Family Medicine Health Maintenance

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 ADA guideline for DMT2 screening?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
1200 mg/day
Every 5 years


2. When should tetanus immunoglobulin be given?
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
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day


3. 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
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
During 2nd - 3rd trimester
Starts at 20 for both M and W


4. What is the most important way to screen for CAD in an asymptomatic patients?
0.4 mg/day
HISTORY
2mo - 4mo - 6-18 mo and 4-6 yrs
When they are > 40 lbs and still less then 5'


5. What is the USPSTF guideline for fall prevention in the elderly?
Meningitis and Epiglottitis
Exercise or physical therapy and vit D for patients > 65
One time abdominal X-ray for all MALES who ever SMOKES
Stroke and DVT


6. How much calcium should adults (19 - 50) take?
1000 mg/day
Adults > 60
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
One dose at 12-15 mod - Booster at least 4-weeks after


7. What 3 things should always be done in an office visit?
1000 mg/day
BP - Height - Weight
Total cholesterol - FOBT
4 mg/day


8. Who should get Tdap vaccine and how often?
Rear facing
Total cholesterol - FOBT
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
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. 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
Stroke and DVT
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
65 (earlier if have increased risk factors)


10. When can children sit in a booster seat?


11. What are the guidelines for visual screening?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
HISTORY
Exercise - Environmental hazard reduction - Close monitoring of medication
Smoking - Alcoholism


12. If traveling to endemic areas - Why should one get a dose of live vaccine?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Exercise or physical therapy and vit D for patients > 65
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
To get IgA protection


13. How much vit D should adults < 50 take?
Breast CA - thromboembolic event - stroke and CAD
800 IU/ day
HISTORY
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


14. How much fluoride should military children in HI be given?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
BP - Height - Weight
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose


15. How much flouride should non military children in the state of HI be given?
Femoral neck
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Stroke and DVT
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day


16. When is area of induration > 15 mm considered TB positive?
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
Persons with no known risk factors
Femoral neck
2mo - 4mo - 6-18 mo and 4-6 yrs


17. What is the USPSTF guideline for chlamydial screening?
In all W < 24 who are sexually active - In W > 24 with increased risk
To get IgA protection
1300 mg/day
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)


18. What is the NCEP III guideline for cholesterol 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
2mo - 4 mo - 6mo and 12-15 mo
Start at 20 for all M and W regardless of RFs
Meningitis and Epiglottitis


19. What is USPSTF guideline for abdominal aortic aneurysm screening?
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
BP - Height - Weight
One time abdominal X-ray for all MALES who ever SMOKES


20. When should the meningococcal vaccine be given and to which group?
1200 mg/day
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
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


21. 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...
Every 5 years
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Exercise - Environmental hazard reduction - Close monitoring of medication


22. How much vit D should adults > 50 take?
HISTORY
1000 IU/day
Exercise or physical therapy and vit D for patients > 65
One time abdominal X-ray for all MALES who ever SMOKES


23. What are some risk factors for CAD?
2mo - 4mo - 6-18 mo and 4-6 yrs
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
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
Femoral neck


24. When is intensive individualized home-based intervention recommended?
Starts at 20 for both M and W
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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo


25. What is the schedule for MMR vaccine?
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
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...
Exercise - Environmental hazard reduction - Close monitoring of medication
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients


26. In which group of patients should aspirin be given as primary prevention for stroke?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
More than 15
Women 55 - 79 yo
When they are > 40 lbs and still less then 5'


27. What is the schedule for polio vaccine?
Starts at 50 (recommends against starting at 40) and every 2 years
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
2mo - 4mo - 6-18 mo and 4-6 yrs


28. What is the USPSTF guideline for DMT2 screening?
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 adults with sustained BP > 135/80 mmHg
Persons with no known risk factors
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients


29. How often do asplenic patients receive pneumococcal vaccine?
1000 IU/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
Femoral neck
Every 5 years


30. In which group of patients should aspirin be given as primary prevention for MI?
1000 IU/day
Men 45 - 79 yo
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...
1000 mg/day


31. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
In adults with sustained BP > 135/80 mmHg
Forearm
Persons with no known risk factors
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


32. Who should get shingles vaccine?
Adults > 60
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
Men 45 - 79 yo
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


33. 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
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
2mo - 4 mo - 6mo and 12-15 mo
Smoking - Alcoholism


34. What is the schedule for rotavirus vaccine?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
1300 mg/day
More than 15


35. What kind of sunscreen SPF is recommended for sun protection?
More than 15
Every 5 years
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...


36. What kind of polio vaccine is preferred?
BP - Height - Weight
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
> 2 yo and less than 40 lbs
Start at 20 for all M and W regardless of RFs


37. Some contraindications for aspirin
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
One time abdominal X-ray for all MALES who ever SMOKES
65 (earlier if have increased risk factors)
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo


38. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
Femoral neck
During 2nd - 3rd trimester
HISTORY
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years


39. When is area of induration > 5mm considered TB positive?
Forearm
800 IU/ day
0.4 mg/day
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


40. How much calcium should women > 50 take?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
1200 mg/day
4 mg/day


41. Which children should use a semi-upright/forward facing carseat?
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
Starts at 50 (recommends against starting at 40) and every 2 years
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
> 2 yo and less than 40 lbs


42. Unopposed estrogen increases risks for what conditions?
Stroke and DVT
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day


43. When should Gardasil be given and for what purposes?
NEVER
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
During 2nd - 3rd trimester
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


44. What are the risks of combination HRT?
One time abdominal X-ray for all MALES who ever SMOKES
0.4 mg/day
> 2 yo and less than 40 lbs
Breast CA - thromboembolic event - stroke and CAD


45. What is the schedule for Hep A vaccine?
12 - 23 mo - 2 doses are to be given 6 mo apart
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
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
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity


46. What is the schedule for Hib vaccine?
2mo - 4 mo - 6mo and 12-15 mo
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
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


47. What is the schedule for Hep B vaccine?
When they are > 40 lbs and still less then 5'
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
> 2 yo and less than 40 lbs
NEVER


48. What can decrease fall in the elderly?
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Adults > 60
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Exercise - Environmental hazard reduction - Close monitoring of medication


49. Who are at increased risk for adverse effect catching a flu?
2mo - 4mo - 6-18 mo and 4-6 yrs
To get IgA protection
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
800 IU/ day


50. When should chest X-ray be used for screening?
NEVER
Meningitis and Epiglottitis
Rear facing
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age