common in the first 3 months and generally diminishes over time)

other SEs:

• androgenic effects (hair growth, male pattern baldness, nausea,
• estrogenic effects (nausea, breast tenderness, fluid retention)

Question 29

Type of testing most appropriate for identifying the diagnosis for a child with multiple malformations with unknown etiology

Answer 29

cytogenetic analysis
(study of chromosome size, number, structure)

NB: direct DNA indicated when looking for a specific genetic disease