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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. When should chest X-ray be used for screening?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
NEVER
More than 15
Adults > 60

2. When should tetanus immunoglobulin be given?
2mo - 4mo - 6-18 mo and 4-6 yrs
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Forearm
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

3. What is the USPSTF guideline for fall prevention in the elderly?
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
Exercise or physical therapy and vit D for patients > 65
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Stroke and DVT

4. What are the guidelines for visual screening?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Exercise or physical therapy and vit D for patients > 65
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Smoking - Alcoholism

5. When should the meningococcal vaccine be given and to which group?
Meningitis and Epiglottitis
Breast CA - thromboembolic event - stroke and CAD
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
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

6. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
NEVER
Starts at 20 for both M and W
4 mg/day

7. When can children sit in a booster seat?

8. How much vit D should adults < 50 take?
800 IU/ day
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 IU/day
Starts at 50 (recommends against starting at 40) and every 2 years

9. What type of illnesses does Hib vaccine prevent?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
0.4 mg/day
In adults with sustained BP > 135/80 mmHg
Meningitis and Epiglottitis

10. What are some RFs for DMT2?
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Stroke and DVT
800 IU/ day

11. Measurement of which anatomic structure is best predictor for hip fracture?
> 2 yo and less than 40 lbs
Femoral neck
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
0.4 mg/day

12. When is area of induration > 10 mm considered TB positive?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
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
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
Stroke and DVT

13. What is the USPSTF guideline for DMT2 screening?
1200 mg/day
In adults with sustained BP > 135/80 mmHg
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

14. What are the USPSTF guidelines for mammogram?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
0.4 - 0.8 mg/day for 1 month prior to conception
2mo - 4mo - 6-18 mo and 4-6 yrs
Starts at 50 (recommends against starting at 40) and every 2 years

15. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Exercise - Environmental hazard reduction - Close monitoring of medication
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Forearm
1200 mg/day

16. How much folate and for How long should a woman take for planned pregnancy?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
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
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
0.4 - 0.8 mg/day for 1 month prior to conception

17. What are the guidelines for pap smear?
One dose at 12-15 mod - Booster at least 4-weeks after
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)
1000 mg/day

18. What kind of sunscreen SPF is recommended for sun protection?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
More than 15
Women 55 - 79 yo

19. What is the USPSTF guideline for chlamydial screening?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
In all W < 24 who are sexually active - In W > 24 with increased risk
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
4 mg/day

20. How much fluoride should military children in HI be given?
Exercise or physical therapy and vit D for patients > 65
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
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
HISTORY

21. What kind of car seat should children < 2 yo be placed in?
Rear facing
0.4 mg/day
More than 15
Children up to 7 yo and < 5' should be placed in a booster seat.

22. In which group of patients should aspirin be given as primary prevention for stroke?
Meningitis and Epiglottitis
Adults > 60
Men 45 - 79 yo
Women 55 - 79 yo

23. Some contraindications for aspirin
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

24. What are 2 conditions that have been proven to be beneficial to screened for?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
When they are > 40 lbs and still less then 5'
Smoking - Alcoholism

25. What is the schedule for MMR vaccine?
Children up to 7 yo and < 5' should be placed in a booster seat.
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Persons with no known risk factors

26. 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
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
Total cholesterol - FOBT
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

27. What are the risks of combination HRT?
Breast CA - thromboembolic event - stroke and CAD
0.4 mg/day
1000 mg/day
More than 15

28. What is the schedule for polio vaccine?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
2mo - 4mo - 6-18 mo and 4-6 yrs
Starts at 50 (recommends against starting at 40) and every 2 years

29. What 3 things should always be done in an office visit?
To get IgA protection
Adults > 60
BP - Height - Weight
1000 IU/day

30. When is area of induration > 5mm considered TB positive?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
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
Start at 20 for all M and W regardless of RFs
Adults > 60

31. What can decrease fall in the elderly?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Women 55 - 79 yo
Exercise - Environmental hazard reduction - Close monitoring of medication
Preschool children : 3-4 yo - Elderly patients: > 65 yo

32. How much flouride should non military children in the state of HI be given?
During 2nd - 3rd trimester
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Exercise - Environmental hazard reduction - Close monitoring of medication
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

33. What is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
2mo - 4 mo - 6mo and 12-15 mo
Femoral neck
1000 mg/day

34. What are some safety issues you should counsel parents with young children?
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...
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
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)
To get IgA protection

35. What tests are appropriate to order in an asymptomatic 57 yo male?
Total cholesterol - FOBT
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
Femoral neck
Forearm

36. In which group of patients should aspirin be given as primary prevention for MI?
NEVER
Breast CA - thromboembolic event - stroke and CAD
Men 45 - 79 yo
In all W < 24 who are sexually active - In W > 24 with increased risk

37. How much vit D should adults > 50 take?
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
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
Adults > 60
1000 IU/day

38. How often do asplenic patients receive pneumococcal vaccine?
Every 5 years
Persons with no known risk factors
During 2nd - 3rd trimester
65 (earlier if have increased risk factors)

39. When should pregnant women get a flu shot?
Forearm
During 2nd - 3rd trimester
Meningitis and Epiglottitis
Starts at 50 (recommends against starting at 40) and every 2 years

40. Which children should use a semi-upright/forward facing carseat?
Forearm
> 2 yo and less than 40 lbs
65 (earlier if have increased risk factors)
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

41. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
1000 IU/day
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

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

43. How much calcium should adults (19 - 50) take?
1000 mg/day
0.4 - 0.8 mg/day for 1 month prior to conception
Adults > 60
Meningitis and Epiglottitis

44. What is the schedule for Gardasil?
2mo - 4 mo - 6mo and 12-15 mo
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
To get IgA protection

45. What is the schedule for Hep A vaccine?
Every 5 years
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...
12 - 23 mo - 2 doses are to be given 6 mo apart
1000 IU/day

46. What is the schedule for rotavirus vaccine?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Children up to 7 yo and < 5' should be placed in a booster seat.
Smoking - Alcoholism
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

47. If traveling to endemic areas - Why should one get a dose of live vaccine?
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
1200 mg/day
To get IgA protection

48. What is the schedule for Hep B vaccine?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Stroke and DVT
Femoral neck
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

49. How much folate should all women of child bearing age take?
Children up to 7 yo and < 5' should be placed in a booster seat.
0.4 mg/day
Total cholesterol - FOBT
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

50. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
4 mg/day
Meningitis and Epiglottitis
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose