Well Patient Exam Flashcards
Plan
Recommend specific immunizations
Recommend lifestyle changes
Recommend screening based on age or testing based on symptoms
Tdap Vaccine
Td = tetanus diphtheria ap = acellular pertussis
One dose, then booster every 10 years
Puncture wound or laceration, updated unless Td booster was within the previous 5 years
Give Tdap once per pregnancy, usually around 32-36 weeks
Human Papilloma Virus (HPV) Vaccine
3 doses up to age 26 in women, up to age 21 for most men, up to age 26 for men who have sex with men or who have other risk factors
Recommended for all boys and girls starting at age 11
Cervical, rectal, esophageal cancers
Vericella
Two does for anyone who doesn’t have documentation of 2 varicella vaccines in lifetime or who hasn’t had the chicken pox
Most adults who were around before the varicella vaccine got the disease but some didn’t - important to ask
Even adults who have had the shingles should get the varicella vaccine if they have not had it before
Pneumococcal Vaccine
All adults age 65 or older
All adults who smoke
Residents of nursing homes
All adults who are diabetic, have chronic lung disease (including asthma), chronic CV disease, chronic renal disease, nephrotic syndrome, chronic liver disease, functional or anatomic asplenia
Five years after first dose, re-dose people with chronic renal failure, nephrotic syndrome, functional or anatomic asplenia
Everybody who has a dose before age 65 gets another dose at or after age 65
Varicella Zoster (“Shingles Shot”)
Starting at age 60 all adults should get one whether or not they have had a previous case of shingles
Goal is to prevent rash AND postherpetic neuropathy (debilitating)
“Persons aged 60 years or older with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy or severe immunodeficiency.”
Influenza Vaccine
All people age 6 months or older should have an annual vaccine
Contraindications: Egg allergies
Age 65 or older may opt for high-dose vaccine
Screening vs. Testing
Screening = testing an asymptomatic patient for a specific disease because they are at a certain age and it’s recommended by a national recommending body
Testing = testing a symptomatic patient for a specific disease because you think their symptoms may point to a specific cause
Cancer Screening: Cervix
Papanicolaou Smear
Not necessary before age 21, then every 3 years to age 65
Women aged 30+ may opt to do Pap plus HPV screening every 5 years
Not necessary to do Pap smear before starting contraceptives in girls or women less than 21 years old
Not recommended for women after 65 unless at high risk for cervical cancer
Not recommended for hysterectomy with cervix removed unless high grade precancerous lesion or cervical cancer
Not recommended to screen for HPV alone or in combination with Pap smear before age 30
Cancer Screening: Mammograms
Recommended at age 50, then every 2 years until 75 (AAFP)
Some recommendation at age 40, then yearly (ACA)
STD Screening: Gonorrhea and Chlamydia
Recommended screening in women age 24 and younger and in older women at increased risk of disease
Current evidence insufficient to assess balance of b enemies/harms for routine screening for men
Screening for HIV
Adults aged 18-65 should be screened for HIV
Older adults who are at increased risk should also be screened
All pregnant women should be screened for HIV
Colon Cancer Screening
Recommended using fecal occult blood testing, sigmoidoscopy, or colonscopy in adults beginning at age 50 and continuing until age 75
Recommended AGAINST screening age 76-85
Cancer Screening: Prostate Specific Antigen (PSA)
USPSTF/AAFP recommend AGAINST routine screening for PSA for prostate cancer
ACS recommends discussion with each man; primary relative with prostate cancer, may consider testing at age 45, other men age 50, with or without digital rectal exam (DRE)
ROS
General: appearance, nervous, relaxed, tearful, calm, well-nourished, obese, thin
HEENT- shine light in eyes, ears, nose, mouth
Neck- check ROM, lymph nodes, thyroid
Heart- listen
Lungs- listen
Abdomen- inspect, auscultate, percuss, palpate
Extremities- general ROM, DTRs, strenght
Genitourinary- consider breast, external genitalia, cervix, penis/scrotum/testicles, rectum
Osteopathic- structural exam, assessment of innominates, etc.
Neurologic- observe gait, assess for anything that may indicate difficulty with hearing, speech
