PREVENTIVE MEDICINE TiKi TaKa

------------------------------. All women > 65 ys should be screened by DEXA scan to exclude Osteoporosis
. Needle stick injury with HBV:
------------------------------. Previusly immunized with HBsAb +ve ----> REASSURANCE.
. Unknown H/O or not immunized ----> HBIG + HBV.
. Adult 23 polyvalent pnemococcal vaccine:
-----------------------------------------. contains capsular polysaccharides.
. Mechanism : Humoral immunity.
. i.e. T cell IN-dependent, B cell response.
. i.e. B-cell NOT T-cell response !
. BUPROPION "not BUSPIRONE" is recommended to aid in smoking cessation.
. PROSTATE CANCER SCREENING:
---------------------------. There is no specific test for PROSTATE cancer screening.
. PSA measurment is controversial !
. Discuss checking the PSA with the patient !!
. Avoid decubitus ulcers by pt repositioning every 2 hours.
. LDL LEVEL CONTROL:
-------------------. A pt with known coronary heart disease "CHD" or a risk equivalent e.g. DM,
. should be ttt with life style modification + STATINS "NOT NIACIN",
. to reach a goal LDL < 100 mg/dl.
. CHD risk equivalents = DM. - CAD - PAD - AAA.
. Risk factors:
--------------. Cigarette smoking.
. BP < 140/90 mmHg.
. Premature CHD in family members (<55ys in men & < 65ys in women).
. Low HDL <40 mg/dl.
. Current age >45ys in men & >55ys in women.
. N.B. HDL > 60 mg/dl is a NEGTIVE risk factor !
. The best management for high LDL is Life style modification + SATATINS,
. to reach LDL < 100 mg/dl.
. Women beyond the age of 65 who have had 3 consecutive NEGATIVE PAP smears no l
onger require regular screening.
. MAMMOGRAMS should be performed every 2 ys starting at the age of 50.
. Although LIVE vaccines are contraindicated in HIV pts, MMR vaccine is an excep
tion.
----------------------------------------------------------------------------------* It can be given to HIV pts with CD4 cells > 200 with no evidence or H/O of AI
DS defining illness.
* Live vaccines e.g. BCG, Oral polio, Meningococcal vaccines are CONTRAINDICATE

D in HIV pts.
* TETANUS & DIPHTHERIA TOXOID booster doses every 10 ys can be given safely.
. INFLUENZA vaccine is recommended ANNUALLY !
-------------------------------------------. Pneumococcal vaccine:
----------------------. Pt < 65 ys --> Once followed by a booster every 5 years.
. Pt > 65 ys --> Once.
. Travelers to developing countries e.g EGYPT should be vaccinated against HEPAT
ITIS A.
. CHLAMYDIA TRACHOMATIS infection:
---------------------------------. should be screened in all sexually active women aged 24 ys & younger.
. If a pt has DM with no vaccines except flu vaccine since childhood series,
--------------------------------------------------------------------------. he should receive TdaP "Tetanus + Diphtheria + Pertussis" ,
. annual IM influenza & pneumococcal vaccines.
. CHRONIC LIVER disease VACCINATIONS:
------------------------------------. HEPATITIS A & B.
. INFLUENZA. "ANNUALLY".
. PNEUMOCOCCAL. "Immunocompromized".
. TdaP "Usual Boosters".
. All adults:
-----------. should have TETANUS & DIPHTHERIA boosters every 10 ys,
. with a one-time tetanus, diphtheria & pertussis booster.
. require INFLUENZA vaccine ANNUALLY.
. Cervical cancer screening:
--------------------------. should be started at age 21 & repeated every 2 - 3 ys.
. Women aged 30-65 ys:
--------------------.. Either PAP smear every 3 ys.
.. Or COMBINATION of PAP smear & HPV testing every 5 ys.
. Vaccinations in pts with HIV:
-----------------------------. Pts with HIV shouldn't receive live vaccines,
. such as BCG,anthrax,oral typhoid,intranasal influenza & oral polio.
. The exceptions r the MMR & VARICELLA vaccines,
. which can be used in pts without evidence of immunity if their CD4 counts > 2
00.
. Screening for BLADDER CANCER:
-----------------------------. is NOT RECOMMENDED even in pts with high risk factors !!!!!
. CANCER COLON SCREENING:
-----------------------. COLONOSCOPY is the best tool.

. All pts aged 50 ys & older.

. 1st degree relative cancer colon ---> 10 ys earlier screening i.e. at 40 ys.
. NO screening tests for PANCREATIC cancers !
-------------------------------------------. CEA -----------> x.
. CA 19-9 -------> x.
. CT or U$ ------> x.
. Abdominal Aortic Aneurysm screening:
------------------------------------. All male smokers >65 ys old should be screened with ABDOMINAL ULTRASOUND to e
xclude AAA
Dr. Wael Tawfic Mohamed
-------------------------