PREVENTIVE MEDICINE TiKi TaKa

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. All women > 65 ys should be screened by DEXA scan to exclude Osteoporosis

. Needle stick injury with HBV:

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. Previusly immunized with HBsAb +ve ----> REASSURANCE.
. Unknown H/O or not immunized ----> HBIG + HBV.

. Adult 23 polyvalent pnemococcal vaccine:

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. 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:

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. 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:

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. 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:
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. 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
longer 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

exception.

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* It can be given to HIV pts with CD4 cells > 200 with no evidence or H/O of AIDS
defining illness.
 * Live vaccines e.g. BCG, Oral polio, Meningococcal vaccines are CONTRAINDICATED
in HIV pts.

* TETANUS & DIPHTHERIA TOXOID booster doses every 10 ys can be given safely.

. INFLUENZA vaccine is recommended ANNUALLY !

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. Pneumococcal vaccine:
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. 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

HEPATITIS A.

. CHLAMYDIA TRACHOMATIS infection:

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. 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,

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. he should receive TdaP "Tetanus + Diphtheria + Pertussis" ,
. annual IM influenza & pneumococcal vaccines.

. CHRONIC LIVER disease VACCINATIONS:

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. HEPATITIS A & B.
. INFLUENZA. "ANNUALLY".
. PNEUMOCOCCAL. "Immunocompromized".
. TdaP "Usual Boosters".

. All adults:
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. should have TETANUS & DIPHTHERIA boosters every 10 ys,
. with a one-time tetanus, diphtheria & pertussis booster.
. require INFLUENZA vaccine ANNUALLY.

. Cervical cancer screening:

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. should be started at age 21 & repeated every 2 - 3 ys.
. Women aged 30-65 ys:
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.. Either PAP smear every 3 ys.
.. Or COMBINATION of PAP smear & HPV testing every 5 ys.

. Vaccinations in pts with HIV:

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. 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 > 200.

. Screening for BLADDER CANCER:

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. is NOT RECOMMENDED even in pts with high risk factors !!!!!

. CANCER COLON SCREENING:

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. 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 !

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. CEA -----------> x.
. CA 19-9 -------> x.
. CT or U$ ------> x.

. Abdominal Aortic Aneurysm screening:

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. All male smokers >65 ys old should be screened with ABDOMINAL ULTRASOUND to
exclude AAA

Dr. Wael Tawfic Mohamed

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