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A 24-year-old woman comes for her annual physical examination. She has no pertinent medical history. She takes no medications. She reports no allergies. She is sexually active with a stable partner. She denies a history of STDs. Her last menstrual period was 7 days ago. She denies any symptoms and her physical examination is normal. You review her immunization record and see that she received all the appropriate vaccines during childhood but has not received any immunizations in the last 10 years.

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1. Which immunizations should you offer to this patient?

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2. What antibody titers (related to immunizations) would it be important to check on this patient?

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Answers

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  1. This patient is a candidate for multiple vaccines. She should be offered the influenza vaccine recommended for all adults. She should start the series of human papillomavirus (HPV) vaccines to prevent cervical cancer and genital warts, as she is within the recommended age group. She should receive the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine that will replace the 10-year tetanus booster.

  2. This patient is at risk of becoming pregnant, so it is important to determine immunity against rubella and varicella and vaccinate if appropriate. Women should have rubella titers tested and if negative, should receive the measles, mumps, and rubella (MMR) vaccine.

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Immunizations and Preventive Medicine

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Preventive medicine includes the routine care of the healthy patient, assessment of lifestyle risk factors, need for immunizations, and screening for prevalent diseases such as hypertension, diabetes, or cancer, among many others.

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In regards to lifestyle risk factors, there is evidence that brief primary care–based interventions to modify risk behaviors are effective. This is particularly important in tobacco and alcohol misuse and includes the “5 A's” model for brief counseling: assess (the behavior), advise (clear behavior change advice), agree (mutual collaboration to set goals), assist (aid patient to reach goals), and arrange (schedule follow-up to provide ongoing support). The “5 R's” model can be used for smokers unwilling to quit and includes: relevance (for the smoker to quit), risks (negative consequences of smoking), rewards (benefits of cessation), roadblocks (barriers to quit), and repetition (repeat motivational counseling at future visits).

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Screening is defined as an evaluation to detect a disease at an asymptomatic stage. It is appropriate when the population to be screened is accessible and willing to undergo testing, the disease causes burden to patients or society, and the test used is sensitive and specific enough to detect disease without undue false-positives or -negatives. Screening should result in a decrease in mortality. However, screening can also result in significant morbidity to the patient. False-positives tests can generate anxiety, and unnecessary tests and procedures. They can also lead to false-negatives, which gives a false sense of reassurance.

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The U.S. Preventive Services Task Force ...

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