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vaccines contraindicated in pregnancy
MMR, Flu Mist, Varicella, Varicella Zoster, HPV
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When can you get pregnant after live vaccines?
3 months
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Neomycin allergy, vaccine contraindicated
IPV, MMR, Varicella, Varicella Zoster
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Egg Allergy-Anaphylactic rxn, vaccine contraindicated
All Influenza vaccines (live and attenuated)
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Baker's Yeast, vaccine contraindicated
Hepatitis B (B- Bakers)
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Streptomycin Allergy- vaccine contraindicated
IPV, Vaccina (small pox)
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Gelatin Allergy, vaccine contraindicated
MMR, Varicella Zoster
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HIV & Vaccinations, when do you NOT give
Live viruses cannot be given if CD4-T lymphocyte cell count is <200
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Hepatitis Vaccine Series- when is 2rd dose given?
1 month after 1st dose
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Hepatitis Vaccine Series- when is 3rd dose given?
5 months after 1st dose (6 months after 1st)
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When do you NOT give any immunizations?
Moderate to Severe illness or hx of anaphylactic RXN to vaccine
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H. Influenza Type B Vaccine (HiB)what does it immunize against?
Meningitis is its most severe manifestation
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How often Td Booster?
Q10 years
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Fever and immunization contraindication
Fever alone does not contraindicate immunization
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Healthy People 2010- what does it focus on?
Health Promotion, Health Protection, Preventive Services, Data & Surveillance
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When can you d/c PAP smears
At age 65 if past 3 PAPs were normal
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Glaucoma screening age
Age 40 and then Q5yrs, Age60 Q2 yrs
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Prostate cancer ethnic group at higher risk & when do you screen them?
African Americans, screen DRE/PSA age 40 then Q1yr
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Prostate cancer screening for non-high risk
Start at Age 50
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When do you start Chantix? How long is tx?
7 days prior to start date, then for 12 wks, with a 12wk refill
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Calculation of ideal weight for males
100 lb for 5 feet, then add 6 lb for each inch over that
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Calculation of ideal weight for females
100 lb for 5 feet, then add 5 lb for each inch over that
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How many calories in one gram of fat?
9 calories
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How many calories in one gram of CHO or Protein?
4 calories
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GOLD recommendation for COPD patient meds?
Inhaled B2 agonist (LABA) plus Inhaled anticholinergic
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What does stress do in the body? (what does it release- hormones)
Cortisol, glucose, glucagon, catecholamines, aldosterone, NA retention
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How do you prevent Travel's diarrhea?
Cook it, boil it, peel it or forget it!
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What DEET strength is needed to be effective against Mosquito Bites?
>35%.. but not on hands/face of kids
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Incubation of Flu?
1-4 days
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What percentage is Flu vaccine effective?
70-80% effective
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When (age cut off) is Flu Mist given?
Live Attenuated Virus- healthy people aged 2-49
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What are s/e of intranasal flu vaccine?
Nasal irritation, discharge, myalgia, fever, sore throat
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Contraindications to LAIV live flu vaccine?
<2, >50, ASA, Chronic heart disease, COPD, DM, Pregnancy, egg allergy
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What is Amatadine and Rimatadine for?
Influenza A only, not recommended much anymore, resistance seen
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What is approved for Influenza A and Influenza B treatment?
Zanamivir (Relenza- inhaled) Oseltamivir (Tamiflu- p.o.)
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When is antiviral flu drugs started? What do they do?
Start in first few days, shortens time frame of feeling ill
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MMR Vaccine- live or not?
Live, attenuated
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How is MMR Administered?
2 shots one month apart for adults born after 1957
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Rubella bad effects if contracted when?
In pregnancy- extremely harmful effects to fetus
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What does pneumococcal vaccine protect against, in addition to pneumonia?
Pneumonia, meningitis, septicemia, and death
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What strains are in pneumococcal vaccine?
23 strains of Streptococcus pneumoniae
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Who should get pneumonovax?
Those >65, smokers, asplenia, immunocompromised, COPD, liver, kidney disease
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What healthy people should be re-vaccinated with pneumovax? & what time frame?
One time if >65 years old, if person was younger than 65 when got it first time
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Who should get pneumovax re-vaccination after 5 years?
CRF, nephrotic syndrome, Asplenia, immunocompromised
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Hepatitis B is risk factor for?
Hepatoma, hepatocellular carcinoma, cirrhosis
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Who is checked for Hepatitis B immunity?
Health Care workers, IVDA, dialysis pts, immunosuppressed pts
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When are dialysis patients given booster Hep B vaccine?
Check yearly, and booster if immunity <10
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What is characteristic about smallpox rash?
ALL vesicular lesions on skin are at the same stage at same time
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Where does smallpox rash appear?
Appears on tongue and mouth first as red spots then open sores, then skin
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What is the immunization called for Chicken Pox?
Varicella-Zoster vaccine
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When is varicella mortality more common?
Age 30-50
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If no evidence of varicella vaccines or immunity, what is vaccination schedule?
TWO doses, 4-8 weeks apart
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When is Varicella vaccine given in pregnancy?
It is NOT given in pregnancy, give right at delivery
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What microorganism causes Tetanus? And other info specific about it?
Clostridium Tetani, Gram Positive, anaerobe, spore forming
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If never immunized and come in contact, what is given?
Tetanus Immunoglobin and Tetanus toxoid
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Diphtheria vaccine, what is it given with?
Given with Tetanus vaccine
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How is diphtheria transmitted and what is it?
gram negative bacteria, person to person or via contaminated liquids (milk)
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What does Diphtheria cause?
Severe Respiratory infection and Pseudomembranous Pharyngitis
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What is the Td Series?
Primary is set of 3 (now, in 1 month, and in 6 months) & booster Q10years
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What's in a Tdap?
Diphtheria, Tetanus, acellular pertussis
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Hepatitis A Vaccine, what is vaccine schedule?
Now and then second in 6-12 months
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How is Hepatitis A Virus Spread?
Fecal oral, contaminated drinking water
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Who should be immunized against HAV?
Children, high risk groups, daycare workers, military, IVDA, liver disease
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What is so bad about getting Hep A? it is a self-limiting infection.
Co-infection with B, or C, or chronic liver disease can lead to liver failure
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Polio Virus, how is it transmitted?
Oral fecal route
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Tobacco Cessation Counseling, what are the 5 A's?
Ask, Advise, Assess, Assist, Arrange
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Sandpaper rash, exudative pharyngitis, fever, anterior cervical lymphadenopathy. Rah erupts on day 2 of pharyngitis and peels a few days later, what is it?
Scarlet Fever. It is strept throat with rash. Cause by Strept pyogenes, a group A beta hemolytic streptococci. TX same as Strept throat tx
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3-7 day period of very high fever, and mild symptoms then discrete rosy-pink macular or maculopapular rash lasting hours to 3 days
Roseola. HHV-6 virus. Mostly seen in kids younger than 2
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Posterior Cervical and Post auricular, Occipital lymphadenopathy 5-10 days prior to the rash onset which is diffuse maculopapular rash lasting 3 days, Mild symptoms of fever, sore throat, malaise, Rash and fever occur together
Rubella. (German Measles or 3 day measles) location of occipital lymphadenopathy is pathognomonic for Rubella
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What is concern with Rubella?
Congenital rubella is great risk to unborn child. It is a reportable disease if you diagnose it.
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Acute presentation of fever, cough, generalized lymphadenopathy, Koplik spots that appear 2 days prior to onset of rash?
Measles. Rubeola. 10 day measles. Risk of pneumonia and death
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What are Koplik Spots?
Palate Petechiae with onset of measles (rubeola) virus, white spots with blue ring inside of a red spot in oral mucosa. Helps to rule Rubeola in, but absence does not rule it out
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