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Family Medicine Health Maintenance

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
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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. When is intensive individualized home-based intervention recommended?
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
Exercise or physical therapy and vit D for patients > 65
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
800 IU/ day

2. Who should get shingles vaccine?
Total cholesterol - FOBT
Adults > 60
During 2nd - 3rd trimester
2mo - 4 mo - 6mo and 12-15 mo

3. How much folate and for How long should a woman take for planned pregnancy?
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
HISTORY
0.4 - 0.8 mg/day for 1 month prior to conception
0.4 mg/day

4. What are the guidelines for colon cancer screening?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
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
0.4 - 0.8 mg/day for 1 month prior to conception
In all W < 24 who are sexually active - In W > 24 with increased risk

5. How much calcium should adults (19 - 50) take?
Femoral neck
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)
1000 mg/day
To get IgA protection

6. When should the meningococcal vaccine be given and to which group?
2mo - 4 mo - 6mo and 12-15 mo
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
In adults with sustained BP > 135/80 mmHg
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

7. What type of illnesses does Hib vaccine prevent?
Meningitis and Epiglottitis
Men 45 - 79 yo
Breast CA - thromboembolic event - stroke and CAD
Starts at 50 (recommends against starting at 40) and every 2 years

8. When is area of induration > 15 mm considered TB positive?
Persons with no known risk factors
Exercise or physical therapy and vit D for patients > 65
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Preschool children : 3-4 yo - Elderly patients: > 65 yo

9. Which children should use a semi-upright/forward facing carseat?
> 2 yo and less than 40 lbs
Exercise - Environmental hazard reduction - Close monitoring of medication
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Women 55 - 79 yo

10. What tests are appropriate to order in an asymptomatic 57 yo male?
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
Total cholesterol - FOBT
800 IU/ day
One time abdominal X-ray for all MALES who ever SMOKES

11. What are some risk factors for CAD?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
4 mg/day
Men 45 - 79 yo

12. Who should get Tdap vaccine and how often?
12 - 23 mo - 2 doses are to be given 6 mo apart
BP - Height - Weight
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
Rear facing

13. What is the schedule for MMR vaccine?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
One dose at 12-15 mod - Booster at least 4-weeks after

14. Who are at increased risk for adverse effect catching a flu?
One time abdominal X-ray for all MALES who ever SMOKES
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

15. When should Gardasil be given and for what purposes?
Children up to 7 yo and < 5' should be placed in a booster seat.
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
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
Start at 20 for all M and W regardless of RFs

16. How much calcium should adolescents (9 -18) take?
Start at 20 for all M and W regardless of RFs
1300 mg/day
1000 mg/day
Adults > 60

17. What is the schedule for Hep B vaccine?
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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
More than 15
HISTORY

18. If traveling to endemic areas - Why should one get a dose of live vaccine?
Children up to 7 yo and < 5' should be placed in a booster seat.
1300 mg/day
To get IgA protection
Women 55 - 79 yo

19. How much fluoride should military children in HI be given?
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...
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Smoking - Alcoholism
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

20. What is the USPSTF guideline for DMT2 screening?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Women 55 - 79 yo
In adults with sustained BP > 135/80 mmHg
BP - Height - Weight

21. What are some RFs for DMT2?
To get IgA protection
BP - Height - Weight
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

22. What is the schedule for polio vaccine?
Femoral neck
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
2mo - 4mo - 6-18 mo and 4-6 yrs
Start at 20 for all M and W regardless of RFs

23. What are the USPSTF guidelines for mammogram?
Starts at 50 (recommends against starting at 40) and every 2 years
Every 5 years
Total cholesterol - FOBT
4 mg/day

24. What can decrease fall in the elderly?
HISTORY
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
2mo - 4 mo - 6mo and 12-15 mo
Exercise - Environmental hazard reduction - Close monitoring of medication

25. What is the schedule for varicella vaccine?
65 (earlier if have increased risk factors)
One dose at 12-15 mod - Booster at least 4-weeks after
Rear facing
2mo - 4mo - 6-18 mo and 4-6 yrs

26. When should pregnant women get a flu shot?
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
Women 55 - 79 yo
Smoking - Alcoholism
During 2nd - 3rd trimester

27. What is HI law for booster seat?

28. How much calcium should women > 50 take?
HISTORY
Forearm
1200 mg/day
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

29. What are the guidelines for visual screening?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Breast CA - thromboembolic event - stroke and CAD
Smoking - Alcoholism
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

30. What is USPSTF guideline for abdominal aortic aneurysm screening?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
During 2nd - 3rd trimester
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
One time abdominal X-ray for all MALES who ever SMOKES

31. When is area of induration > 5mm considered TB positive?
1000 IU/day
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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
Femoral neck

32. What are the 4 main groups of people who are candidates for pneumococcal vaccine?

33. What is the USPSTF guideline for chlamydial 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
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
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
In all W < 24 who are sexually active - In W > 24 with increased risk

34. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
During 2nd - 3rd trimester
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
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
65 (earlier if have increased risk factors)

35. What is the NCEP III guideline for cholesterol screening?
Starts at 20 for both M and W
Start at 20 for all M and W regardless of RFs
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
Every 5 years

36. Unopposed estrogen increases risks for what conditions?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Forearm
2mo - 4 mo - 6mo and 12-15 mo
Stroke and DVT

37. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
NEVER
Forearm
More than 15

38. What is the schedule for DTap vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
12 - 23 mo - 2 doses are to be given 6 mo apart
Start at 20 for all M and W regardless of RFs
Stroke and DVT

39. Measurement of which anatomic structure is best predictor for hip fracture?
Forearm
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
Femoral neck
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

40. How often do asplenic patients receive pneumococcal vaccine?
Every 5 years
Rear facing
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

41. When should chest X-ray be used for screening?
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
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Rear facing
NEVER

42. What is the ADA guideline for DMT2 screening?
In adults with sustained BP > 135/80 mmHg
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
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
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

43. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
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
4 mg/day
Starts at 50 (recommends against starting at 40) and every 2 years
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

44. What are some safety issues you should counsel parents with young children?
When they are > 40 lbs and still less then 5'
BP - Height - Weight
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...
2mo - 4 mo - 6mo and 12-15 mo

45. What are the risks of combination HRT?
Breast CA - thromboembolic event - stroke and CAD
65 (earlier if have increased risk factors)
NEVER
Children up to 7 yo and < 5' should be placed in a booster seat.

46. What is the most important way to screen for CAD in an asymptomatic patients?
Total cholesterol - FOBT
12 - 23 mo - 2 doses are to be given 6 mo apart
Forearm
HISTORY

47. How much vit D should adults < 50 take?
1000 mg/day
800 IU/ day
> 2 yo and less than 40 lbs
During 2nd - 3rd trimester

48. Some contraindications for aspirin
1300 mg/day
> 2 yo and less than 40 lbs
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

49. What is the schedule for rotavirus vaccine?
Exercise or physical therapy and vit D for patients > 65
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
> 2 yo and less than 40 lbs
Stroke and DVT

50. What kind of sunscreen SPF is recommended for sun protection?
0.4 - 0.8 mg/day for 1 month prior to conception
1000 mg/day
More than 15
Total cholesterol - FOBT