Routine Healthcare maintenance and VACCINATIONS Flashcards
Screening exams and Vaccinations
when to screen abdominal aortic aneurysm
men ages 65-75 with any smoking history one time test of abdominal duplex U/S
When to repair a large AAA?
>5.5 cm or have found to have .5 cm in half a year
what is considered a abdominal aortic aneurysm
>3 cm and affects the infrarenal aorta
risk factors for AAA
smoking, age, white, male sex, family history and atherosclerotic disease
Symptoms of AAA
asymptomatic, may have abdominal flank or back pain. May have lower limb ischemia or thromboembolism and rupture will see abdominal distension and shock
management of AAA
smoking cessation, statin and aspirin therapy elective repair for >5.5 or rapidly enlarging or 0.5 cm in 6 months
follow up imaging for AAA if present is
medium 4-5.4 cm is every 6-12 months smaller: ultrasound every 2-3 years.
HIV screening is for
15-65 yrs and increased risk regardless age, RF, or prior screening
lung cancer screening is for people with
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.
Routine screening age for low risk pts for hyperlipidemia?
all men >35 get a lipid panel all women >44 get a lipid panel
who gets screened for coronary artery disease and hyperlipidemia?
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.
diabetes screening is supposed to happen in:
pts who fall into higher prevalence groups are more likely to benefit from current treatment: overweight, age >45 yrs, HTN and HLD.
Age for herpes zoster vaccination?
>60 yrs old
Hepatitis A vaccination?
anyone who is at increased risk for complications or infection. (liver dx, who travel to endemic areas)
Vaccinate asplenic pts?
14 days before and after splenectomy and every 5 years thereafter.
medical indications for hepatitis A vaccination:
chronic liver dx, clotting factor deficiency, exposure during outbreak (childcare worker) close contact with index case
lifestyle indications for hepatitis A vaccination
men who have sex with men illicit drug use travel to endemic area lab work with hepatitis A close contact to a international adoptee
signs of intimate partner violence
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
tips to interview for intimate partner violence
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)
what vaccines are contraindicated in someone who is on immunosuppressive medications
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.
Indications for HPV vaccine?
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
who do you NOT give HPV vaccine to?
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.
what does HPV vaccine do?
decreases risk for cervical cancer, penile cancer, oropharyngeal cancer associated with HPV 16 and 18 yrs
Is HPV vaccine ok in breast feeding women?
yes it’s fine.
give vaccine at 4 and 8 and 24 weeks
what if pt has only gotten one or two HPV vaccines?
not a contraindication and can be still administered.
schedule for pneumococcal vaccinations
Screening for abdominal aortic aneurysm based on size
increased risk for rupture is:
male gender
age >65
smoking history.
30 day mortality for endovascular surgical repair of AAA
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
when should pts get a open surgery for repair of AAA?
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.
When to get CT abdomen for AAA?
prior to surgical planning for elective repair
also if there’s a suspected leak or rupture.
For women ages 21-29 should get:
cervical cancer screening with cytology alone even those who got vaccinated against HPV.
or do it every 3 years
Which vaccine do you give a celiac pt?
pneumoccocal vaccine - increased rates of hyposplenism for some reason.
routine screening in a man who has sex with men
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.
when to screen for DM2 in pt?
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.
