Wellness Exam Lecture-1/6/16

Question 1

What is the adult recommendation for HPV in females and males?

Answer 1

3 doses up to age 26 years for women, up to age 21 for most men, up to age 26 for men who have sex with men or who have other risk factors

Recommended for all boys and girls at age 11

Question 2

What is the adult recommendation for the varicella vaccine?

Answer 2

2 doses for anyone who doesn’t have documentation of 2 varicella vaccines in lifetime or who hasnt had the chicken pox

Even adults who have had the shingles should get the varicella vaccine if they have not had it before

Question 3

What is the adult recommendation for pneumococcal vaccine?

Answer 3

• all adults age 65 or older
• all adults who smoke
• residents of nursing homes
• all adults who are diabetic, have chronic lung disease (including asthma), chronic CV disease, chronic renal disease, nephrotic syndrome, chronic liver disease, alcoholism, functional or anatomic asplenia
• 5 years after 1st dose, re-dose people with chronic renal failure, nephrotic syndrome, function or anatomic asplenia
• everybody who has a dose before age 65 gets another dose at or after age 65

Question 4

What is the adult recommendation for varicella zoster vaccination?

Answer 4

• starting at age 60, all adults should get one, whether or not they have had a previous case of shingles
• goal is to prevent not just the painful rash, but the postherpetic neuropathy, which is debilitating
• straight from CDC card: “persons aged 60 yrs or older with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy, or severe immunodeficiency

Question 5

What is the adult recommendation for the influenza vaccine?

Answer 5

1 dose annually

• all people age 6 months or older should have annual vaccine
• Contraindications: egg allergies
• age 65 or older may opt for high-dose vaccine, if available

Question 6

What are recommendations for Papanicolaou smear?

Answer 6

• Not necessary before age 21, then every 3 years to age 65

- For women age 30+, may opt to do Pap plus HPV screening every 5 years

Question 7

When are Pap smears not necessary or not recommended?

Answer 7

• Not necessary to do pap smear before starting contraceptives in girls or women less than 21 years old
• Paps not recommended for women after 65 unless at high risk for cervical cancer
• Paps not recommended for hysterectomy with cervix removal unless high grade precancerous lesion or cervical cancer

Question 8

What are recommendations for Mammograms?

Answer 8

• AAFP recommends mammograms begin at age 50, then do every 2 years until age 75
• American Cancer Association recommends these start at age 40 then yearly

Question 9

What are recommended screenings for gonorrhea and chlamydia?

Answer 9

• Recommended screening for GC/CT in women age 24 younger and in older women at increased risk of disease
• Current evidence insufficient to assess balance of benefits/harms for routine screening for men

Question 10

What are recommendations for screening for HIV?

Answer 10

Adults age 18-65 should be screened for HIV.
Older adults who are at increased risk should also be screened
All pregnant women should be screened for HIV

Question 11

What are recommendations for colon cancer screening?

Answer 11

• recommend screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 years and continuing until age 75.
• Recommend against screening age 76-85

Question 12

What are recommendations for PSA screening?

Answer 12

The USPSTF/AAFP recommend AGAINST routine screening of PSA for prostate cancer

American Cancer Society recommends discussion with each man and evaluation of his risk factors. For men who have a primary relative with prostate cancer, may consider testing at age 45, other men age 50, with or without digital rectal exam

Question 13

What is the recommended adult immunization schedule for Tdap?

Answer 13

Give 1 dose of Tdap, then every 10 years thereafter give Td booster; for people who are around infants, may wish to give a Tdap to protect the adult as well as infants they care for from pertussis

• When people have a puncture wound or laceration, they will be updated unless their Td booster was within the previous 5 years
• Give Tdap once per pregnancy, usually around 32-36 weeks