Red Book Stuff Flashcards
What are THREE vaccines recommended for adults > 65 years?
- Influenza vaccine (annually)
- Pneumococcal vaccine (single dose, opportunistically)
- Herpes zoster virus vaccine (single dose, > 60 years)
What vaccines are recommended prior to pregnancy (if not already immune / up to date)?
- diphtheria, tetanus, pertussis (DTP)
- measles, mumps, rubella (MMR)
- varicella
- hepatitis B
- influenza
N.B. if a woman has received a live vaccine (measles, mumps, rubella, varicella) she is to be advised NOT to fall pregnant within the next 28 days.
What vaccines are available under the National Immunisation Schedule (NIS) for the following age groups: ✔️ birth ✔️ 2 months ✔️ 4 months ✔️ 6 months ✔️ 12 months ✔️ 18 months
BIRTH
✔️ hepatitis B
2 MONTHS
✔️ DTPa - HBV - IPV / Hib
✔️ Pneumococcal
✔️ Rotavirus
4 MONTHS
✔️ DTPa - HBV - IPV / Hib
✔️ Pneumococcal
✔️ Rotavirus
6 MONTHS
✔️ DTPa - HBV - IPV / Hib
✔️ Pneumococcal
✔️ Rotavirus
12 MONTHS
✔️ measles, mumps, rubella
✔️ Hib - MenC
✔️ Pneumococcal (at risk groups only)
18 MONTHS
✔️ measles, mumps, rubella, varicella
✔️ DTPa
4 YEARS
✔️ MMR or MMRV (if missed)
✔️ DTPa - IPV
✔️ Pneumococcal (at risk groups only)
What vaccines are appropriate for all healthcare workers?
✔️ hepatitis
✔️ MMRV
✔️ DTPa
✔️ influenza
What are the screening guidelines for colorectal cancer in an individual with NORMAL RISK?
For normal risk individuals, iFOBT should be conducted every 2 years from the age of 50 to 74 years with repeated negative results.
What factors constitute MODERATE RISK for colorectal cancer? How should these people be screened?
CRITERIA:
✔️ one family member diagnosed with CRC < 55 years of age
✔️ two first degree relatives or one first degree + one second degree (same side of the family) diagnosed with CRC at any age
SCREENING: colonoscopy every five years from 50 years of age or 10 years prior to age of diagnosis
What factors constitute HIGH RISK for colorectal cancer? How should these people be screened?
CRITIERA:
✔️ three first degree or three second degree relatives with CRC (at least one < 55 years)
✔️ three or more first degree relatives with CRC at any age
✔️ family history of Lynch Syndrome
SCREENING: iFOBT every two years from 35 to 44 years and then colonoscopy every five years from 45 to 74 years
What are the screening guidelines for breast cancer in an individual with NORMAL RISK?
For normal risk individuals, mammogram should be conducted every 2 years from 50 to 74 years with repeated negative results.
What factors constitute MODERATE RISK for breast cancer? How should these people be screened?
CRITERIA:
✔️ one or more family member diagnosed < 50 years
✔️ two first degree relatives (on the same side of the family) diagnosed at any age
✔️ two second degree relatives diagnosed at any age (however, one must be < 50 years)
SCREENING: consider mammogram every year from 40 years of age (minimum screening recommendations is mammogram every two years from 50 years)
What factors constitute HIGH RISK for breast cancer? How should these people be screened?
CRITERIA:
✔️ first degree relative diagnosed < 40 years of age
✔️ breast + ovarian cancer in the same women
✔️ bilateral breast cancer
✔️ male breast cancer
SCREENING: referral to a breast screening program for individualised surveillance
What are the screening guidelines for cervical cancer in an individual with NORMAL RISK?
All women should be screened for cervical cancer via the CST from 25 years of age, or TWO years after their first experience of sexual intercourse, whichever is later. Screening should take place every 5 years.
Describe the current recommendations / guidelines in place for screening of prostate cancer.
- Currently in Australia, prostate cancer is not routinely screened for via the DRE or PSA.
- Risk naturally increases with increasing age and a family history.
- Due to slow progression of the disease, any man > 75 years or with a life expectancy < 10 years at the time of diagnosis, is more likely to die “with” prostate cancer than “from” prostate cancer.
- Any requests from the patient should be acknowledge and met where possible, however, it is also important to council the patient on the limitations of the PSA.
Describe the current recommendations / guidelines in place for screening of skin cancer.
- All Australians should be educated about sun safety / protection.
- Self-skin examinations should be encouraged every three months, particularly for individuals at a “high risk.”
- Clinical assessment of high risk individuals may be necessary every six months.
- Factors that influence risk stratification include:
✔️ age
✔️ gender
✔️ family history
✔️ ethnicity / skin type
✔️ skin responsiveness to sun exposure / burn
✔️ evidence of keratinic skin
✔️ number of atypical melanocytic naevi
Define OSTEOPOROSIS.
Osteoporosis is reduced bone density, micro-vasculature fractures within the bone and a T score of < -2.5
Note that in a patient who has experienced a fragility fracture, a T Score of < -2.5 is NOT required for a diagnosis.
T score < -1.5 is suggestive of osteopenia.
Risk factors for osteoporosis?
✔️ increasing age ✔️ female gender ✔️ post-menopausal ✔️ low BMI ✔️ physical inactivity / immobility ✔️ inadequate Vitamin D or Ca ++ intake ✔️ malnutrition ✔️ smoking ✔️ excessive alcohol consumption
Define secondary osteoporosis. Identify some causes.
Secondary osteoporosis is reduced bone mineral density that occurs as a result of a primary medical condition. This includes: ✔️ Cushing's Disease / Syndrome ✔️ hyperthyroidism ✔️ hyperparathyroidism ✔️ anorexia nervosa ✔️ malabsorption (e.g. Coeliac Disease) ✔️ inflammatory conditions (e.g. RA) ✔️ drugs and medications (e.g. methotrexate, corticosteroids) ✔️ chronic liver or kidney disease
What are the current screening recommendations / guidelines in Australia for osteoporosis?
Women should be screened from 45 years of age.
Men should be screen from 50 years of age.
The bone mineral density test (DXA) test is appropriate for screening. Measurements should be taken from at least two areas (e.g. pelvic, femur) every two years.
Define METABOLIC SYNDROME.
Metabolic syndrome requires THREE of the following five criteria:
- triglycerides > / = to 1.7 mmol / L
- glucose resistance > 5.5 mmol / L (fasting)
- HDL-C to total-C ratio < / = to 1.0 mmol / L (males) or < / = 1.3 mmol / L (females)
- waist circumference > / = 102 cm (males) or > / = 88 cm (females)
- blood pressure > 130 mmHg SBP or > 80 mmHg DBP
Metabolic syndrome is characterised by a cluster of features that all share the same underlying pathophysiology of insulin resistance, and significantly increase an individuals’ risk of both diabetes mellitus and cardiovascular disease.
Outline management of METABOLIC SYNDROME.
Metabolic syndrome depends on both lifestyle (non-pharmacological) and pharmacological interventions:
✔️ weight loss of 5 to 10%
✔️ caloric deficit of ~600 kCal per day
✔️ 30 mins of moderate physical activity per day
✔️ smoking cessation
✔️ alcohol reduction to within appropriate limits
✔️ pharmacological management of hypertension, dyslipidemia and insulin resistance (if appropriate)
✔️ cessation of drugs contributing to hyperglycaemia / insulin resistance
Define ABSOLUTE CARDIOVASCULAR RISK.
Absolute cardiovascular risk assessment is a tool used to stratify the risk that an individual will experience an adverse cardiovascular event (e.g. stroke, MI) within the next FIVE years.
It should be calculated every TWO years from the age of 45 years (non-ATSI people) or from 35 years (ATSI people).
Identify HIGH RISK populations in regard to the absolute cardiovascular risk (i.e. people who do not require an assessment).
✔️ diabetes mellitus > 60 years of age
✔️ diabetes mellitus with microalbuminemia
✔️ ATSI people > 74 years
✔️ moderate or severe CKD
✔️ familial hypercholesterolemia
✔️ triglycerides >7.5 mmol / L
✔️ SBP > / = 180 mmHg or DBP > / = 110mmHg
✔️ previous adverse cardiovascular event (e.g. MI, stroke)
Outline the components of the ABSOLUTE CARDIOVASCULAR RISK assessment.
NON-MODIFIABLE RISK FACTORS
✔️ age
✔️ gender
✔️ ATSI status
MODIFIABLE RISK FACTORS ✔️ smoking ✔️ diabetes mellitus ✔️ systolic blood pressure ✔️ left ventricular hypertrophy on ECG ✔️ HDL-C to total-C ratio
Outline interpretation of the ACR.
Low risk: <10%
Moderate risk: 10 to 15%
High risk: >15%
Blood pressure values / cutoffs for: ✔️ normal ✔️ high normal ✔️ Grade 1 HTN ✔️ Grade 2 HTN ✔️ Grade 3 HTN
Normal: SBP < 120 mmHg DBP < 80 mmHg
High Normal: SBP 120 - 139 mmHg DBP 80 - 89 mmHg
Grade I HTN: SBP 140 - 159 mmHg DBP 90 - 99 mmHg
Grade II HTN: SBP 160 - 179 mmHg DBP 100 - 109 mmHg
Grade III HTN: SBP > 180 mmHg DBP > 110 mmHg
