Preventive Medicine Flashcards
breast cancer screening test that lower mortality the MOST
mammogram
breast self-examination or by physician
-20-40 yo, q 3 yrs
->40 yo, annually
has NO proven benefit
breast cancer screening”mammogram”
- -start age 40 or 50 (controversial)
- stop at 74
- annually
- or every 1-2 years
cervical cancer screening: Pap smear guidelines
- start at age 21
- regardless of sexual activity
- every 3 years
- Pap: every year without HPV testing till age 30
- if age greater than 30 then do a pap and HPV test q3yr
(-if 3 neg cytology tests)
(- if Pap+HPV then q yr if HPV and cytology neg)
- until age 65
if Pap smear shows ASCUS
HPV testing
if ASCUS is HPV positive
COLPoscopy
colon cancer screening
- start at age 50 to 75
- colonoscopy q 10 yr
- or Flex sig, double contrast barium enema, CT colonography q 5 yr
- or fecal occult blood, fecal immunochemical test, annually
colon cancer screening if close family member had colon cancer
- start at age 40, or 10 years earlier than when family member was diagnosed, whichever comes first
hereditary nonpolyposis colon cancer syndrome (HNPCC) definition
- 3 family members
- 2 generations
- 1 premature (colon cancer before age 50)
hereditary nonpolyposis colon cancer syndrome (HNPCC) colon cancer screening
- start at age 25
- every 1-2 years
prostate cancer screening
NO recommendation to do routine screening
influenza vaccine greatest benefit
- everyone older than 50
- pregnant women
- health care workers
indications for influenza and pneumococcal vaccines
- patient with chronic lung, heart, liver, kidney, and cancer conditions
- HIV positive patients
- patients on steroids
- DM patients
influenza vaccine should be given
annually
pneumococcal vaccine should be given to
all patients greater than 65 yoa or 2-65 in certain circumstances
- adults >65 yo, one time
- ages 2-64 w chronic dz, asplenia, q 5 yr boosters
pneumococcal vaccine should be given
once (single injection)
meningococcal vaccination
- age 11
children at high risk of meningitis
- functional/anatomic asplenia
- terminal complement deficiency
HPV vaccination
- ALL females between ages 13-26
varicella-zoster vaccination for shingles
- everyone above 60 yoa
most effective method of achieving smoking cessation
oral medication = bupropion, or varenicline
osteoporosis screening
- bone densitometry (DEXA)
- all women >=65 yo: DEXA scan
- > =60 yo + RF: DEXA
osteopenia: T score -1.5 to -2.5
osteoporosis: Tscore
abdominal aortic aneurysm (AAA) screening
- age 65-75
- EVER smokers
- screen ONCE with US
with one time abd US for an abd aortic aneurysm
diabetes screening
- only if pt have risk of dz like HTN
- diag: 2 fasting glu >126, or random glu >200 with symp
HTN screening
ALL patients above age 18 at EVERY office visit
hyperlipidemia screening
- men greater than 35 yoa
- women greater than 45 yoa
- start men 35 yo, women 45 yo w/o RF
vaccinations for HIV pt
influenza, hepatitis viruses, pneumococcal polysaccharide
- no live virus vaccines except MMR, varicella, zoster (>60yo) if CD4>200 and no h/o AIDS illness
- no BCG, anthrax, oral typhoid, intranasal influenza, oral polio, yellow fever
Levels for therapy for hyperlipidemia
risk LDL goal lifestyle change drug tx CHD or risk equiv <100 all 130 >2 RF. <130 all 130 2 RF <130 130 160 0-1 RF. <160 160 190 risk equiv: DM, PVD, CAD, AAA RF: men>45, women>55, HTN, smoke, HDL< 40, fam h/o premature CHD
Vision exam in children
- screen for strabismus, amblyopia, refractive errors
- child age 0-5 yo
Rota virus vaccine
-given to infant between 2-8 months old
Meningococcal vaccine
- given to child 11-12 yo
- aplenic child may be given vaccine at 2 yo
Pelvic exam
- if 21-64 yo: annual or q3yr if 3 normal exams
- >65 yo, annual
Hep B vaccine
- adolescent - 18 yo
- adults at high risk
Rubella vaccine
- women child bearing age, ppl around preg women
- no preg 4 weeks after vaccine
still birth definitionDi
prenatal or natal (during delivery) death after 20 wks of gestation
MCC neonatal mortality, rate in US?
- prematurity
- 6/1000 (high in blacks)
maternal mortality causes
causes
- maternal related deaths (while preg or in first 42 days after delivery/100,000 live births
- PE, preeclampsia/eclampsia, hemorrhage
BP screening men and women
at least once every two years
colon, prostate screening
- initiate 40 yo
- digital rectal exam annually
PSA
- start at 50 yo
- controversial benefit, offer annually
Gyn pelvic exam
- 21 -64 yo: annually
- –after 3 normal exams, q2-3 yr
Endometrial cancer screening
- at menopause, do endometrial biopsy
- no routine screening
diabetes screening
-check blood glucose or HBA1c screening starting at 45 yo, q 3 yrs
Top 3 causes of death in men
Heart disease 26.3%
Cancer 24.1 %
Unintentional injury 6.6%
Top 3 causes of death in women
heart disease 25.8%
cancer 22%
stroke 6.7%
Top cancers in men
Prostate, lung, colorectal
Top cancer in women
Breast, lung, colorectal
Meningicoccal vaccine
-recommended if some other risk factor present: military recruits, microbiologists, complement pathway deficiencies, asplenia, at risk individuals vaccinated in that past 3-5 yrs, travelers to endemic area for meningococcal disease, adolescents between 11-18 yo
Top cancer in both sexes
Lung cancer
Who gets the tetanus booster shot?
-recommended in second trimester of pregnancy to all women who have not received booster in the 10 yrs before the pregnancy
or
pt who have not completed the course of immunization in childhood
breast self-examination
Monthly
HTN screening
every 1 to 2 years
HPV vaccine
11-26 one series of 3 vaccines
Influenza vaccine
everyone
Diphtheria/tetanus/pertussis vaccine
19-64 years one time in place of diptheria/tetanus booster
Diphtheria/tetanus vaccine boster
every 10 years and after 65 once
VZV vaccine shingles
once after 60
Counselling for adults
FuNEy SASS. Fire arm safety, nutrition, exersise alcohol, abuse, drugs, safe sex, and seat belt,
Counsel for kids
Heads assessment, no drugs
Menopausal
Hormone replacement counseling, osteoporosis
