Vaccines & boosters — USMLE Step 2 CK Notes
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Tetanus Prophylaxis
If vaccinated:
Clean/minor wound: only give vaccine if last dose over 10 years ago
No TIg
Dirty/sever wound: give vaccine if last dose over 5 years ago
No TIg
Unimmunised, uncertain or less than 3 tetanus toxoid vaccine doses:
Clean/minor wound: give vaccine but No TIg
Dirty/severe wound: give vaccine AND TIg
All adults should receive one time dose of Tdap vaccine in place of Td booster
Especially if pregnant, close contact with kids or if vaccination hx unknown
Abdo Aortic Aneurysm
Men age 65-75
Risk Factor: Any smoking hx
One time abdo duplex US
Bladder Cancer
None!
Statin therapy
Established ASCVD
LDL >190
Age 40 with DM
Estimated 10 year risk of ASCVD >7.5-10%
If they dont tolerate a statin try alternative statin!
ASCVD <7.5% —-> Lipid Profile every 5yrs in pts with cardiac risk factors
——>> >50yrs, HTN, Smoking, fam Hx
Fibrates used for hyperTG and low HDL Usually given w a statin
Cervical Cancer Screening
Discontinued at age 65 if low risk
Pneucoccus Vaccine
Age 19-64. AGE >65
PPSV23 ALONE: moderate risk Sequential PCV13+PPSV23
Chronic disease of heart, lung or liver
Current smoker or DM
PCV13+PPSV23: v high risk pt. Sequential PCV13+PPSV23
CSF leaks; asplenia
Immunocompromised eg HIV or cancer
CKD
Any patient aged 40-70 with BMI over 25 should be screened for DM
Breast Cancer Screening
Mammogram every 2 yrs for ages 50-74 Can start at age 40 or 50 depending on preference of pt
Possible genetic testing if evidence of high risk family hx
Breast self exam not beneficial
Colon cancer screening
Ages 50-75
FOBT annually or
Flexible sigmoidoscopy every 5yrs + FOBT every 3 yrs or
Colonoscopy every 10 years
Postpartum Screening
Intimate Partner Violence 3-6 wks after delivery
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