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Family Medicine Health Maintenance

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is the schedule for MMR vaccine?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
BP - Height - Weight
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
One time abdominal X-ray for all MALES who ever SMOKES

2. In which group of patients should aspirin be given as primary prevention for MI?
1) Children < 2yo 2) All adults smokers 3) Adults and children > 2 yo with high risk: cardiopulmonary disease - asplenic - Hodgkin's disease - multiple myeloma - chronic liver disease - alcoholism - renal failure - immunocompromised 4) Healthy adults
Starts at 20 for both M and W
Men 45 - 79 yo
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

3. If traveling to endemic areas - Why should one get a dose of live vaccine?
To get IgA protection
Femoral neck
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Recent arrival (< 5 y) from high prevalence countries - IV drug users - Residents and employees of high risk settings: prison - nursing homes - hospitals - homeless shelters - and residential facilities for AIDS patients - Mycobacterial lab personnel

4. Which children should use a semi-upright/forward facing carseat?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
> 2 yo and less than 40 lbs
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
More than 15

5. At what age should women have DEXA scan?
1200 mg/day
Starts at age 50 for normal risk - age 40 for increased risk - FOBT every year - OR - Sigmodoiscopy every 3-5 years - OR - Colonoscopy every 10 years
65 (earlier if have increased risk factors)
Forearm

6. What tests are appropriate to order in an asymptomatic 57 yo male?
Women 55 - 79 yo
Exercise or physical therapy and vit D for patients > 65
12 - 23 mo - 2 doses are to be given 6 mo apart
Total cholesterol - FOBT

7. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
Starts at 20 for both M and W
Persons with no known risk factors
Starts at age 21 regardless of age becoming sexually active and repeats every 3 years - For W > 30 - can extend the interval to every 5 years with HPV testing - Stop at 65 yo (USPSTF)
Adults - every 10 years - If sustain deep or contaminated wound - every 5 years - Best to give first dose 11-18 yo - then followed by Td booster

8. When should tetanus immunoglobulin be given?
2mo - 4 mo - 6mo and 12-15 mo
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
During 2nd - 3rd trimester
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

9. What is the schedule for Hep A vaccine?
12 - 23 mo - 2 doses are to be given 6 mo apart
2mo - 4 mo - 6mo and 12-15 mo
Preschool children : 3-4 yo - Elderly patients: > 65 yo
NEVER

10. What is the schedule for Hib vaccine?
Women 55 - 79 yo
Starts at 20 for both M and W
Men 45 - 79 yo
2mo - 4 mo - 6mo and 12-15 mo

11. How much calcium should adolescents (9 -18) take?
Meningitis and Epiglottitis
Start at 20 for all M and W regardless of RFs
1300 mg/day
Children up to 7 yo and < 5' should be placed in a booster seat.

12. What 3 things should always be done in an office visit?
BP - Height - Weight
Persons with no known risk factors
0.4 mg/day
In all W < 24 who are sexually active - In W > 24 with increased risk

13. What are the guidelines for visual screening?
2mo - 4mo - 6-18 mo and 4-6 yrs
Preschool children : 3-4 yo - Elderly patients: > 65 yo
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Women 55 - 79 yo

14. How much folate and for How long should a woman take for planned pregnancy?
0.4 - 0.8 mg/day for 1 month prior to conception
One dose at 12-15 mod - Booster at least 4-weeks after
Starts at 20 for both M and W
Women 55 - 79 yo

15. What are some risk factors for CAD?
When they are > 40 lbs and still less then 5'
2mo - 4 mo - 6mo and 12-15 mo
Every 5 years
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

16. How much fluoride should military children in HI be given?
Starts at age 50 for normal risk - age 40 for increased risk - FOBT every year - OR - Sigmodoiscopy every 3-5 years - OR - Colonoscopy every 10 years
One dose at 12-15 mod - Booster at least 4-weeks after
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Recent arrival (< 5 y) from high prevalence countries - IV drug users - Residents and employees of high risk settings: prison - nursing homes - hospitals - homeless shelters - and residential facilities for AIDS patients - Mycobacterial lab personnel

17. What type of illnesses does Hib vaccine prevent?
Meningitis and Epiglottitis
HIV positive patients - Recents contact with TB case - Persons with fibrotic changes on CXR consistent with old healed TB - Patients with organ transplant - Immunocompromised patients
2mo - 4 mo - 6mo and 12-15 mo
To get IgA protection

18. What is the most important way to screen for CAD in an asymptomatic patients?
In adults with sustained BP > 135/80 mmHg
Total cholesterol - FOBT
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
HISTORY

19. Who are at increased risk for adverse effect catching a flu?
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
2mo - 4 mo - 6mo and 12-15 mo
Recent arrival (< 5 y) from high prevalence countries - IV drug users - Residents and employees of high risk settings: prison - nursing homes - hospitals - homeless shelters - and residential facilities for AIDS patients - Mycobacterial lab personnel
2mo - 4mo - 6-18 mo and 4-6 yrs

20. In which group of patients should aspirin be given as primary prevention for stroke?
0.4 mg/day
Women 55 - 79 yo
> 2 yo and less than 40 lbs
800 IU/ day

21. Who should get Tdap vaccine and how often?
Adults - every 10 years - If sustain deep or contaminated wound - every 5 years - Best to give first dose 11-18 yo - then followed by Td booster
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
NEVER
800 IU/ day

22. What is the ADA guideline for DMT2 screening?
When they are > 40 lbs and still less then 5'
Fires: install smoke detectors - flame-resistant nightwears - Burns: set hot water to 110-120 F. - Poisoning: keep the number for poison control 800-222-1222. Do not use IPECAC. - Helmets - knee/elbow pads...
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

23. What kind of car seat should children < 2 yo be placed in?
0.4 mg/day
Rear facing
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
HISTORY

24. What are some RFs for DMT2?
In adults with sustained BP > 135/80 mmHg
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
To get IgA protection

25. What is USPSTF guideline for abdominal aortic aneurysm screening?
In adults with sustained BP > 135/80 mmHg
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
One time abdominal X-ray for all MALES who ever SMOKES
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

26. What is HI law for booster seat?

27. When is intensive individualized home-based intervention recommended?
HIV positive patients - Recents contact with TB case - Persons with fibrotic changes on CXR consistent with old healed TB - Patients with organ transplant - Immunocompromised patients
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Patients > 75 - Patients 70 - 74 who are on psychoactive or cardiac meds - who are on > 4 meds and who have impaired cognition - strength - balance and vision

28. What is the USPSTF guideline for DMT2 screening?
Persons with no known risk factors
One time abdominal X-ray for all MALES who ever SMOKES
In adults with sustained BP > 135/80 mmHg
When they are > 40 lbs and still less then 5'

29. How much flouride should non military children in the state of HI be given?
Starts at 50 (recommends against starting at 40) and every 2 years
Women 55 - 79 yo
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

30. Who should get shingles vaccine?
Adults > 60
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
1200 mg/day
Forearm

31. What are the risks of combination HRT?
During 2nd - 3rd trimester
Breast CA - thromboembolic event - stroke and CAD
1200 mg/day
Rear facing

32. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
4 mg/day
More than 15
Total cholesterol - FOBT
Starts at 20 for both M and W

33. When can children sit in a booster seat?

34. When is area of induration > 15 mm considered TB positive?
Starts at age 21 regardless of age becoming sexually active and repeats every 3 years - For W > 30 - can extend the interval to every 5 years with HPV testing - Stop at 65 yo (USPSTF)
When they are > 40 lbs and still less then 5'
Persons with no known risk factors
HISTORY

35. What are the guidelines for colon cancer screening?
Starts at age 50 for normal risk - age 40 for increased risk - FOBT every year - OR - Sigmodoiscopy every 3-5 years - OR - Colonoscopy every 10 years
Recent arrival (< 5 y) from high prevalence countries - IV drug users - Residents and employees of high risk settings: prison - nursing homes - hospitals - homeless shelters - and residential facilities for AIDS patients - Mycobacterial lab personnel
2mo - 4mo - 6-18 mo and 4-6 yrs
> 2 yo and less than 40 lbs

36. What kind of sunscreen SPF is recommended for sun protection?
9 - 26 yo - To prevent cervical cancer in W and anal cancer in M and genital warts - Protect against HPV type 11 - 16 and 18
More than 15
One dose at 12-15 mod - Booster at least 4-weeks after
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

37. Some contraindications for aspirin
Patients > 75 - Patients 70 - 74 who are on psychoactive or cardiac meds - who are on > 4 meds and who have impaired cognition - strength - balance and vision
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
0.4 - 0.8 mg/day for 1 month prior to conception
Exercise or physical therapy and vit D for patients > 65

38. What is the schedule for Gardasil?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
In adults with sustained BP > 135/80 mmHg
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Persons with no known risk factors

39. What are the guidelines for pap smear?
Every 5 years
Starts at age 21 regardless of age becoming sexually active and repeats every 3 years - For W > 30 - can extend the interval to every 5 years with HPV testing - Stop at 65 yo (USPSTF)
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

40. What can decrease fall in the elderly?
1300 mg/day
Adults - every 10 years - If sustain deep or contaminated wound - every 5 years - Best to give first dose 11-18 yo - then followed by Td booster
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Exercise - Environmental hazard reduction - Close monitoring of medication

41. When should Gardasil be given and for what purposes?
9 - 26 yo - To prevent cervical cancer in W and anal cancer in M and genital warts - Protect against HPV type 11 - 16 and 18
In adults with sustained BP > 135/80 mmHg
Men 45 - 79 yo
NEVER

42. Measurement of which anatomic structure is best predictor for hip fracture?
Femoral neck
2mo - 4mo - 6-18 mo and 4-6 yrs
Preschool children : 3-4 yo - Elderly patients: > 65 yo
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

43. What is the NCEP III guideline for cholesterol screening?
HIV positive patients - Recents contact with TB case - Persons with fibrotic changes on CXR consistent with old healed TB - Patients with organ transplant - Immunocompromised patients
BP - Height - Weight
Start at 20 for all M and W regardless of RFs
NEVER

44. How much calcium should adults (19 - 50) take?
Stroke and DVT
NEVER
12 - 23 mo - 2 doses are to be given 6 mo apart
1000 mg/day

45. What is the schedule for varicella vaccine?
Adults > 60
0.4 - 0.8 mg/day for 1 month prior to conception
One dose at 12-15 mod - Booster at least 4-weeks after
During 2nd - 3rd trimester

46. How much calcium should women > 50 take?
1200 mg/day
Starts at 50 (recommends against starting at 40) and every 2 years
One dose at 12-15 mod - Booster at least 4-weeks after
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

47. What is the schedule for DTap vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
4 mg/day
9 - 26 yo - To prevent cervical cancer in W and anal cancer in M and genital warts - Protect against HPV type 11 - 16 and 18
1000 mg/day

48. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Forearm
HIV positive patients - Recents contact with TB case - Persons with fibrotic changes on CXR consistent with old healed TB - Patients with organ transplant - Immunocompromised patients
1000 IU/day

49. When should the meningococcal vaccine be given and to which group?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
In all W < 24 who are sexually active - In W > 24 with increased risk
Exercise or physical therapy and vit D for patients > 65
2mo - 4 mo - 6mo and 12-15 mo

50. What are some safety issues you should counsel parents with young children?
Femoral neck
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Fires: install smoke detectors - flame-resistant nightwears - Burns: set hot water to 110-120 F. - Poisoning: keep the number for poison control 800-222-1222. Do not use IPECAC. - Helmets - knee/elbow pads...
Recent arrival (< 5 y) from high prevalence countries - IV drug users - Residents and employees of high risk settings: prison - nursing homes - hospitals - homeless shelters - and residential facilities for AIDS patients - Mycobacterial lab personnel