Routine Healthcare maintenance and VACCINATIONS

Question 1

when to screen abdominal aortic aneurysm

Answer 1

men ages 65-75 with any smoking history one time test of abdominal duplex U/S

Question 2

When to repair a large AAA?

Answer 2

>5.5 cm or have found to have .5 cm in half a year

Question 3

what is considered a abdominal aortic aneurysm

Answer 3

>3 cm and affects the infrarenal aorta

Question 4

risk factors for AAA

Answer 4

smoking, age, white, male sex, family history and atherosclerotic disease

Question 5

Symptoms of AAA

Answer 5

asymptomatic, may have abdominal flank or back pain. May have lower limb ischemia or thromboembolism and rupture will see abdominal distension and shock

Question 6

management of AAA

Answer 6

smoking cessation, statin and aspirin therapy elective repair for >5.5 or rapidly enlarging or 0.5 cm in 6 months

Question 7

follow up imaging for AAA if present is

Answer 7

medium 4-5.4 cm is every 6-12 months smaller: ultrasound every 2-3 years.

Question 8

HIV screening is for

Answer 8

15-65 yrs and increased risk regardless age, RF, or prior screening

Question 9

lung cancer screening is for people with

Answer 9

55-80 yrs and 30 pack year history AND current smoker or quit smoking within the last 15 years Pt must not have other conditions that would limit life expectancy and would be unable to unwilling to undergo curative surgery Can stop screening if >80 yrs, quit smoking >15 yrs or can’t undergo tx for lung cancer.

Question 10

Routine screening age for low risk pts for hyperlipidemia?

Answer 10

all men >35 get a lipid panel all women >44 get a lipid panel

Question 11

who gets screened for coronary artery disease and hyperlipidemia?

Answer 11

increased risk pts all should get screened regardless of age with a lipid panel if have one risk factor: personal history of DM2, HTN, obesity, coronary heart dx, or other atherosclerotid dx, tobacco use or family history Men <50 or women <60.

Question 12

diabetes screening is supposed to happen in:

Answer 12

pts who fall into higher prevalence groups are more likely to benefit from current treatment: overweight, age >45 yrs, HTN and HLD.

Question 13

Age for herpes zoster vaccination?

Answer 13

>60 yrs old

Question 14

Hepatitis A vaccination?

Answer 14

anyone who is at increased risk for complications or infection. (liver dx, who travel to endemic areas)

Question 15

Vaccinate asplenic pts?

Answer 15

14 days before and after splenectomy and every 5 years thereafter.

Question 16

medical indications for hepatitis A vaccination:

Answer 16

chronic liver dx, clotting factor deficiency, exposure during outbreak (childcare worker) close contact with index case

Question 17

lifestyle indications for hepatitis A vaccination

Answer 17

men who have sex with men illicit drug use travel to endemic area lab work with hepatitis A close contact to a international adoptee

Question 18

signs of intimate partner violence

Answer 18

location of injuries (genitals, torso, face, head and neck inconsistent explanation, evasive and fearful non adherence to follow up and emergency department visits partner who resists patient being seen alone discomfort in examination STDs and chronic pelvic pain

Question 19

tips to interview for intimate partner violence

Answer 19

ensure privacy non judgmental empathetic, open ended questions avoid pressuring to disclose abuse or report or leave partner assess immediate safety, determine emergency safety plan, provide referrals for resources as needed (shelters, domestic violence agency and mental health)

Question 20

what vaccines are contraindicated in someone who is on immunosuppressive medications

Answer 20

no live vaccines (MMR or varicella or zoster) need to hold TNF alpha or immunosuppressive for at least 2-3 months prior but IM influenzae and pneumoccal are ok.

Question 21

Indications for HPV vaccine?

Answer 21

all girls and women ages 11-26 but can be given up to age 45 yrs boys and men ages 11-21 (up to ages 26 for men who have sex with men) immunocompromised pts (including HIV pts) age 11-26 yrs Not indicated in pregnant women

Question 22

who do you NOT give HPV vaccine to?

Answer 22

contraindicated in those with previous allergy reaction or hypersensitivity to vaccine. Not recommended in pregnant women because not been studied. OK to give in breast feeding women.

Question 23

what does HPV vaccine do?

Answer 23

decreases risk for cervical cancer, penile cancer, oropharyngeal cancer associated with HPV 16 and 18 yrs

Question 24

Is HPV vaccine ok in breast feeding women?

Answer 24

yes it’s fine.

give vaccine at 4 and 8 and 24 weeks

Question 25

what if pt has only gotten one or two HPV vaccines?

Answer 25

not a contraindication and can be still administered.

Question 26

schedule for pneumococcal vaccinations

Answer 26

Question 27

Screening for abdominal aortic aneurysm based on size

Answer 27

increased risk for rupture is:

male gender

age >65

smoking history.

Question 28

30 day mortality for endovascular surgical repair of AAA

Answer 28

1-2% for endovascular repair

4.5% for open surgical repair of AAA but surgery is recommended for >5.5 cm or an increase of >0.5% in 6 month period

Question 29

when should pts get a open surgery for repair of AAA?

Answer 29

symptomatic repair of AAA regardless of size.

surgery is recommended for >5.5 cm or an increase of >0.5% in 6 month period

endovascular repairs being used with increasing frequency for elective repair regardless of size of aneurysm.

Question 30

When to get CT abdomen for AAA?

Answer 30

prior to surgical planning for elective repair

also if there’s a suspected leak or rupture.

Question 31

For women ages 21-29 should get:

Answer 31

cervical cancer screening with cytology alone even those who got vaccinated against HPV.

or do it every 3 years

Question 32

Which vaccine do you give a celiac pt?

Answer 32

pneumoccocal vaccine - increased rates of hyposplenism for some reason.

Question 33

routine screening in a man who has sex with men

Answer 33

screen for genital and extragenital gonorrhea and chlamydia

HIV

syphilis

All MSM should be tested for hep A and B

HPV vaccinations in all pts through age 26

vaccination against hep A and B.

Question 34

when to screen for DM2 in pt?

Answer 34

40-70 yrs adults with overweight or obesity

screen any patient at any age with overweight or obesity + one additional risk factor for diabetes.

if no risk factors start screening at 45 years.