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    TiKi TaKa CK Preventive Medicine

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    1. Women over 65 should get bone density scans to check for osteoporosis. Needle stick injuries in HBV patients should get reassurance if previously immunized or HBIG and HBV vaccines if not immunized. 2. Adults over 23 should get the 23-valent pneumococcal vaccine, which produces a B cell immune response. Bupropion, not buspirone, can help with smoking cessation. Prostate cancer screening is controversial as no single test exists and discussing PSA with patients is recommended. 3. Patients with known heart disease or diabetes should aim for LDL <100 mg/dl through lifestyle changes and statin treatment, not niacin. Regular screening is

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    TiKi TaKa CK Preventive Medicine

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    1. Women over 65 should get bone density scans to check for osteoporosis. Needle stick injuries in HBV patients should get reassurance if previously immunized or HBIG and HBV vaccines if not immunized. 2. Adults over 23 should get the 23-valent pneumococcal vaccine, which produces a B cell immune response. Bupropion, not buspirone, can help with smoking cessation. Prostate cancer screening is controversial as no single test exists and discussing PSA with patients is recommended. 3. Patients with known heart disease or diabetes should aim for LDL <100 mg/dl through lifestyle changes and statin treatment, not niacin. Regular screening is

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    1. Women over 65 should get bone density scans to check for osteoporosis. Needle stick injuries in HBV patients should get reassurance if previously immunized or HBIG and HBV vaccines if not immunized. 2. Adults over 23 should get the 23-valent pneumococcal vaccine, which produces a B cell immune response. Bupropion, not buspirone, can help with smoking cessation. Prostate cancer screening is controversial as no single test exists and discussing PSA with patients is recommended. 3. Patients with known heart disease or diabetes should aim for LDL <100 mg/dl through lifestyle changes and statin treatment, not niacin. Regular screening is

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    TiKi TaKa CK Preventive Medicine

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    1. Women over 65 should get bone density scans to check for osteoporosis. Needle stick injuries in HBV patients should get reassurance if previously immunized or HBIG and HBV vaccines if not immunized. 2. Adults over 23 should get the 23-valent pneumococcal vaccine, which produces a B cell immune response. Bupropion, not buspirone, can help with smoking cessation. Prostate cancer screening is controversial as no single test exists and discussing PSA with patients is recommended. 3. Patients with known heart disease or diabetes should aim for LDL <100 mg/dl through lifestyle changes and statin treatment, not niacin. Regular screening is

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    PREVENTIVE MEDICINE TiKi TaKa

    ------------------------------. All women > 65 ys should be screened by DEXA scan to exclude Osteoporosis
    . Needle stick injury with HBV:
    ------------------------------. Previusly immunized with HBsAb +ve ----> REASSURANCE.
    . Unknown H/O or not immunized ----> HBIG + HBV.
    . Adult 23 polyvalent pnemococcal vaccine:
    -----------------------------------------. 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:
    ---------------------------. 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:
    -------------------. 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:
    --------------. 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 l
    onger 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 excep
    tion.
    ----------------------------------------------------------------------------------* It can be given to HIV pts with CD4 cells > 200 with no evidence or H/O of AI
    DS defining illness.
    * Live vaccines e.g. BCG, Oral polio, Meningococcal vaccines are CONTRAINDICATE

    D in HIV pts.
    * TETANUS & DIPHTHERIA TOXOID booster doses every 10 ys can be given safely.
    . INFLUENZA vaccine is recommended ANNUALLY !
    -------------------------------------------. Pneumococcal vaccine:
    ----------------------. 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 HEPAT
    ITIS A.
    . CHLAMYDIA TRACHOMATIS infection:
    ---------------------------------. 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,
    --------------------------------------------------------------------------. he should receive TdaP "Tetanus + Diphtheria + Pertussis" ,
    . annual IM influenza & pneumococcal vaccines.
    . CHRONIC LIVER disease VACCINATIONS:
    ------------------------------------. HEPATITIS A & B.
    . INFLUENZA. "ANNUALLY".
    . PNEUMOCOCCAL. "Immunocompromized".
    . TdaP "Usual Boosters".
    . All adults:
    -----------. should have TETANUS & DIPHTHERIA boosters every 10 ys,
    . with a one-time tetanus, diphtheria & pertussis booster.
    . require INFLUENZA vaccine ANNUALLY.
    . Cervical cancer screening:
    --------------------------. should be started at age 21 & repeated every 2 - 3 ys.
    . Women aged 30-65 ys:
    --------------------.. Either PAP smear every 3 ys.
    .. Or COMBINATION of PAP smear & HPV testing every 5 ys.
    . Vaccinations in pts with HIV:
    -----------------------------. 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 > 2
    00.
    . Screening for BLADDER CANCER:
    -----------------------------. is NOT RECOMMENDED even in pts with high risk factors !!!!!
    . CANCER COLON SCREENING:
    -----------------------. 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 !
    -------------------------------------------. CEA -----------> x.
    . CA 19-9 -------> x.
    . CT or U$ ------> x.
    . Abdominal Aortic Aneurysm screening:
    ------------------------------------. All male smokers >65 ys old should be screened with ABDOMINAL ULTRASOUND to e
    xclude AAA
    Dr. Wael Tawfic Mohamed
    -------------------------

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