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AANP > Primary and Secondary Prevention > Flashcards

Primary and Secondary Prevention Flashcards

1
Q

Primary Prevention

A

Preventing the health problem
* Immunizations
* safety counseling
* disease prevention

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2
Q

Secondary Prevention

A

Detecting disease early, asymptomatic, or in a preclinical state
* Screening tests
* BP check
* mammography
* colonoscopy

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3
Q

Tertiary prevention

A

minimizing negative disease induced outcomes
* disease is established
* adjusting therapy to avoid further target organ damage

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4
Q

Immunization Principles

A
  • Remove geographic barriers - vaccinate where people are located
  • When in doubt re-immunize
  • IZ deffered = IZ denied - the presence of a minor illness does not necessate deferring or delay - defer only in presence of mod to severe illness with or without fever (need for hospital)
  • Hive alone without annaphylaxis is not a contratindication to vaccinate
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5
Q

Active immunization

A

response to a vaccine resulting in the creation of antibodies
* protection in aticipation of possible exposure
* onset usually within 1 month
* durration years-lifelong

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6
Q

Passive immunization via adminstration of immune globulin

A
  • anibody produced in another host and conferred to patient
  • given post exposure - patient needs to present with risk or report of exposure
  • onset within hours
  • durration 6-9 months
  • limited diseases - varicella, hep A/B, tetanus, rabies
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7
Q

Hx of Anaphylactic reaction to Neomycin

A

Avoid IPV, MMR, Varicella

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8
Q

Hx of Anaphylactic reaction to Streptomycin, polymixin B, Neomycin

A

Avoid IPV, Vaccinina (small pox)

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9
Q

Hx of Anaphylactic reaction to
Baker’s yeast

A

Avoid Hep B vaccine

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10
Q

Hx of Anaphylactic reaction to Gelatin

A

Avoid MMR

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11
Q

Anaphylaxis

A

Acute lifethreatenting systemic reaction that results from sudden systemic release of mediators from mast cells and basophils
* rapid onset within minutes-hours of exposure to allergen

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12
Q

Most common Anaphylaxis presentation

A
  • Uticaria
  • angioedema
  • respiratory compromize (cough/wheeze)
  • Sudden reduced BP
  • GI symptoms
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13
Q

Anaphylaxis criteria

A
  1. Sudden onset with involvemtn of the skin, mucosal tissue or both and sudden resporitory symtoms or sudden reduced BP/symptoms of end organ dysfunction (hypotonia, incontinence) OR
  2. 2 or more of the following that occur suddenly - sudden skin or mucosal s/s, sudden respiratory s/s, sudden reduced BP, sudden GI symptoms OR
  3. Reduced BP after exposure to a known allergen (gerater than 30% decrease in systolic BP
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14
Q

Primary care interventions for anaphylaxis

A
  1. assess ABC
  2. Place pt in supine possition
  3. Activate EMS for ER transfer
  4. Admin Epi to antiror-lateral thigh - no contraindication for use in anaphylaxis
  5. Give H1/H2 blocker PO (diphenhydramine/famotadine)
  6. IV access, O2, onging monitoring
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15
Q

Anaphylaxis after care

A
  • education on the use of EPI pen, potential for bi-phasic reaction, trigger avoidance
  • consider Rx for PO antihistamines and systemic corticosteroids
  • referral to allergist if unknown cause.
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16
Q

Live attenuated Virus vaccine

A

MMR
Varicella
intranasal influenza virus vaccine
Rotavirus (PO for infants)

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17
Q

Precautions to live virus

A
  • theoretical risk in pregancy - may pass virus to fetus
  • Severe immnicompromise - risk of becomminginfected
  • Guidelines if HIV + ( usuallu ok if CD4 >200
  • Rotaviris not for infants with severe combined immunodeficiency - recognized early ot Hx of intussusception. Shed in stool practice diaper hand hygeine
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18
Q

Hep B vaccine

A
  • transmission via blood/body fluids
  • 3 dose series starting at birth
  • catch up 3 doese series at 0, 1-2, and 6 months
  • revaccination in not generally reccomended
  • post vaccination serology available
19
Q

DTaP
teanus, diptheria, accellular pertussis

A
  • 5 dose series with completion at 4-6 years of age (ages 2, 4, 6, 18months and 4 years)
  • wound mamgement in children >7 with atleast 3 doses: wounds other than clean supperficial admin DTap if >5 years since last dose
  • booster Q 10 years
  • reactions: fatigue, poor appetite, Gi upset, rare: seizure, nonstop crying, T>105, anaphylaxis
20
Q

Tetanus prophylaxis in wound mamgement

A
  • obligate anaerobe- grows in deep wounds
  • with unknow tetenus vaccine Hx or <3 doses - vaccinate
  • Hx of 3+ doses: give if >10 yrs from last dose or >5years for deep wound/dirty wound
  • DTap should be used for children <7
  • Tdap is reccomended booster for adolecents and adults
  • Tdap dose reccomednded during each pregnancy reguardless of Hx.
21
Q

Hib vaccine
Heamophilus influenzae type B

A
  • 4 dose series
  • 2, 4, 6, months with booster at 12-15 months
  • Unvaccinated at 15-59 months- 1 dose needed
  • Previously unvaccinated 60 months or older, not at high risk do not require catch up vaccine
22
Q

IPV
polio

A
  • 4 dose series @ 2,4,6-18 months, and 4-6 years
  • Catch up in 1st 6 months of life only for travel to polio-enemic region or during outbreak
  • Not routinely reccomended for US resident 18 years or older
23
Q

MMR

A
  • minimum age 12 months
  • 2 dose series, 1 year and 5 years
  • Catch up children/adolescents 2 doses at least 4 weeks apart
  • reaction: mld rash. lymphadeopathy, Rare: seizure, teratogen
24
Q

Varicella

A

minimum age 12 months
* 2 dose series 12-15months, 4-6 yrs
* catch up 2 dose series at least 4 weeks apart for people >7 yrs

25
Q

Hep A

A
  • minumum age 12 months for routine
  • 2 dose series 6 months apart
  • Catch up - up to age 18 should get 2 dose series
  • 18 or older can get combined HepA/B series
26
Q

MenACWY
meningococcal

A
  • 2 dose series at age 11-12 years and 16 years
  • reccomended for 1st y ear college students or military recruits if not previously vaccinated by 16
27
Q

RZV
Zoster

A
  • shingles
  • age 50 or older
  • 2 dose series at least 4 weeks apart
28
Q

Pneumococcal Vaccination
PCV 15, 20, 23

A
  • Series for adults 65 or older
  • one dose of PCV 15 or PCV 20, one year later PPSV 23 (if Pcv 15 used)
29
Q

calculation og pack year Hx

A

number of packs per day x number of years smoked

30
Q

5 A’s of smoking intervention

A
  1. Ask - id and document tabacco use with every pt visit
  2. Advise - in a personalized manner urge quitting
  3. Assess - willingness to quit
  4. Assist - couseling and pharmacotherapy to help quit
  5. Arrange- follow up in 1 week after the quit date.
31
Q

top causes of death

A
  • ages 10-44 - #1: unintentional injury (includes firearms)
  • 45 - 64 #1 maliganant neoplasms, #2, heart disease
  • All ages
    1. Heart disease
    2. malignant neoplasms
    3. Covid
    4. unintentioanl injury
    5. cerebrovascular disease
    6. Chronic lower respirtaroy disease
32
Q

New Cancer Cases

A
  • Male
    1. Prostate
    2. lung
    3. colon
    4. bladder
    5. melanoma
  • Female
    1. Breast
    2. Lung
    3. colon
    4. uterine
    5. melanoma
33
Q

Cancer deaths

A

Male
1. lung
2. prostate
3. colon
4. pancreas
5. liver/bile duct
Female
1. Lung
2. breast
3. colon
4. pancreas
5. ovary

34
Q

Prostate cancer screen

A
  • men 55-69 years PSA based screening
  • based on family Hx, race, comorbids, benifits/risks of treatments
  • USPSTF reccomends against PSA-based screening in men >70
35
Q

Genitic risk assessment and BRCA mutation for breast and ovarian Ca

A
  • assess women with personl or family Hx of breast, ovarian, tubal, or peritoneal cancer, or people with acestery associated with BCRA mutation,
36
Q

colorectal screening

A
  • initiated at 45 years, contine to 75 possibly up to 85 yrs
  • FIT annually,
  • Stool DNA Q3 years
  • Colonoscopy Q10 yrs
  • Flexible sigmoidoscopy Q5 yrs
37
Q

Endometrial cancer screening

A

wmn shoul dbe informed to report post menopausal bleeding, screening is performed by endometrial Bx
* Heriditary non-polposis colon cancer - anual screening with endometrial bipsy begining at 35

38
Q

Lung cancer screen

A
  • annual low dose CT for ages 55-74 in good health with a 30 year pack Hx who currently smoke or who quit in the last 15 years
  • may be discontinued if more than 15 years since smoking.
39
Q

Cervical Cancer Screen

A
  • no screening before 21 - then q3 yrs Pap only
  • women over 30-65 HPV and Pap every 3-5 years
  • > 65 no screening after adequate negative screening
40
Q

Candities for TB testing

A
  • suspected exposure
  • From a country wher TB is endemic (latin america, carribian, africa, aisia, eastern europe, Russia)
  • People who live or work in ares where active TB is more common
  • Healthcare workers
  • People with HIV or weakened immune system
  • People with s/s of TB
  • People who inject illegal drugs
41
Q

Reactive mantoux tuberculin skin test

A
  • > 5mm: HIV, recent exposure, immunisuppresed, previous infection
  • > 10mm: Immigrants from high-prevalance countires, IV drug user, work/live in high risk setting, <4 yrs, exposure to high risk adults
  • > 15: considered positive for everyone
42
Q

Latent TB

A
  • No symptoms
  • +skin test or serologic test
  • Normal CXR
  • Normal sputum
  • Treatment : Isoniazid and Rifapentine (3 months), rifampin (4 months), Isoniazid (6-9 months)
43
Q

TB disease

A
  • Sig cough >3 wks, chest pain, hemoptysis or sputum production, weakness/fatigue, weight loss, lack of appetite, chills, fever, night sweats
  • Positive skin or serologic test
  • CXR consistent with TB
  • Abnormal sutum
  • Treatment: several drugs for 6-9 months, INH, rifampin, Ethambutol, pyrazinamide
  • pregnant women should be treated immediately but medications may be adjusted (babies are rarley born with TB)

AANP (20 decks)

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