USMLE Step 2 CK Prevention and Screening

USMLE Step 2 CK Prevention and Screening osteoporosis in women ️️women 65 years old should get DEXA scan. screening starts at 60 y.o. if there is low body weight or increased risk of fractures abdominal aortic aneurysm ️️U/S one time in men 65 who have ever smoked. There is no screening recommendations for male non-smokers and women smokers or women non-smokers. the role of physicans to prevent injuries ️️seat belts, wearing helmets and not driving under the influence of alcohol; women - especially domestic violence - ask if they've been hit, kicked can increase identification by more than 10% high cholesterol ️️screening starts in men age 35 with no risk factors. Repeat every 5 years in low risk individuals. in both men and women with risk factors for coronary artery disease, screening should be done routinely after age 20. diabetes mellitus ️️screening for DM should be considered only for patients with hypertension. diagnosis of diabetes is two fasting glucose measurements are ≥126 mg/dL OR HA1c 6.5% or symptomatic random glucose is 200mg/dL . carotid artery stenosis ️️there is no recommendation for screening carotid artery stenosis. future travel plans ️️set appointment 4-6 weeks prior to departure, discuss the following: HepA - get vaccine 2 weeks of departure = vaccine + Ig booster shot 6 months after initial vaccine confers 10 yrs of immunity HepB - Malaria - mefloquine for prophylaxis (doxycycline as alternative although has photosensitivity adverse effect) for pregnant patients, use chloroquine instead. Rabies - recommended for travel to India Asia and Mexico people with concurrent malaria prophylaxis, use IM administration of Rabies vaccine(instead of intradermal) to avoid chloroquine interactions with vaccine. hep B vaccination for travel ️️vaccine recommended for the folllowing activities: -working with indigenous population -having sex with indigenous population -receiving medical or dental care -staying abroad for 6 months Typhoid vaccination for travel ️️developing countries either oral live attenuated form (refrigerated) and in immunocompetent patients OR polysaccharide vaccine - IM as single injection (irritation at site of injection) ; it is the preferred form - well tolerated and doesn't require refrigeration when to give meningococcal booster ️️If primary vaccine occurred prior to 16 yrs of age and if they are between ages of 16-21 years old. patient with no history of prior meningococcal vaccine what do you give him? ️️21 yrs old consider administering if he has following: 1) asplenia 2) complement deficiency 3) HIV 4) exposure to community outbreak 5)travel to an endemic area 6) living in close quarters with others traveler's diarrhea for travel ️️avoid raw foods, street vendor foods loperamide for watery diarrhea Tx with FQ or macrolide for moderate to severe symptoms polio for travel ️️3 doses of inactivated polio vaccine. previously immunized patients should take a booster shot before traveling breast cancer screening ️️mammography between ages of 50-74 every 1-2 years. Patients with very strong family history (≥2 first degree relatives) should consider prophylactic tamoxifen cervical cancer screening ️️pap smear between 21-65 every 3 years. Women ages 30-65 can screen every 5 years with pap smear AND HPV test. prostate screening ️️men age 75 no significant benefit to screen greater than 75 colon cancer screening ️️In patients with no significant family history: (1) annual fecal occult blood test (2) sigmoidoscopy with barium enema every 5 years (3) colonoscopy every 10 years (If the initial screen is normal).