Preventative Medicine Flashcards
What are the 2 types of influenza vaccine?
What is the age group recommendations?
Influenza - trivalent inactivated influenza
vaccine and nasal live attenuated influenza
vaccine (FluMist)
recommended to all people >6m
Test - N/A for immunity test
Who gets FluMist?
Flumist avail to all healthy, nonpreg, <50 yo
What are the contraindications for influenza vaccine?
Contra - in people anaphylaxsis to eggs or
vaccine components, used in preg
What are the 2 types of pneumococcal vaccines?
Pneumococcus - 2 available vaccines
PPSVS23 and PCV13
polyvalent polysach inactivated vaccine
against 23 & 13 for s. pneumo
Who gets which pneumococcal vaccine?
PCV13 recommended for adults 65yo w high risk condition
chronic pulm disease, smokers, DM, nursing
home or long term care facility
What is the schedule for giving pneumococcal vaccine?
Schedule - >65yo w/o hx of vaccination give
PPSV23 - only one vaccination after 65 yo
- single re-vaccination after 5 years in people who are immunocompromised or if 1st injection was before 65
What is the contraindication to pneumococcal vaccine?
Contra - allergic rxn,
severe acute illness,
avoid in chemo/radiation,
pregnancy
What is Zoster vaccine? recommendations? how many doses?
Zoster - live attenuated vaccine, Zostava
decreases herpes zoster reactivation infection
shingles, reduces incidence of post herpetic
neuralgia
Recommended for adults >60 regardless of
previous zoster history
Schedule 1 dose after 60
What is the contraindications of Zoster vaccine?
Contra - preg, planned preg within 4 weeks,
immunocomp individual (high dose steriods,
leukemia, HIV<200, anaphylaxsis rxn to gelatin
or neomycin
What is the vaccination for Hep A? Schedule of doses? How to check for immunity? Contraindications to this vaccine?
Hep A - in combo w Hep B called Twinrix
Schedule - 0 & 6m (2 doses)
Immunity - check IgG Ab
Contra - preg, severely ill pts
Who gets Hep A vaccine?
Recommended for pts w increase risk for liver complications or existing liver disease, men who have sex w men, pts who work, travel in endemics areas close family contacts
Who gets Hep B vaccine? Scheduling doses? Immunity testing?
Hep B - given to all children, majority of
unvaccinated people are adults
Recommended for ERRD, HIV, IVD use,
heath care workers, sexual active
Schedule - 3 doses, at 0m, 1-2m, 4-6m
Testing - screen vaccination status w HbsAb/
HBVab, if chemo add HBcAb
What is the contraindications of Hep B vaccines?
Contra - in pts w yeast allergy or previous
rxn to dose
What is recommendations of tetanus vaccine? Scheduling? How do you test for immunity?
Tetanus/Diptheria/acellular pertussi Td or combo Tdap prevents tetanus Recommended - for everyone Tdap @ Om Td @ 1m Td @ 7-12m Tdap booster 1x Td booster every 10 years Test immunity- NA
Who routinely gets Tdap?
Preg women on every pregnancy
What is the contraindications for tetanus vaccine?
History of encephalopathy,
caution w GBS,
Hx of Arthus rxn to tetanus toxoid <10 yrs
Wound management for person who has had all 3 primary doses if they have minor (clean) infection? major infection?
People who received 3 doses and the cut is a clean or minor cut then if its been > 10 years since last dose then give Td
if the wound is dirty or major and its been > 5 years since last dose then give Td
Wound management of person who had less 3 doses or who has unknown immunity against tetanus? Clean wound and dirty wound management?
Clean wound
just give the vaccine Td
Dirty wound
give the vaccine Td and TIG (immunoglobulin)
What is the available vaccines for meningococcal? Who do you give it to?
- polysach inactivated vaccine (MPSV4) 56 yo
Asplenia
Terminal complement deficiency
Military recruits
Residents of college dormitories
Travelers to Mecca or Medina in Saudi Arabia for the Hajj (pilgrimage)
What is the scheduling vaccine meningococcal doses? Contraindications?
2 doses of MCV4 @ 2m apart
re-vaccinating every 5 yrs in pt w/ increase risk
asplenic/complement def
contra - acute fibrile illness (>100; 37.8),
pregnancy
Varicella vaccine is given to who? What type of vaccine is it? Doses? Immunity test?
Varciella -live attenuated
Recommended - to all kids >12m + adults w/o
immunity to varciella
Schedule - 2 doses (0 & 1-2m)
Test - documentation, birth before 1980, VZVIgG
hx of varciella/HZ
What are the contraindications to varicella vaccine?
Contra - preg - give after birth or delivery,
anaphylaxsis to neomycin/gelatin, immunocomp
HIV <200 CD4
What is the HPV vaccines? 2 types? Who are the recommended for?
HPV vaccine - Gardasil (HPV4) against 6, 11,
16, 18 Cervarix - against 16 & 18
HPV vaccine can be given to patients w hX of
genital warts, abnormal paps, + HPV DNA
Recommended for women 11-12yo and 13-21
if not vaccinated ; The quadrivalent (Gardasil) HPV vaccine is recommended for routine use in boys ages 13 to 21 years (who have not initiated or completed the 3-dose series), as well as men ages 22 to 26 years.
What is scheduling of HPV vaccines? immunity test?
Contraindications for the vaccine?
schedule - 3 doses 0,2m, 6m test - N/A contra - allergic to previous dose (Gardasil) or latex allergy (Cervarix) acute fever >100F, preg
What are the MMR vaccine recommendations? immunity testing? Live or not?
MMR - 3 live attenuated vaccines
Recommended - adult born during or after
1957 w/o evidence of incidence of immunity
2nd dose of MMR is recommended for adults
w/ recent disease esp/ healthcare workers
schedule - 1 dose or 2 dose > 28 day apart
if international travelers
test - MMR titer
What are the contraindications for MMR vaccine?
contra - preg women or planned w/in 4 wks
ok w BR feeding, contra in anaphylaxsis to
neomycin, severly inmunocomp
When do you screen for colon cancer? How do you screen?
- In the patient with no significant family history of colon cancer, screening should begin at age 50
- The choices are annual fecal occult blood testing or sigmoidoscopy with barium enema every 5 years. The preferred screening modality for colon cancer is colonoscopy every 10 years.
What about screening colon cancer in person who has family history of colon cancer?
In the patient with a single first-degree relative diagnosed with colorectal cancer before age 60 or multiple first-degree relatives with colon cancer at any age, colonoscopy should begin at age 40 or 10 years before the age at which the youngest affected relative was diagnosed, whichever age occurs earlier.
When do you stop screening for colon cancer?
no routine screening in patients age >75.
When do you start screening for breast cancer?
screen btw 50-74 and recommended every 1-2 yrs
If patient has BRCA family history - what drugs can you give prophylactically?
consider giving tamoxifen or raloxifene prophylactically in patients that have >1 family member with BRCA
What screening method lowers mortality?
Mammography
What age do women start getting pap smears?
21 regardless of onset of sexual activity
When do you stop doing pap smears on women?
65 yrs of age - you should do a pap smear every 3 years
What can women do to lengthen the time in between pap smears?
They can do Pap and HPV every 5 years
When is chlamydia screen done in women?
15-25 yo
What vaccines are you considering if you are traveling?
Hep A Hep B Malaria Rabies Typhoid Polio
Hepatitis A - how it contracted? how does the immunization work for Hep A? no booster or booster?
fecal contamination of food or drinking water
- if patient is leaving within 2 weeks of being seen both vaccine and immune globulin are recommended
- booster shot given 6 months after initial vaccination confers immunity for 10 yrs
Hep B - are given to people who travel for how long?
if they are going to be abroad for >6 months
Malaria - what do you give prophylaxsis?
mefloquine - alt is doxycycline
What do you give pregnant women for malaria prophylaxsis?
chloroquine
What do you give chloroquine resistant malaria?
atovaquone
When do you give rabies vaccine?
people traveling to India, Asia, Mexico
What do you have to be careful when giving rabies vaccine and malaria prophylaxsis?
chloroquine blocks response to intradermal form of rabies vaccine
there for patients who require rabies vaccine then give intramuscular form
How do you get typhoid?
prolonged exposure to contaminated food and water
What are the two forms of typhoid vaccine? preferred?
oral live attenuated and capsular polysach vaccine (IM)
polysach vaccine preferred and its save in HIV pts
What is the side effects of typhoid vaccine?
irritation at the injection site, headache and fever are rare
If you’re traveling, how many doses of inactivated polio vaccine should you get?
3 doses, if you previously vaccinated give 1x booster shot
Who should get the meningococcal vaccine - if they are traveling?
people going to sub sahara Africa, northern India, nepal, mecca travelers
asplenia
routinely given at 11 yo
How do you treat travelers with travelers diarrhea?
tx w fluroquinolone or azithromycin
When do you screen for osteoporosis? how?
women > 65 , do DEXA scan
When do you screen for AAA?
men >65 who have ever smoked, no screen for nonsmokers
When do you screen cholesterol without RFs? repeat?
at 35 yo w/o RFs
if CAD RFs start at 20
repeat every 5 years in low risk patients
When do you screen for DM?
in patients with HTN > 135/80
How do you Dx DM? 3 ways?
> 125 2 FBG measurements
HbA1C >6.5
random glucose >200 w/ symptoms of DM
When do you start screening for HTN?
18 yo
