Summary LEIK EXAM TIPS

LEIK EXAM TIPS Health Screening and Health Promotion US Health Statistics/Mortality Statistics Leading cause of death (all ages/genders): 1. Heart disease (or diseases of the heart) 2. Cancer (or malignant neoplasms) 3. Chronic lower respiratory diseases (i.e., chronic obstructive pulmonary disease [COPD]) Leading Cause of Cancer Death 1. Lung Cancer for both men and woman 2. Men – prostate & Woman- Breast 3. Colorectal Cancer for both men and woman Leading Cause of Death in Adolescents (^ in males than females) 1. Accidents /Unintentional Injuries 2. Suicide 3. Homicide Leading Cause of Death by Age Group  Birth to 12 months:  Congenital malformations (20.3%)  Ages 1 to 44 years:  Unintentional injuries  Ages 45 to 64 years:  Cancer (30.9%)  Ages 65 and older:  Heart disease (25.6%) Average Life Expectancy: 78.8 years of life Cancer Statistics Most Common Cancer: skin cancer Most Common type of skin Cancer: Basal Cell Carcinoma and Melanoma causes the majority of skin cancer related deaths. Most Common Cancer by Gender  Men – Prostate cancer (there are more cases of prostate cancer, however lung cancer is still the highest mortality cancer associated to males).  Females- Breast Cancer (there are more cases of breast cancer, however lung cancer is still the highest mortality cancer associated to females). Most Common Cancer among all children: Acute Lymphoblastic Leukemia (34% of all cancers in children). Sensitivity vs. Specificity  Sensitivity: is a good way of detecting those people who have the disease (i.e. true positive).  Specificity: is a good way of detecting those people without the disease (i.e. true negative). Top Three Cancers in Children  Leukemia (34%)  Brain and nervous system tumors (27%)  Neuroblastoma (7%) Health Promotion Aspirin Use to prevent Cardiovascular Disease or Colorectal Cancer  Begin at age 50-59 with =/> 10 % risk for cardiovascular disease (ASCVD score) Breast Cancer  Risk factors o age 50 or greater, o previous hx of breast CA, o two or more first * relatives o nulliparity, early menarche, late menopause (longer exposure to estrogen) o Obesity (adipose cells can synthesize small amounts of estrogen)  Baseline mammogram starts at 50 years of age  Repeat every 2 years from ages 50-74 years of age NOTE: Does NOT apply to those individuals with known genetic mutations (BRCA1 or 2), familial breast cancer history, history of chest radiation at a young age or previously diagnosed with high risk breast lesions, who may benefit from starting screenings at age 40. So, essentially if at high risk start screenings at age 40-49. Cervical Cancer  Risk factors o Multiple sexual partners o Younger age onset of sex o Immunosuppressed and/ or smoking individuals. Age Group Recommendations for Pap/Liquid Cytology Age 20 years or younger Do not screen (even if sexually active with multiple partners). rare before age 21 Age 21 to 65 years Baseline at age 21 years. Screen every 3 years. Age 30 to 65 years Another option starting at age 30 years is to screen with combination of cytology plus human papillomavirus (HPV) testing every 5 years. Had hysterectomy with removal of cervix If hysterectomy with cervical removal was not due to cervical intraepithelial neoplasia (CIN grade 2) or cervical cancer, then can stop screening. Age Group Recommendations for Pap/Liquid Cytology Women older than 65 years who had adequate prior screening Do not screen if history of adequate prior screening and is otherwise not at high risk for cervical cancer. Colorectal Cancer  Risk factors o Familial history of polyposis (multiple polyps on colon) o 1 st * relative with colon cancer o Chron’s disease (ulcerative colitis)  Start at age 50-74 years of age is routine screenings  Age 76-85 years of age: against routine screening, but may have individual considerations for screening.  Screening Modalities for Colorectal Cancer o High-sensitivity fecal occult blood test (gFOBT) for three consecutive stool samples annually o Flexible sigmoidoscopy or CT colonography every 5 years o Colonoscopy every 10 years Lipid Disorders  Must be fasting for a minimum of 9 hours.  40-74 years of age  Must have 1 or more risk factors i.e.- dyslipidemia, DM, HTN, and/ or smoking.  ASCVD of 10 % or greater Lung Cancer  Screening for individuals who smoke 30 pack-years or have quit in the past 15 years.  Age 55-80 years of life – low dose CT Prostate Cancer  Risk Factors o 50 years or older o African Ancestry o 1 st * relative with prostate cancer.  Does not recommend PSA screening for prostate CA.  The benefits do NOT outweigh the disadvantages. Ovarian Cancer  Very high-risk women with BRCA1/BRCA2 mutations: Refer to specialists. If ovarian cancer screening is done, transvaginal ultrasound with serum cancer antigen (CA-125) is ordered.  Screening starts at age 30  Some recommend BSO between age 35-40 years of life.  Who is at high risk? o Look for family history of having two or more first- to second-degree relatives with a history of ovarian cancer or a combination of ovarian cancer; women of Ashkenazi Jewish ethnicity with first-degree relative (or second-degree relatives on the same side of the family) with breast or ovarian cancer. Skin Cancer Counseling  Should occur starting at age 10-24 with fair skin.  Should avoid sunlight from 10am-to- 4 pm and use of 15 spf sunblock or higher, protective clothing, wide brim hats. No Routine Screening for the following  Ovarian cancer  Oral cancer  Prostate cancer  Testicular cancer General Recap of Screening Recommendations Vaccination Facts Hepatitis B Vaccine  Total of 3 doses with one given at birth and 4 weeks given between 1st and 2nd dose.  If patient only one dose of hep B vaccine? o Do not restart the series, just give the second dose. Then given 3rd when time permits. Influenza Vaccination  6 months is the youngest age at which it can be given.  Most flu vaccinations are manufactures using egg-based technology. o Note: only 1.3% of children and only 0.02 % of adults have egg allergies.  Use caution with pt’s with previous reactions, history of Guillain-Barre syndrome within 6 weeks prior to previous immunization.  Live vaccine contraindications o Pregnancy o Chronic disease (i.e. COPD, Renal failure, DM, and immunosuppression). o In children on aspirin therapy ages 2-64 years of age. Tetanus Vaccines (Tdap and/ or Td)  Given every 10 years with boosters (i.e. contaminated wounds) every 5 years.  Age Implications o Infancy and younger than 7 years of age : use DTap form. o 7 years of age and older: only use Td or Tdap forms of the vaccine o All forms are given IM  Tdap can be used as a booster and substitute for Td (but only once in a lifetime) in adolescent and adults starting at 11-12 years of age.  What do you do for someone with a tetanus prone wound that has no tetanus history? o Give Td/Tdap vaccine and the tetanus immunoglobin (TIG) injection ASAP.  High risk wounds for Tetanus exposure o Puncture wounds o Wounds with devitalized tissue o Soil contaminated wounds o Crush injuries o Other injuries that are high risk for tetanus infection.  Use in caution with hx of Guillian-Barre Syndrome within 6 weeks of previous dose as well as pertussis component in individuals with progressive or unstable neurological disorder and or uncontrolled seizures. Pneumococcal Vaccinations  Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax (50% effective): 65 years of age or older.  Pneumococcal conjugate vaccine (PCV13 or Prevnar) (85% effective) o All children less than 5 years of age o Those who are at high risk for pneumococcal disease  Chronic Disease (alcoholism, DM, CSF leaks, asthma, chronic hepatitis).  Anatomical or functional asplenia (including sickle cell disease)  Immunocompromised or on medications that are immune-compromising.  Malignancy or cancers of the blood.  Renal Disorders  History of organ or bone marrow transplant.  65 years or older – CDC recommends giving PCV 13 first (if they never had PPSV23) then 12 months later give PPSV23 (better immunologic response is seen with this order)  In Adults less than 65 years of age who were previously vaccinated with Pneuovax 23 a booster should be given every 5 years after the initial dose. Shingles Vaccination  Risk factors for shingles o Older age (60 or >) o Immunocompromised – HIV, steroids, chemotherapy o Leukemia or lymphoma  Zoster Vaccine (Zostavax) is a LIVE vaccination.  Give at age 60 with a one time-SC even with a past history of shingles or chicken pox.  Certain anti-viral medications (acyclovir, famciclovir, valacylovir decrease the effectiveness if taken within 24 hours prior and 14 days after vaccination.  Can cause an exacerbation of asthma and polymyalgia rhematica (PMR)  Youngest age Zostavax can be given is 50 years of age.  Shingles is contagious until the lesions are dry and crusted (follow contact precautions)  NOTE: Shingles vaccine has 14 more times VZV then the varicella vaccine (Varivax) Varicella Vaccination  Varivax is a LIVE vaccine  1 st Dose: given at 12-15 months (no younger) and ADVISE woman not to get pregnant for 1 month after getting vaccination.  Reactions: Mild rash or several small chickenpox rashes can occur after vaccination (contagious, avoid immunocompromised people).  DO NOT administer to someone born in the United States before 1980