PREVENTIVE MEDICINE:

Td vaccine booster should be given every 10 years after age 18. A single tetanus, diphtheria, and
acellular pertussis (DTaP) booster is recommended between ages 19 and 64 years ?

Pap smear: it should start on a yearly basis starting at age 21 or 3 years after their first sexual
encounter, whichever comes first. The screening interval can increase to every 3 years if the patient has
2 or 3 consecutive pap smears that are normal and has one monogamous partner. This cycle must be
restarted with every new sexual partner.
Women who have had their cervix removed for non-malignancy related reasons and are over the
age of 65 or 70 do not need cervical pap smears.

The HPV vaccine may be given to females aged 9-26yrs and is most effective if given before
coitarche.

The influenza vaccine is for adults who are in close contact with children aged 0-59 months (<5
years)
should be given to all adults aged 50 and older. It should also be given to all adults with chronic
heart, lungs, liver, kidney, or metabolic, immunosuppressed or pregnant. Healthcare workers and those
in nursing homes should be vaccinated. Healthy, non-pregnant persons aged 5-49 years may receive the
intranasal influenza vaccine.

Children with CF should receive annual influenza vaccinations throughout their lives and a
pneumococcal booster between the ages of 4 and 6 (PCV 2 doses+ PPV for maximal effect)

Screening for bladder cancer is NOT recommended, even in patients who are at risk for developing
the disease.

T score: -1.5 to -2.5 is OSTEOPENIA. Patients with a T score of less than -1.5 plus risk factors for
osteoporosis or a T score of less than -2.0 should receive preventative medications. The preferred med
Is either oral bisphosphonate or raloxifene.

Patients with cirrhosis should receive an assembly of preventative care. They should be immunized
against hepatitis A and B, pneumococcal disease, and yearly influenza vaccination. All adults should
have a Td booster at least every 10 years.

The risk factors for CAD are men >= 45 years, women >= 55 years, HTN, cigarette smoking, HDL < 40
mg/dL and family history of premature CAD (male < 55 years and female < 65 years). Having an HDL
level >= 60 negates one risk factor.
CAD risk equivalents include DM, PAD, symptomatic carotid artery disease, abdominal aortic
aneurysm, or a 10 year risk of CAD of >= 20 %

Screening for an abdominal aortic aneurysms is recommended for smoker men aged 65-75.
Ultrasound is the recommended screening test. ONCE

Some vaccines induce a predominantly IgA response. The best example is the oral polio vaccine,
which promotes the development of anti-poliovirus IgA antibodies in the GI tract.

Patients who have CIN II/III should receive a pap smear with or without colostomy and end cervical
curettage every 6 months until 3 negative samples are obtained. Once 3 negative samples are obtained
the patient may resume age and behavior appropriate cervical cancer screening.

Recommendations for who should receive the meningococcal vaccine: individuals who are of
college age or living in barracks or dormitories, patients who are asplenic, and those with travel
exposures. (Saudi Arabia)

HIV recommended vaccines: influenza, hepatitis B, and pneumococcal. The hepatitis A vaccine
should be given to men who engage in sexual activites with men.
In general, HIV patients should not receive live vaccines. These include BCG, varicella (chickenpox),
varicella zoster (shingles), anthrax, oral typhoid, intranasal influenza, oral polio, and yellow fever.
The one exception is the MMR vaccine which may be used in patients without evidence of
immunodeficiency if their CD4 count is > 200/mm3 and they have no history or evidence of an AIDS
defining illness.

Osteoporosis should be screened in all women who are 65 years and older with a DEXA scan.
Additionally women should be screened if they are at least 60 years old and if they have other risk
factors (i.e cigarettes smoking, steroid use, lack of weight-bearing exercises, low body mass, alcohol,
poor calcium/vitamin D intake)

Colonoscopy is recommended for colon cancer screening. It should start at the age of 50 for people
of normal risk and be repeated every 10 years unless there is evidence of polyps. People with high risk
polyps should receive follow-up colonoscopies every 3-5 years.

Colon cancer screening is recommended in all patients aged 50 and older. There are many tests that
can be used for screening, i.e. FOBT(annual) , flexible sigmoidoscopy(every 5 yrs) colonoscopy(every 10
yrs), or double contrast barium enema.
The standard recommendation for patients with an affected first-degree relative is to start screening
at 10 years before the age at the relative was diagnosed. Thus if a patients father was diagnosed with
colon cancer at age 50, screening for the patient should begin at age 40.

If a patient is immune to hepatitis B and they are exposed to it, reassurance is all you need to do.

Patients with unknown vaccination history, who are exposed to hepatitis B, should receive both
passive and active immunity. Passive immunity is provided via hepatitis B immunoglobulin shortly after
exposure (ie within 24 hours). Active immunity is via the hepatitis B vaccine.

Vaccinations for preterm infants are given according to their CHRONOLOGIC age, not their
gestational age. This is because prematurity does not markedly change the immune response to
vaccines and the risk of infection and complications in preterm infants is greater than term babies. A
preterm infant should thus receive a hepatitis B vaccine at birth (unless the infant weighs less than 2
kg), and hepatitis B, rotavirus, DTaP, HiB, pneumococcal, and inactivated polio(SALK) at 2 months of
age.

Pancreatic cancer is a fatal cancer. It is often diagnosed at a locally advanced or metastatic age.
Right now there is NO serologic or radiographic test that has proven effective in screening for
pancreatic cancer in asymptomatic adults.

Decubitus ulcers are a significant source of morbidity in hospitalized patients. Frequent
repositioning every 2 hours is a simple and effective way to reduce ulcer (2 hours is the interval chosen
because this is the point at which uninterrupted pressure on a surface begins to induce tissue damage).
Pressure reducing devices (air/foam mattresses) are also important methods of prevention.

Remember that smoking during pregnancy carries a risk of IUGR but microcephaly is NOT a
feature.

The TORCH infections (toxoplasmosis, rubella, CMV, HSV, and syphilis) cause a syndrome
characterized by microcephaly, hepatosplenomgaly, deafness, chorioretinitis, and thrombocytopenia.

Women at average risk for breast cancer should begin having yearly mammograms at age 40.
Clinical breast exams also may be appropriate every 3 yrs for women less than 40 and yearly for older
women. There is not a clearly defined stop time for mammogram screening, but many experts agree
that screening through at least age 70 is appropriate.

Routine cholesterol screening: in men at average risk for CAD should begin at age 35 and in women
at age 45. Experts advocate checking lipids no more than every 5 years in patients with normal risk for
CAD and normal lipids in the past. But in the presence of risk factors or a family history of cardiovascular
disease before age 50 in a male relative or before age 60 in a female relative, screening should begin
between ages 20 and 35 for males and between ages 20 and 45 for females.
It is reasonable to screen individuals every 5 years, with shorter intervals for people who have lipid
levels close to those warranting therapy.

Chlamydia trachomatis (frequency?) screening is recommended routinely in all sexually active
women age 24 and younger, and in other asymptomatic women(>24yrs) at increased risk for STDs.
Patients at increased risk include those with other STD and those with new or numerous partners.

In patients who have HDL less than 40mg/dl, it is recommended that you should increase the HDL
above 40 mg/dL once non-HDL cholesterol goals have been met.
The 2 m.c meds to increase HDL levels are fibrates and nicotinic acid. Both of them increase HDL
and decrease LDL and triglycerides. But fibrates decrease triglycerides a LOT and niacin increases HDL a
lot. Rhabdomyolysis is a potentially serious side effect that can occur when fibrates are used in
conjunction with statins.

Pneumococcal vaccine is recommended for people over age 65, people below age 65 with co
morbidities like heart, renal, liver, lung failure, etc, and infants and young children. It contains
polysaccharides. Whereas peptides get presented to T cells by macrophages and B-cells,
polysaccharides cannot be presented to T cells. Thus they yield a B cell only, T cell independent
response. Persons vaccinated before age 65 need a booster in 5 years.

Children aged 0-5 years should be given vision screening to identify those with strabismus,
amblyopic, and refractive errors.

Ovarian CA screening:
Pts with low risk family Hx ( isolated relatives with Ovarian CA) Annual transvaginal USG + CA
125
Pts with high rish family Hx( Multiple relatives with ovarian and breast CA OR single relative with
ovarian CA < 40yrs old) BRCA 1 & 2 + CA 125 TWICE every year
Pts who test + BRCA 1 and 2 Prophylactic oophorectomy after completing family.

Venous insufficiency:
Pneumatic decompression devices to prevent venous ulcers.

MMR:
born after 1957 and not vaccinated 1 dose MMR
MMR booster given who had MMR as a child.