Screening Guidelines & Immunizations Flashcards
Screen for AAA
Screen 1x for AAA via US in men 65-75 yo who have ever smoked
DO NOT screen women
DO NOT screen men nonsmokers
Would you use nontraditional risk factors (eg ABI, hs-CRP, fasting gluc) to screen asymptomatic men and women w/ no hx of CHD to prevent CHD events?
NO
When screen for EtOH abuse/misuse?
> = 18yo
No evidence to see if this has benefit or harm
Screen for Iron Deficiency Anemia
Screen:
- asymptomatic pregnant women
Supplement Fe in asymptomatic children ages 6 to 12 months who are at increased risk for iron deficiency anemia
Aspirin use recs
YES for:
- men 45-79 when benefit of preventing MI outweigh GI bleed risk
- women 55-79 when benefit of preventing ischemic stroke outweigh GI bleed risk
DO NOT use for:
- ppx colorectal ca in ppl w/ average risk
- women < 55 yrs for stroke prevention
- men < 45 yrs for MI ppx
Pregnancy screens
YES Screen:
- asymp bacteriuria w/ UCx for preggers @ 12-16 wks gestation
- HIV
- syphillis
- chlamydia
- gonorrhea if high risk
- rubella (risk microcephaly) and hep b immunity screen
- iron deficiency anemia in asymptomatic
NO Screen:
- Bacterial vaginosis in asymp preggers @ low risk preterm delivery
Do you screen for bladder cancer?
No
Screen for HTN
in adults >=18yo
q2y
Breast screening - genetic testing
Screen if women have family w/ cancers of breast, ovarian, tubal, peritoneal
Breast screening
Self breast exam >=20 yo q 1mo
PE q3y until 40. Then q1 y
Mammogram:
- Age 40 yo q1-2 yrs
- If FHx, age 30 yo q1yr
OR
50-74 q2 y if avg risk
NOT if > 75
Screen for carotid A stenosis
DO NOT screen asympatomatic
Pap smear testing for cervical cancer
HPV screening
YES:
- cytology:
- ——21-65yo q3 yr regardless of sexual activity
OR
- Cytology + HPV testing:
——-30-65 yo q5 years if nl paps and want to lengthen time between
Otherwise, no HPV screen and just q3yr paps
HPV screening > 30 yo
- this is because most young women will clear their HPV and also the dysplasia. So will undergo invasive testing and cause more consequences
- if find LISL, monitor until 26 yo
NO:
- < 21 yo
- > 65-70 who had 3 consecutive negative pap smears
- > 65 yo w/ nl screening and not at high risk
- women w/ hysterectomy w/ removal of cervix w/o hx of high grade precancerous lesion
Chlamydia screening
YES:
- all sex active non-preggers < =24yo
- older non-preggers at increased risk
- all preggers < 24
- older preggers at increased risk
NO:
- >25 yo not at increased risk
Lipid/cholesterol/HLD disorder screening
> =20 yo –> Measure NONFASTING total cholesterol + HDL chol q5y.
- Don’t need LDL level for screening
- if nl, repeat q5yr
- if > 240, do complete lipoprotein (LDL) profile
Men
- screen >= 35 yo
- screen 20-35 yo if at increased risk for CHD
Women
- > =45 yo
- 20-45 yo if INCREASED RISK
Screen for COPD
DO NOT use spirometry to screen for COPD
Screen for CRC
> 50 yo low risk
- FOBT q1y + flex sig q5y
- FOBT q1y + colonoscopy q10y
- double contrast barium enema q5yr
Start screening 10 years before first degree relative developed colon cancer
If have polyps or personal hx CRC (high-grade dysplasia, three or more adenomas, adenomas with villous features, and an adenoma ≥1 cm in size)
- colonoscopy q3y
- if nl, q5y
Do not routine screen 75-85. Do not screen >85
Screen for CHD
NO:
- EKG in asymptomatic w/ low risk
Prevent dental caries in kids
- oral F for > 6mo if H2O source is deficient
Screen for depression
- kids
- adults
For both, only if staff-assisted depression care support in place to make sure accurate dx, effective tx and f/u
Screening for DM 2
- screen in asymptomatic adults w/ sustained BP (tx or w/o tx) > 135/80
Folic acid rec for preggers
Planning or capable of pregnancy take daily folic acid 400-800 mcg
Screen for Gestational DM
Not sufficient evidence to recommend routine screening
Ppx for gonococcal ophthalmia neonatorum
Recs ppx ocular topical meds for all newborns for prevention
Screen for Gonorrhea
YES:
- all sex active women if at increased risk
NO:
- men and women at low risk infection
Unsure
- preggers without inc risk
- routine in men at inc risk
Screen for hearing loss
YES in newborns
Not routine in adults
Screening for hemachromatosis
NOT for asympatomatic
Screen for sickle cell
In all newborns
Hep B screening
Screen for hep B in preggers at 1st prenatal visit
Screen for Hep C
Screen
- 1x for adults born between 1945-1965
- intravenous drug abuse no matter how long or how often,
- receiving clotting factor produced before 1987,
- persistent alanine aminotransferase elevations,
- recent needle stick with HCV-positive blood
HIV screening
YES
- 15-65 yo
- high risk younger or older
- all preggers
Screen for congenital hypothyroidism
Yes
Domestic violence screen
YES
The USPSTF recommends that clinicians screen women of childbearing age for intimate partner violence, such as domestic violence, and provide or refer women who screen positive to intervention services.
Screening for intrapartum electronic fetal monitoring?
Not recommended for routine use
But it is common practice in US
Lead screening
NO:
- asymptomtatic kids 1-5yo at avg risk
- asympt preggers
Screen for Lung cancer
YES!
Low-dose CT if 55-80 yo + have 30 pack year smoking hx and currently smoke or quit in past 15 years
Stop after person not smoked for 15 years or no longer candidate for curative lung cancer surgery (b/c not healthy)
Osteoporosis screening
All women ≥65 & all men ≥70 should be screened for osteoporosis.
For men and women age 50–69, the presence of factors associated with low bone density would merit screening.
Risk factors include low body weight, previous fracture, a family history of osteoporosis with fracture, a history of falls, physical inactivity, low vitamin D or calcium intake, and the use of certain medications or the presence of certain medical conditions.
Screen for PKU in newborns?
YES
PSA based screening for prostate cancer?
No recommended screening
CAn cause more tests, tx, and pain
but Am Uro Assoc:
- PSA + DRE @40 w/ counseling about risks and benefits of screening
- screen in pts up to 75 yo w/ life expectancy at least 10 yrs
Syphillis screening
YES:
- if increased risk
- all preggers
NO:
- asympt, not at inc risk
When do vision screening?
If between 3-5 yo
When give rotavirus vaccine?
For viral gastroenteritis
Recommended for all
three doses to be given at 2, 4, and 6 months of age
Requirements for Department of Transportation regulations to serve as commercial driver
Disqualify:
Insulin-dependent diabetes, even if well controlled,
OK:
- Vision of 20/40 or better
- Adequate hearing in one ear
- well-compensated controlled heart disease
- Blood pressure of <160/90 mm Hg = 2 yr driving
- BP160/90–181/105 mm Hg can receive a 3-month temporary certification during which treatment for hypertension should be undertaken.
Recommended vaccines for all international travelers
Hep A tetanus, diphtheria, polio, measles
Sensitivity
is the ability of a test to identify patients who actually have the disease, or the true-positive rate
Sensitivity is the percentage of patients with a disease who have a positive test result
specificity,
which is the ability to correctly identify patients who do not have the disease, or the true-negative rate
Specificity is the percentage of patients without the disease who have a negative test result.
Regular breast self-examinations to screen for breast cancer result in..
increase the number of breast biopsies performed
leading cause of cancer-related deaths in the United States
Lung cancer
Routine polyvalent pneumococcal vaccination (Pneumovax 23) recommendationso
Start at age 65
< 65 vaccination if have chronic condition
Booster 5 years later if vaccinated before 65
Chronic conditions:
- chronic lung dz (asthma COPD, emphysema)
- chronic CV dz
- DM
- Chronic liver dz
- smokers
- Alcoholism
- Cochlear implants
- CSF leaks
- immunocompromised
- asplenia (sickle cells, splenectomy)
- if they were vaccinated >5 years previously and were aged < 2 years of age should receive the 13-valent conjugate vaccine as a part of their routine well child vaccinations at 2, 4, 6, and 12 to 15 months of age.
All persons between the ages of 19 and 64 who smoke should receive this vaccine. One-time revaccination after 5 years is recommended for persons with chronic renal failure, asplenia (functional or anatomic), or other immunocompromising conditions.
Case:
50 yo man
no sig PMHx
What screenings and immunizations to do?
Cardio:
BP
Lipids
Cancer: FOBT Flex sig Colonoscopy Double contrast barium enema
? PSA
Immunizations:
Tdap
Flu vaccine
Screen for peripheral artery disease?
NOT in asymptomatic
Cancers to NOT screen for in asymptomatic adults
Bladder
Testicular
Pancreatic
Thyroid
Vaccines ok for preggers
Flu
Tetanus
No;
Varicella
Rubella
When screen for diabetes in asymptomatic patient?
bmi > 25 and 1+ DM risk factors
No risk factors –> @ 45 yo
If tests normal, repeat at least q3years
OR
For any pt with BP > 135/80
Shingles vaccine
> 60 yo adults
appropriate follow-up options for managing women with an ASC-US (atypical squamous cells of undertermined significance) Papanicolaou (Pap) test result:
If 21-24yo
Pap test q1 year
If find 3 abnormal tests, then colposcopy
If >=25 yo,
First do HPV test
If negative, pap+HPV at 3 yrs
If positive, colposcopy
(1) two repeat cytologic examinations performed at 6-month intervals;
(2) reflex testing for HPV, if nl, then come back at regular 12 mo intervals
(3) a single colposcopic examination
routine physical examination every
3–5 years for young adults until the age of 40.
Lead screening is recommended for
at-risk individuals between 6 months and 6 years of age
Two doses of varicella vaccine are recommended for
all children unless they are immunocompromised
Vaccines recommended for diabetics
Influenza vaccine should be provided to patients with diabetes annually.
Pneumococcal polysaccharide vaccine should be provided to all patients with diabetes over 2 years of age. A one-time revaccination is recommended for patients over 64 years of age if the vaccine was first received greater than 5 years ago. Otherwise, patients should also receive the re-vaccination if they have nephrotic syndrome, chronic renal disease or are in an immunocompromised state.
Hepatitis B vaccine should be administered to all unvaccinated adults with diabetes, HIV, other immunocompromising conditions, or liver disease.
The USPSTF recommends screening for what cancers?
breast cancer
colorectal cancer
cervical cancer
Td and TdaP (Tetanus, Diphtheria, and Pertussis) vaccine given…
Td booster q10y >18 yo
1 TdaP booster for all adults >19 unless you had it at 11-18
1 TdaP for all preggers regardless of number years since last
CAn preggers get intranasal flu vaccine?
No
Vaccines for HIV +
Flu Hepatitis S. pneumo Td Meningococcal HPV HiB
If CD4 > 200
MMR
Varicella
Zoster (> 60yo)
Forward vs rear facing car seat for infants…?
the rear-facing position should be used until the child is
- at least 12 months old AND weighs at least 20 lb (9 kg).
For example, a 13-month-old child who weighs 19 lb should face rearward
When do you screen for asymptomatic bactruria?
asymptomatic pregnant women at 12–16 weeks gestation, or at the first prenatal visit if it occurs later
Categories of prevention
Primary prevention targets individuals who may be at risk to develop a medical condition and intervenes to prevent the onset of that condition (e.g., childhood vaccination programs, water fluoridation, antismoking programs, and education about safe sex).
Secondary prevention targets individuals who have developed an asymptomatic disease and institutes treatment to prevent complications (e.g., routine Papanicolaou smears, and screening for hypertension, diabetes, or hyperlipidemia).
Tertiary prevention targets individuals with a known disease, with the goal of limiting or preventing future complications (e.g., screening diabetics for microalbuminuria, rigorous treatment of diabetes mellitus, and post-myocardial infarction prophylaxis with β-blockers and aspirin).
Evaluating patients with atypical glandular cells of undetermined significance (AGUS)
(1) colposcopy
(2) endocervical curettage;
endometrial sampling is recommended in women 35 years of age or older, and in those with AGUS favoring neoplasia or suggesting an endometrial source.
