Screening Tests - all harmful effects during screening tests (i.e.

perf during EGD) are iatrogenic - only screen for dz w/ an effective treatment which is acceptable to pt - regular screening happens for: colon, breast and cervix - Colon o Begins at age 50 if no indication of cancer in family Fecal occult blood testing annually Sigmoidoscopy every 5 years Barium enema Cscope every 10 years preferred o First degree relatives w/ colorectal ca dx before 60 start screening at 40 or 10 years prior to dx, whichever is younger Cscope every 5 years - Breast o Mammography 1-2 years starting at 40 o Manual breast exam Performed by dr Every 3 years, starting at 20-30 o Self-breast exam No longer recommended o Pts w/ strong fam hx (multiple first degree relatives) of brca should get tamoxifen prophylacitcally - Cervical o Pap smear o Begin 3 years after sexual activity / 21 yo o < 30, annual screenings o > 30, every 2 years if > 3 normal paps in a row Travel Medicine - see pt 4-6 weeks prior to departure - Hep A o Immune serum globulin and vaccine if pt leaving within 2 wks of appt o Booster 6 mo after first vaccination gives immunity for ~ 10 yrs - Hep B o Recommended for pts who are going to be sexually active, will be abroad for > 6 mo, or plan on receiving medical / dental care abroad - Malaria prophy o mexico, central America (except panama), Caribbean chloroquine chloroquine-resistant malaria, use mefloquine / doxy monitor for photosensitivity w/ doxy - Rabies o india, asia, mexico o response to intradermal vaccine can be decreased by chloroquine administer intramuscular vaccine instead if going to area w/ malaria prophy

Yellow fever o sub-saharan Africa and some of south America - Typhoid fever o vaccination for pts going to developing countries w/ prolonged exposure to contaminated food / water o oral live attenuated and capsular polysaccharide vaccines parenterally polysaccharide vaccine preferred and safe for HIV pts - Polio o unvaccinated pts should get 3 doses of inactivated poliovax o vaccinated pts should get a booster x 1 o live attenuated vaccine now contraindicated - Meningococcal meningitis o Nepal, sub-saharan Africa, n. india o Polysaccharide vaccine o Asplenic / functionally asplenic pts should receive vaccinations o Routine at age 11 - Travelers Diarrhea o dont eat salad / water / unwashed fruit Vaccinations - Tetanus and diphtheria o Unvaccinated: 3 doses o Booster vaccine every 10 years for life otehrwise