Pusmle2 medicine 01 Preventive Medicine

Question Answer
colon CA – who should get screened? 1. If no FHx, start screening at 50. 2. If ONE 1st degree relative diagnosed <60yo 3. >1 first degree relative with colon CA (dx at any age)
If someone has no FHx of colon CA, when should they be screened and what should they get done? Start screening at 50yo. 1. q year FOBT, 2. q 5y sigmoidoscopy and barium enema, 3. q 10 y colonoscopy
If someone has FHx of colon CA, when should they be screened and what should they get done? Start screening at age 40 or 10 years younger than age of diagnosis of youngest affected family member, whichever comes first. 1. q year FOBT, 2. q FIVE YEARS colonoscopy
Mammography – who and how often? women > 40 if no history of BrCA, q1-2y
Breast exam by physician – who and how often? any woman >20 q 3 years
What should a woman with strong family history (1st degree relative) of BrCA get? prophylactic tamoxifen
Cervical cancer screening Pap smear. Start age: 3 years after sexually active or 21 (whichever comes first). If < 30, screen q1y if conventional PAP, q2y if liquid. If >=30, screen q2y if >3 normal annual PAPs.
Pt leaving for travel in two weeks wants to be immunized against Hep A. What do you give him? vaccine and IVIg (usually vaccine +6mo booster covers for 10 years)
Malaria prophylaxis. What if in a malaria med-resistant area? What if pregnant? Chloroquine. Mefloquine if resistant area. Atovaquone and proguanil together if pregnant.
What if pt needs Malaria and rabies immunizations together? intra muscular rabies (instead of intradermal), then can use chloroquine. (Chloroquine blunts the response to intradermal rabies)
Who should get N. meningitidis vaccine? 1. travel to Nepal, Africa, India, Saudi Arabia – mecca. 2. asplenia or complement deficiences, 3. at age 11
Traveler gets loose stools (no fever or blood) – what to take? Traveler gets bloody diarrhea – what to take? Loperamide if no blood/fever. If more severe sx's with blood, fluoroquinolone (ie cipro) or azithromycin.
Tetanus and diphtheria immunizations need 3 shots and booster q10 y
who should get flu vaccine? 1. >50yo, 2. any age: cardio/pulm disease, DM, Hbopathy, chronic care facilities, 3. pregnant in 2nd or 3rd trimester
who should get Strep PNA vaccine? 1. >65yo, 2. sickle cell or splenectomy, 3. CPulm dz, EtOH/cirrhosis, 4. Alaska or Native American, 5. immunocompromised
Who is considered immunocompromised? hematologic malignancies, chronic renal failure, nephrotic syndrome, HIV, immunosuppression
who should get Hep B vaccination? 1. IVDU, 2. male homosexuality, 3. household or sexual contact with HepB carriers, 4. blood product exposure, 5. chronic liver dz
live attenuated vaccines varicella, MMR
who can't get live attenuated vaccines? 1. IVIg, must wait 1 mo, 2. pregnant, 3. immunocompromised (HIV+ but asymptomatic OK to get vaccine)
5 A's of smoking cessation Ask Advise Attempt Assist Arrange
who should be screened for osteoporosis? DEXA scan for all women >65 if no risk factors. If low body weight or increased risk of fractures, then start at age 60.
What should a male smoker >65yo be screened for? AAA with U/S – one time.
Cholesterol screening no risk factors: men >35, women >45 if risk factors for CAD, >20 yo
DM screening only if have DM risk: obese, impaired fasting glucose, high risk ethnicity, +FamHx.
Diagnosis of DM 1. 2 fasting glucose >126, 2. random glucose >200 + sx's
blood pressure screening >18 yo q2 2y
alcoholism assessment CAGE 1. felt the need to Cut down on drinking? 2. Annoyed by criticism of drinking? 3. Guilty about drinking? 4. Eye opener? POSITIVE screen if 2 YES's
tx for a prolactinoma dopamine agonist: cabergoline or bromocriptine
order of intervention for prolactinoma dopamine agonist first, then surgery esp if compression of other structures or neuro sx's, last radiation
Non pregnant woman with elevated prolactin level. What to do? If >100, get MRI of pituitary.
what is acromegaly? excessive GH secretion from ant pituitary
acromegaly increases risk for what? DM
What is the best initial test for acromegaly? what is confirmatory test? IGF-1. Need to confirm with oral glucose challenge (100g glucose) –> then check GH. Confirmed is high GH since glucose load should normally suppress GH.
How to follow disease in acromegaly? IGF (also called somatomedin)
How to tx acromegaly 1. transphenoidal surgery, then 2. octreotide (somatostatin; blocks GH) – BEST medical therapy, then 3. bromocriptine/cabergoline (dopamine agonists; dopamine inhibits GHRH), then 4. pegvisomant (block GH from binding to its receptor peripherally)
what is the most common cause of death in acromegaly? cardiac failure
severe HA, n/v, depression of consciousness, pt w h/o pituitary adenoma pituitary aPOPlexy – acute hemorrhagic infarction of adenoma –> EMERGENCY! The adenoma POPs!
post-partum pt won't lactate. what should you check? pituitary function (think: Sheehan post-partum necrosis)
who is at greater risk for cervical cancer? what special screening rules apply to them? 1. DES exposure before birth, 2. HIV, 3. immunocompromised (steroids, organ transplant, on immunosuppressives, chemo). Even if >30 and 3 nl PAP's, still get yearly screen.
who should start prostate screening earlier and at what age? 45 yo if 1. AA, 2. strong fam hx, 3. relative dx <65yo
how old to start prostate screening? what does it consist of? 50yo. DRE and PSA.
should adults get a booster of inactivated polio? yes!! esp if traveling to polio-endemic country!
malaria prophylaxis chloroquine or mefloquine, 2 weeks before travel until 4 weeks after travel
malaria prophylaxis with primaquine 1-2 days before and 7 days after travel (shorter than chloroquine or mefloquine
drug helpful in smoking cessation first line: bupropion; second line: clonidine or amitryptiline
best screening test for DM fasting plasma glucose
screening for DM start at age 45 q3y
….not shown to be effective in preventing EtOH-impaired driving! designated driver programs

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