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------------------------------. 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 longer require regular screening.