Primary and Secondary Prevention Flashcards
(43 cards)
1
Q
Primary Prevention
A
Preventing the health problem
* Immunizations
* safety counseling
* disease prevention
2
Q
Secondary Prevention
A
Detecting disease early, asymptomatic, or in a preclinical state
* Screening tests
* BP check
* mammography
* colonoscopy
3
Q
Tertiary prevention
A
minimizing negative disease induced outcomes
* disease is established
* adjusting therapy to avoid further target organ damage
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
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
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
7
Q
Hx of Anaphylactic reaction to Neomycin
A
Avoid IPV, MMR, Varicella
8
Q
Hx of Anaphylactic reaction to Streptomycin, polymixin B, Neomycin
A
Avoid IPV, Vaccinina (small pox)
9
Q
Hx of Anaphylactic reaction to
Baker’s yeast
A
Avoid Hep B vaccine
10
Q
Hx of Anaphylactic reaction to Gelatin
A
Avoid MMR
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
12
Q
Most common Anaphylaxis presentation
A
- Uticaria
- angioedema
- respiratory compromize (cough/wheeze)
- Sudden reduced BP
- GI symptoms
13
Q
Anaphylaxis criteria
A
- 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 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
- Reduced BP after exposure to a known allergen (gerater than 30% decrease in systolic BP
14
Q
Primary care interventions for anaphylaxis
A
- assess ABC
- Place pt in supine possition
- Activate EMS for ER transfer
- Admin Epi to antiror-lateral thigh - no contraindication for use in anaphylaxis
- Give H1/H2 blocker PO (diphenhydramine/famotadine)
- IV access, O2, onging monitoring
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.
16
Q
Live attenuated Virus vaccine
A
MMR
Varicella
intranasal influenza virus vaccine
Rotavirus (PO for infants)
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
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
Hep 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
MenACWY
meningococcal
* 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
RZV
Zoster
* shingles
* age 50 or older
* 2 dose series at least 4 weeks apart
28
Pneumococcal Vaccination
PCV 15, 20, 23
* Series for adults 65 or older
* one dose of PCV 15 or PCV 20, one year later PPSV 23 (if Pcv 15 used)
29
calculation og pack year Hx
number of packs per day x number of years smoked
30
5 A's of smoking intervention
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
top causes of death
* 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
New Cancer Cases
* Male
1. Prostate
2. lung
3. colon
4. bladder
5. melanoma
* Female
1. Breast
2. Lung
3. colon
4. uterine
5. melanoma
33
Cancer deaths
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
Prostate cancer screen
* 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
Genitic risk assessment and BRCA mutation for breast and ovarian Ca
* assess women with personl or family Hx of breast, ovarian, tubal, or peritoneal cancer, or people with acestery associated with BCRA mutation,
36
colorectal screening
* 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
Endometrial cancer screening
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
Lung cancer screen
* 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
Cervical Cancer Screen
* 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
Candities for TB testing
* 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
Reactive mantoux tuberculin skin test
* >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
Latent TB
* 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
TB disease
* 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)
