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28 Cards in this Set

  • Front
  • Back
drawbacks of screening
iatrogenia, expensive, unpleasant, inconvenient, harmful, stigma

"screening-HESIItant"
valid screening test
shown to decrease overall mortality in screened population in randomized double-blind trial
malignancies to regularly screen for
colon, breast and cervix cancers
screening for colon cancer, no significant family history
after age 50: annual fecal occult blood, sigmoidoscopy every 5 years and barium enema. Preferred modality: colonoscopy every 10 years
screening for colon cancer, high-risk patients
colonoscopy every 5 years starting at age 40 or 10 years younger than at the age at which youngest affected relative was diagnosed
screening for breast cancer
mammography every 1-2 years from age 40
breast exam by physician every 3 years from ages 20-30
self breast exam is no longer recommended
patients with strong family history should receive prophylactic tamoxifen
screening for cervix cancer
Pap smear annually starting 3 years after becoming sexually active or at age 21

patients <30 screen annually if conventional methods or every 2 years if using liquid-based

patients >30 screen every 2 years if >3 normal annual Pap smears
vaccinations for travelers
Hep A
Hep B
malaria
rabies
yellow fever
typhoid fever
polio
meningococcal meningitis
depending on case
Hep A vaccination
if traveler is leaving within 2 weeks of being seen give Hep A vaccine plus immune serum globuline; booster after 6 months confers immunity for 10 years; also recommended for day-care employees, homosexual men and chronic liver disease
Hep B vaccination
for travelers who will work closely with indigenous population or will engage in sexual intercourse, receive medical or dental care and those who plan to remain abroad for over 6 months; also IV drug users, male homosexuals, contact with carriers, frequent exposure to blood or chronic liver disease
prophylaxis for malaria
for patients traveling to Mexico, Central America or Caribbean: chloroquine

for areas with chloroquine resistance: mefloquine or doxycyline (2nd line)

for pregnant: atovaquone plus proguanil
prophylaxis for rabies
patients travelling to Mexico, India, Asia
intradermal vaccine or intramuscular in case patient is also receiving malaria prophylaxis
not routine for most
yellow fever vaccine
for patients travelling to sub-saharan Africa and some south American countries
typhoid vaccination
travelers to developing countries; live atenuated vaccine is contraindicated in HIV patients; intramuscular polysacchride vaccine is preferred
polio vaccination
given to unvaccinated travelers to developing countries
three doses of inactivated vaccine or one-time booster if previously immunized
meningococcal meningitis vaccine
travelers to endemic or epidemic areas (Nepal, sub-Saharan Africa, northern India); required for pilgrims to Mecca; patients with functional asplenia or terminal complement deficiencies
11-12 years
tetanus and diptheria immunization
unvaccinated adults should receive three doses
first 2 are 1-2 months apart and third dose 6-12months later
booster every 10 years
2, 4, 6 months; 15-18 months; booster 10 years
influenza vaccination
recommended annually for all healthy adults after age 50
patients with history of cardiopulmonary disease
diabetes
hemoglobinopathy
pregnant women will be in 2nd or 3rd trimester during influenza season
pneumococcal vaccination
Revaccination recommended for all over 65

or at any age in case of: sickle-cell patients, splenectomy, cardiopulmonary disease, alcoholism, cirrohsis, immunocompromised (hematologic malignancies, chronic renal failure, HIV, etc.)

Patients with high risk of fatal infections should be revaccinated every 5 years

"enCCApSSIlated over 65"
varicella vaccine
live attenuated recomemded for all adults who lack childhood history of varicela except immunocompromised or pregnant
MMR vaccine
live attenuated vaccine given to children or unvaccinated adults born after 1956; except HIV or pregnant;

given at 12-15 months with pre-school booster 4-6 years
smoking cessation
responsible for 1/5 of deaths in US

Ask
Advise
Attempt
Assist
Arrange follow-up
osteoporosis prevention
women older than 65 should receive DEXA scan
if low body weight or fracture risk start screening at 60
abdominal aortic aneurysm screening
ultrasound to male smokers older than 65
no screening necessary for male non-smokers and women regardless of smoking history
hypertension screening
patients older than 18, at every visit, at least every 2 years
cholesterol screening
start screening at age 35 in men and 45 in women without risk factors

patients with risk factors for atherosclerosis screen routinely after 20 years of age
diabetes screening
if risk factors are present (obesity, impaired fasting glucose, high-risk ethnicity, positive family history, hypertension, hyperlipidemia)

two fasting glucose above 126mg/dL or random measure greater than 200 w/symptoms are diagnostic
alcohol abuse screening
two "yes" answers to CAGE questionare

Cut down
Annoyed
Guilty
Eye opener