II. History

  1. Medical History
  2. Surgical History
  3. Medications
  4. Allergies

IV. Prevention: Cardiovascular

  1. Coronary Artery Disease
    1. See Cardiovascular Risk Management
    2. USPTF Coronary Heart Disease Guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsacad.htm
      2. http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm
  2. Hypertension
    1. USPTF Hypertension Guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspshype.htm
  3. Hyperlipidemia
    1. Indications
      1. Cardiovascular Risk Factors
        1. Start screening for men and women at age 20 years old
      2. No risk factors
        1. Men: Over age 35 years old
        2. Women: Over age 45 years old
    2. Screen every 5 years
      1. Fasting lipid profile or
      2. Total Cholesterol and HDL Cholesterol
    3. USPTF Dysplipidemia guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm
  4. Abdominal Aortic Aneurysm
    1. Screening with Ultrasound (Indications per USPTF)
    2. Indications
      1. Men aged 65 to 75 years with lifetime Tobacco use greater than 100 Cigarettes
      2. Women have no screening guidelines per USPTF
      3. See Abdominal Aortic Aneurysm for broader screening guidelines per Society Vascular Medicine
    3. USPTF AAA screening guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsaneu.htm
    4. References
      1. (2005) Am Fam Physician 71(11):2144-8 [PubMed]
  5. Carotid Artery Stenosis Guidelines
    1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsacas.htm

V. Prevention: Cancer in Men and Women

  1. Colorectal Cancer
    1. See Colorectal Cancer Screening
    2. Indications
      1. Start screening at age 50 years (and stop between 75 and 85 years old)
      2. See Colorectal Cancer Screening regarding indications to start screening earlier
    3. Options
      1. Colonoscopy: Every 10 years (preferred) or
      2. Flexible Sigmoidoscopy: Every 5 years or
      3. Occult Blood in stool: Annually
    4. USPTF Colorectal Cancer Screening guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm
  2. Lung Cancer
    1. Screening
      1. Indicated in age 55 to 80 years old with 30 py Tobacco use (ongoing or quit in last 15 years)
      2. Screen with annual low dose CT chest
      3. Advantages
        1. Number Needed to Screen in 5 years to prevent one death: 320
        2. All cause mortality Relative Risk Reduction: 6.7%
      4. Disadvantages
        1. Cummulative radiation and cost with annual screening will be substantial
        2. High False Positive Rate with screening (96%) will require significant resources to evaluate
        3. Despite USPTF recommendation for screening, other organizations, such as AAFP do not recommend
      5. References
        1. Aberle (2011) N Engl J Med 365(5): 395-409 [PubMed]
        2. Gates (2014) Am Fam Physician 90(9): 625-31 [PubMed]
        3. Kovalchik (2013) N Engl J Med 369(3): 245-54 [PubMed]
    2. Prevention
      1. Tobacco Cessation
      2. Consider Radon Gas testing in the home
    3. USPTF Lung Cancer screening guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspslung.htm

VII. Prevention: Men

  1. Prostate Cancer
    1. Prostate Specific Antigen (PSA)
      1. See Prostate Cancer Prevention for an Informed Consent outline for PSA testing
      2. Discuss risks and benefits of test (including that it is not recommended by most organizations other than ACS and AUA)
      3. Offer test annually between ages 55 to 69 years (previously ages 50 to 75 years) after discussion of test poor efficacy
    2. USPTF Prostate Cancer Screening guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsprca.htm
  2. Testicular Cancer
    1. No routine screening recommended by USPTF or NCI
    2. USPTF Testicular Cancer screening
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspstest.htm

VIII. Prevention: Eye

  1. Glaucoma
    1. Medicare will cover an annual dilated Eye Exam and Glaucoma screening
    2. Consider baseline exam indications
      1. Age over 40 years
      2. Family History of Glaucoma related Vision Loss
    3. USPTF Glaucoma screening guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsglau.htm
      2. USPTF does not recommend routine screening
  2. Vision
    1. USPTF Visual Acquity Guidelines (older adults)
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsviseld.htm

IX. Prevention: Miscellaneous

  1. Diabetes Mellitus
    1. Diabetes Screening recommended in patients with treated or untreated Hypertension (BP >135/80)
    2. USPTF Diabetes Mellitus Guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdiab.htm
  2. COPD
    1. Routine screening with Spirometry not recommended (USPTF)
    2. USPTF COPD Guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspscopd.htm
  3. Hepatitis C
    1. Screen all patients born between 1945 and 1965 for Hepatitic C
    2. CDC Hepatitis C Screening Guidelines
      1. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm

X. Prevention: Immunizations

  1. Tetanus Vaccine
    1. Tetanus Vaccine given every 10 years
    2. Age under 65 years; Give Tdap (e.g. Adacel) once at next opportunity
    3. Age over 65 years: Give Tdap (e.g. Adacel) once if in contact with infants under age 1 year old
  2. Measles Vaccine
    1. Booster for 1 dose if born after 1956
  3. Rubella Vaccine
    1. Fertile woman without proof of immunity
  4. Influenza Vaccine
    1. Annual Vaccine recommended in all patients
    2. See Influenza Vaccine for indications
  5. Pneumococcus Vaccine
    1. One dose over age 65 years or Asplenic
  6. Tuberculin Skin Test (Purified Protein Derivative)
    1. Recommended for high risk patients for Tuberculosis
  7. Hepatitis B Screening and Immunization
    1. See Hepatitis B Vaccine for Immunization indications
    2. See Hepatitis B Serology for screening indications
  8. Shingles
    1. One dose over age 60 years (consider for age over 50 years)
  9. CDC Immunization Schedules
    1. http://www.cdc.gov/vaccines/recs/schedules/default.htm

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