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25 Cards in this Set

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Cancer screening

Only recommended for colon, breast, & cervix




Smokers --> low dose CT scan/yr

Colon cancer screening

No sig family hx --> begin at age 50




Colonoscopy every 10 yrs




Fecal occult blood testing every yr (if positive --> colonoscopy)




Sigmoidoscopy with barium enema every 5 yrs

High risk colon cancer

first degree relative dx at age <60 OR MULTIPLE first degree relatives dx at any age




Screening should start at age 40 OR 10 yrs earlier than age at which youngest affected relative was dx




Colonoscopy every 5 yrs

Breast Cancer

50-75 years old --> Mammography every yr




Self breast exam cannot be screening tool alone

High risk breast cancer

Multiple first degree relatives




consider prophylatic tamoxifen

Cervical cancer

Starting age 21 --> Pap smear annually




< 30 yrs old --> screen annually using conventional methods OR q2 yrs using liquid based methods




> 30 yrs old --> screen q2 yrs if > 3 normal annual pap smears




IF PAP SMEARS ARE ALWAYS NEG --> STOP AT AGE 65

Hepatitis A

Hep A is most common vaccine preventable disease for travelers




Due to fecal contamination of food or drinking water




> 2 weeks away from travel --> vaccine




< 2 weeks of travel --> vaccine & immune globulin




Acute Hep A infection --> vaccine & immune globulin




Booster shot given 6 months after initial vaccination --> immune for 10 yrs

Hepatitis B

Transmitted via sexual intercourse or receive medical or dental care




If traveling for > 6 months --> should be vaccinated

Malaria prophylx

Chloroquine for traveling to:


Mexico


Central America (except Panama)


Caribbean




Mefloquine for traveling to any other endemic areas --> given 1 week prior to leaving, while in travel location, & for 2 weeks after they return to US




Mefloquine has psychiatric side effects including depression, very bad dreams, hallucinations




Instead of mefloquine --> doxcycline (given q1 day) but photosensitivity maybe side effect




For pregnant --> can use cholorquine, if not, atovaquone+proguanil

Rabies

Vaccine recommended for travel to areas where rabies is common among domesticated animals (eg India, Asia, Mexico)




Chloroquine can blunt response to intradermal rabies vaccine --> need to get vaccine prior to chloroquine

Yellow fever

Vaccine is live-attenuated




Vaccine is required to sub-saharan Africa and some South American countries




Contraindicated in immunocompromised & pregnant woman

Typhoid

Vaccine is capsular vaccine (live attenuated is also available but maybe difficult to give to pt)




Recommended for travelers to countries in which they will have prolonged exposure to contaminated food and water

Polio

Adults traveling to developing countries who have never been vaccinated




Should receive 3 doses of inactivated polio vaccine




Previously immunized should receive a 1 time booster




Live attenuated polio vaccine is no longer recommended bc of risk of vaccine associated disease

Meningitis

Polysaccharide vaccine




Should get for travel to Nepal, sub-saharan Africa, northern India




Saudi Arabia requires immunization for pilgrims to Mecca




In US, ppl living in close quarters (eg army barracks, college dorms) should receive vaccine




Pts with functional or actual asplenia and/or complement def should also receive vaccine




Should receive meningococcal vaccine at age 11




Exposed to Neisseria Menigitis --> prophx with rifampin and/or cipro

Diarrhea

Avoid salads and unwashed fruit and drinking tap or ice water




Loperamide --> for non bloody diarrhea with no fever




Fluoroquinolone or Azithro --> moderate to severe Sxs (eg fever, leukocytosis, bloody diarrhea)




E. coli --> Most common IDENTIFIED cause of travelers diarrhea

Influenza Vaccine

Annually for all adults regardless of age




Regardless of age --> Hx of cardiopulmonary dz, DM, hemoglobinopathy, residents of chronic care




Pregnant woman in 2nd or 3rd trimester should receive




Most common side effect is local erythema




DOES NOT CAUSE INFLUENZA LIKE SYNDROME

Pneumococcal vaccine

Polysaccharide vaccine with 23 different types (PPSV23)




65+ years of age




If PPSV23 given prior to age 65 --> booster shot if it was given more than 5 yrs earlier




High risk so get at any age:


Sickle cell dz or splenectomy


Cardiopulmonary dz


Etohics or cirrhosis


Alaskan natives and certain Native American populations


Immunocompromised


Chronic renal failure or nephrotic syndrome




High risk patients should get revaccinated 1x after 5 yrs of initial vaccination (particularily asplenic pt)

Varicella vaccine

Live attenuated virus




All adults who do not have hx of childhood infection




CONTRAINDICATED IN IMMUNOCOMPROMISED OR PREG WOMAN

Shingles vaccine

Lyophilized live attentuated VZV




60+ yrs of age is recommended




Only 1 dose is given




No need to get hx or serology for evidence of prior varicella infection, can still give vaccine




Pts with hx of zoster AND chronic medical condition (kidney disease, DM, etc), can be vaccinated




NOT INDICATED FOR ACUTE ZOSTER

HPV vaccine

Vaccine against 4 types of HPV (6, 11, 16, 18) assoc with genital warts & cervical cancer




Given in 3 doses & recommended in ages 11-12 but can be given at age 9 or later




If not vaccinated btwn age 13-26, can also receive




Males can also receive btwn age 9-26 to prevent genital warts




Pap smear screening should continue after vaccination

Smoking cessation

Smoking responsible 1/5 deaths in US




5 steps:


1) ASK about smoking at every visit


2) ADVICE all smokers to quit at every visit


3) ATTEMPT to identify those willing to quit


4) ASSIST --> set quit date and use nicotine patches/gum or bupropion (or Varenicline) supportive therapy


5) ARRANGE f/u




Patches or medical supportive therapy should be continued 6-9 months after quitting

Smoking and AAA

Male smokers >65 should be screened once with u/s for abdominal aortic aneurysm




If aneurysm found --> need to follow, but if >5cm ---> requires surgery

Osteoporosis prevention

DEXA scan is screening modality




All woman >65




High risk --> low body weight or increased risk of fractures screen at age 60

Preventing etoh abuse

Most important screening tool is CAGE questionare




Cut down?


Annoyed by criticism of your drinking?


Guilty about your drinking?


Eye opener in morning?




Yes to 1 question --> raise possibility of etoh abuse


Yes to 2 questions --> positive screen

Injury and violence prevention

Common cause of death <65




seat belts, bicycle helmets, not driving under the influence, firearm safety




Only call protective services for child abuse or elderly individual who cannot take care of themselves