Preventive Medicine

Front 1

drawbacks of screening

Back 1

iatrogenia, expensive, unpleasant, inconvenient, harmful, stigma

"screening-HESIItant"

Front 2

valid screening test

Back 2

shown to decrease overall mortality in screened population in randomized double-blind trial

Front 3

malignancies to regularly screen for

Back 3

colon, breast and cervix cancers

Front 4

screening for colon cancer, no significant family history

Back 4

after age 50: annual fecal occult blood, sigmoidoscopy every 5 years and barium enema. Preferred modality: colonoscopy every 10 years

Front 5

screening for colon cancer, high-risk patients

Back 5

colonoscopy every 5 years starting at age 40 or 10 years younger than at the age at which youngest affected relative was diagnosed

Front 6

screening for breast cancer

Back 6

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

Front 7

screening for cervix cancer

Back 7

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

Front 8

vaccinations for travelers

Back 8

Hep A
Hep B
malaria
rabies
yellow fever
typhoid fever
polio
meningococcal meningitis
depending on case

Front 9

Hep A vaccination

Back 9

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

Front 10

Hep B vaccination

Back 10

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

Front 11

prophylaxis for malaria

Back 11

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

Front 12

prophylaxis for rabies

Back 12

patients travelling to Mexico, India, Asia
intradermal vaccine or intramuscular in case patient is also receiving malaria prophylaxis
not routine for most

Front 13

yellow fever vaccine

Back 13

for patients travelling to sub-saharan Africa and some south American countries

Front 14

typhoid vaccination

Back 14

travelers to developing countries; live atenuated vaccine is contraindicated in HIV patients; intramuscular polysacchride vaccine is preferred

Front 15

polio vaccination

Back 15

given to unvaccinated travelers to developing countries
three doses of inactivated vaccine or one-time booster if previously immunized

Front 16

meningococcal meningitis vaccine

Back 16

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

Front 17

tetanus and diptheria immunization

Back 17

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

Front 18

influenza vaccination

Back 18

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

Front 19

pneumococcal vaccination

Back 19

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"

Front 20

varicella vaccine

Back 20

live attenuated recomemded for all adults who lack childhood history of varicela except immunocompromised or pregnant

Front 21

MMR vaccine

Back 21

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

Front 22

smoking cessation

Back 22

responsible for 1/5 of deaths in US

Ask
Advise
Attempt
Assist
Arrange follow-up

Front 23

osteoporosis prevention

Back 23

women older than 65 should receive DEXA scan
if low body weight or fracture risk start screening at 60

Front 24

abdominal aortic aneurysm screening

Back 24

ultrasound to male smokers older than 65
no screening necessary for male non-smokers and women regardless of smoking history

Front 25

hypertension screening

Back 25

patients older than 18, at every visit, at least every 2 years

Front 26

cholesterol screening

Back 26

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

Front 27

diabetes screening

Back 27

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

Front 28

alcohol abuse screening

Back 28

two "yes" answers to CAGE questionare

Cut down
Annoyed
Guilty
Eye opener