Screening/Prevention Flashcards
When should we start to screen for dyslipidemia?
If the patient has risk factors like fm hx of dyslipidemia, risk factors for atherosclerosis or they are obese then we would start screening at 20. If the patient doesn’t have any of the latter risk factors then we will wait until 35 to initially screen.
What are the side affects of statins?
Myopathy and hepatitis (elevated ALT:AST)
There is an increased chance of a patient acquiring myopathy while they are taking a statin with what other drug?
fibrates, in someone you suspect of having myopathy always check TSH levels and also consider if this patient has hypothyroidism.
What labs should you check before starting a patient on a statin?
TSH and LFT’s
What are the live vaccines that are given to adults.
HIM alive ; herpes zoster, influenza, and MMR
What are the live vaccines we give children?
liv CRIME; chicken pox, rotavirus, MMR
influenza,
What vaccines should patients with asplenia get?
SHIN (streptococcus, Haemophilus, and Nisseria M
How often should the influenza vaccine be administered in adults ?
Annually vaccines can start as early as six months of age, contraindications include persons with egg allergies
How often should the TDap vaccine be administered in adults ?
Adults > 19
If someone steps on a nail what is the protocol for tetanus vaccination?
What’s the protocol for administering rabies vaccine?
When do we begin to vaccinate for HPV (papilloma)?
age 11
When do we administer a shingles vaccine?
age 50
When would we consider immunization for Hep A/B?
chronic liver dz or STD, specifically for Hep B if they have also been exposed or they work in healthcare
How is strep pneumonia vaccine delivered.
Everyone should at most have a PCV13 vaccine in their lifetime, but PPSV23 can be administered up to three times.
When do we start screening for HPV? and what is the frequency with follow up?
age 21
When do we screen for diabetes?
Typically around age 35 or if the patient has fm hx, risk factors for CAD, obese, hyperlipidemia.
When should a female start screening for breast cancer?
45-50 ( can start as early as 40 if there is genetic predisposition)
Should females who smoke get a chest X-ray lie men if they have a significant smoking history?
Yes, typically this should start at age 65
When should we start screening females for osteoporosis?
60
When should we implement statins?
When ASCVD risk score is >7.5% (had a previous history of stroke or TIA, had an MI, angina, or heart surgery, or had a vascular surgery or hx of coagulation). LDL >100, triglycerides >150, Cholesterol >200.
When should we screen for AAA in men?
age 60 with history of smoking
When should we screen for lung cancer in males?
Age 55 with 20 year history of smoking.
What other etiologies/differentials do we consider for someone with milk discharge from the nipple?
Pregnancy, anti-dopaminergic drugs, hypothyroidism.
A 25 yo patient comes with c/o of production of milk form the breast. She also explains she sometimes has mild headache and blurred vision, what’s the next best step in management?
Prolactin.
Why would someone with hypothyroidism have nipple discharge?
Elevated TRH would have activating effects on prolactin.
After you’ve ruled out the other possibilities of milk production, what’s the best next step in management if you suspect a prolactinomma?
MRI of the pituitary
What is the first line treatment in a prolactinomma?
Cabergoline (dopaminergic agonist), if the condition is refractory to medical management we consider surgical removal
Hyponatremia that is 135-130 should be treated how?
Conservatively with water restriction
If a patient has hypovolemic hyponatremina (125-130).
The patient should be given normal saline
If the patient has hypervolemic hyponatremia how should we approach treatment?
The patient should be on fluid restriction and
Total serum calcium=
bound calcium (bound to negatively charged things like proteins citrate phosphate) + free calcium
What are the hormones that regulate calcium?
PTH and vitamin D
How do low levels of albumin affect calcium levels?
The don’t change the free calcium, but their is a decrease the total calcium concentration
