This is a video on preventative care, including screening for cancer, medical, infectious, substance abuse, and psycho/social conditions, as well as vaccinations for pediatrics and adults.
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ADDITIONAL TAGS:
Vaccinations
internal medicine
family medicine
pediatrics
preventative care
Hepatitis B
All children 3x: birth, 1-2m, 6-18m
Adults: healthcare, ESRD/diabetes, IV drug users, liver disease
HiB. All children 4x: 2/4/6m, 12-15m
Tetanus/diphtheria/pertussis
All children DTaP 5x: 2/4/6m, 15-18m, 4-6y
Adults: booster every 10 years
Wound: Ig if insufficiently vaxxed ( 3 lifetime doses); Tdap if dirty wound and last vax 5y; Tdap if clean wound and last vax 10y
Polio. Children 4x IPV: 2/4/6-18m, 4-6y
Meningococcal
All children: MenA at 11-12, 16y; MenB at 16
Adults: asplenia, college dorm, military, pilgrimage, HIV
Pneumococcal
All children 4x PCV13: 2/4/6m, 12-15m
All adults =65y: PCV13 → 12m gap → PPSV23
1 year gap btwn PCV13 and PPSV23 unless immunocomp, asplenic, CSF leak, cochlear implants
Influenza
Children 6 months annually. Also preggo, i/c, healthcare
Contraindicated if anaphylactic rxn to eggs or previous vax; rash is ok (monitor for 30 min); use recombinant in 18y
Intranasal is live: don’t use in immunocomp
Hepatitis A
All children: 12-24m
Adults: traveling to endemic areas, IV drug users, liver disease
Varicella/zoster
All children: 12-15m, 4-6y. Don’t do pox parties
Adults: =50-60y Zostavax
Live: don’t use in immunocompromised
Measles/mumps/rubella
All children: 12-15m, 4-6y
Live: don’t use in immunocomp, pregnancy
Side effect: fever (→seizure); arthralgias, rash
Rotavirus
All children 3x: 2/4/6m
Live: Live: don’t use in immunocompromised, intussusception
Side effect: intussusception
Human papillomavirus (HPV)
All children: 2 shots if age 11-12; 3 shots if age 15 or weak immune system
Side effect: syncope (observe for 15 min)
Medical screening
Hypertension. All patients, every visit
Hyperlipidemia. Lipid panel in M 35, W 45, or any patients 20 yo with CV disease (aorta, peripheral, coronary, carotid)
Diabetes mellitus
Screen patients that are obese, hypertension, hyperlipidemia
fasting glucose, A1c, random glucose, 2 hour GTT
AAA. Ultrasound screen if male, age 65-75 and ever smoker or fam hx; other imaging ok
Osteoporosis. DEXA scan if female at age 65
Psych/social screening
Depression
PHQ2 → PHQ9, EPDS, GAD7
Intimate partner violence
“Do you feel safe at home?”
Abuse (children, disabled, elder)
Substance abuse screening
Smoking
Ask about tobacco use
Advise to stop smoking
Provide behavioral interventions and pharmacotherapy for cessation
Alcoholism
CAGE: cut down, angry, guilty, eye-opener
Infectious disease screens
HIV. One ELISA in anyone age 15-65 → confirm before reporting; repeat if high risk
Hepatitis C. One Ab test if born 1945-65 (boomers)
Chlamydia + gonorrhea. Sexually active W age 25
Cancer screening
Lung
Annual low dose CT scan in patients with =30 pack-year smoking history from ages 55-80. Don’t do x-rays
UNLESS they’ve quit =15 years ago
Colon
Screen between ages 45-75 (or 10 yr before first relative’s diagnosis). Screening options:
Colonoscopy every 10 years
Flexible sigmoidoscopy every 5 years
Cologuard (stool DNA) q3yr
Fecal immunochemical test (FIT) every year (more sensitive than guaiac-FOBT)
Continue screen between ages 75-85 if high risk
Cervical
Pap smear every 3 years starting at age 21
OR pap+HPV every 5 in patients over 30
Stop at age 65, unless high risk
Breast
Mammogram every 1-2 years starting at age 40-50
USPSTF, ACS, ACOB, ACR all have slightly different recs
No longer heavily promote breast self-examination
Stop at age 75, unless high risk
Prostate: no longer routinely screened unless high risk (fam hx, symptoms, etc.)
Used to do DRE and PSA
PSA does detect lesions, but they most often don’t need to be treated. Men die with, not of PC.
Ovarian: no longer
Endometrial: no screen unless symptoms
No tumor markers: AFP, CEA, CA125
