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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 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
Rear facing
Total cholesterol - FOBT
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

2. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Forearm
800 IU/ day
4 mg/day

3. What is the USPSTF guideline for DMT2 screening?
In adults with sustained BP > 135/80 mmHg
Persons with no known risk factors
BP - Height - Weight
2mo - 4mo - 6-18 mo and 4-6 yrs

4. When should the meningococcal vaccine be given and to which group?
To get IgA protection
Breast CA - thromboembolic event - stroke and CAD
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

5. What is HI law for booster seat?

6. In which group of patients should aspirin be given as primary prevention for MI?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Men 45 - 79 yo
Breast CA - thromboembolic event - stroke and CAD
Starts at 50 (recommends against starting at 40) and every 2 years

7. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Children up to 7 yo and < 5' should be placed in a booster seat.
1300 mg/day
Forearm
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

8. How much folate should all women of child bearing age take?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
0.4 mg/day
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Exercise or physical therapy and vit D for patients > 65

9. How much calcium should women > 50 take?
1200 mg/day
Starts at 50 (recommends against starting at 40) and every 2 years
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

10. Unopposed estrogen increases risks for what conditions?
Stroke and DVT
Starts at 50 (recommends against starting at 40) and every 2 years
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

11. Some contraindications for aspirin
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
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
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

12. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
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
Starts at 20 for both M and W
During 2nd - 3rd trimester

13. 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
Smoking - Alcoholism
Start at 20 for all M and W regardless of RFs
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

14. What is the schedule for DTap vaccine?
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
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
To get IgA protection
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

15. How much calcium should adults (19 - 50) take?
Starts at 50 (recommends against starting at 40) and every 2 years
BP - Height - Weight
HISTORY
1000 mg/day

16. 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
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
1300 mg/day

17. 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
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
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

18. In which group of patients should aspirin be given as primary prevention for stroke?
Women 55 - 79 yo
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Smoking - Alcoholism
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

19. 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
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Stroke and DVT

20. What is the schedule for Hib vaccine?
BP - Height - Weight
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
During 2nd - 3rd trimester
2mo - 4 mo - 6mo and 12-15 mo

21. Who should get shingles vaccine?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Adults > 60
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

22. What are some safety issues you should counsel parents with young children?
In all W < 24 who are sexually active - In W > 24 with increased risk
Meningitis and Epiglottitis
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...
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

23. 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
Men 45 - 79 yo
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
In adults with sustained BP > 135/80 mmHg

24. Who should get Tdap vaccine and how often?
HISTORY
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Men 45 - 79 yo
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

25. What are the guidelines for pap smear?
Children up to 7 yo and < 5' should be placed in a booster seat.
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)
2mo - 4mo - 6-18 mo and 4-6 yrs
1000 IU/day

26. What is the schedule for varicella vaccine?
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
One dose at 12-15 mod - Booster at least 4-weeks after
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and 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

27. What is the schedule for Hep B vaccine?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
In adults with sustained BP > 135/80 mmHg
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
NEVER

28. What is the USPSTF guideline for chlamydial screening?
65 (earlier if have increased risk factors)
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
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

29. What are the USPSTF guidelines for mammogram?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Starts at 50 (recommends against starting at 40) and every 2 years
Total cholesterol - FOBT
Meningitis and Epiglottitis

30. When is area of induration > 15 mm considered TB positive?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
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
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
Persons with no known risk factors

31. What 3 things should always be done in an office visit?
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
BP - Height - Weight
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
Adults > 60

32. When is area of induration > 5mm 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)
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
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 IU/day

33. When should pregnant women get a flu shot?
1200 mg/day
HISTORY
> 2 yo and less than 40 lbs
During 2nd - 3rd trimester

34. What are some RFs for DMT2?
Femoral neck
When they are > 40 lbs and still less then 5'
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Breast CA - thromboembolic event - stroke and CAD

35. When should chest X-ray be used for screening?
BP - Height - Weight
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
NEVER
2mo - 4mo - 6-18 mo and 4-6 yrs

36. When should Gardasil be given and for what purposes?
1300 mg/day
Exercise or physical therapy and vit D for patients > 65
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
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

37. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Starts at 20 for both M and W
Total cholesterol - FOBT
Persons with no known risk factors

38. What kind of sunscreen SPF is recommended for sun protection?
Adults > 60
In adults with sustained BP > 135/80 mmHg
0.4 mg/day
More than 15

39. What are 2 conditions that have been proven to be beneficial to screened for?
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)
Meningitis and Epiglottitis
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

40. 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
Femoral neck
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 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

41. What type of illnesses does Hib vaccine prevent?
One time abdominal X-ray for all MALES who ever SMOKES
800 IU/ day
Meningitis and Epiglottitis
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

42. How much vit D should adults > 50 take?
Breast CA - thromboembolic event - stroke and CAD
More than 15
0.4 - 0.8 mg/day for 1 month prior to conception
1000 IU/day

43. What is the most important way to screen for CAD in an asymptomatic patients?
HISTORY
Rear facing
Exercise or physical therapy and vit D for patients > 65
0.4 mg/day

44. When is area of induration > 10 mm considered TB positive?
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
Breast CA - thromboembolic event - stroke and CAD
Children up to 7 yo and < 5' should be placed in a booster seat.
One time abdominal X-ray for all MALES who ever SMOKES

45. What is the schedule for Gardasil?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
When they are > 40 lbs and still less then 5'
Femoral neck
1300 mg/day

46. What is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
Every 5 years
Starts at 50 (recommends against starting at 40) and every 2 years
2mo - 4 mo - 6mo and 12-15 mo

47. When can children sit in a booster seat?

48. What is the USPSTF guideline for fall prevention in the elderly?
0.4 - 0.8 mg/day for 1 month prior to conception
Exercise or physical therapy and vit D for patients > 65
Stroke and DVT
Starts at 50 (recommends against starting at 40) and every 2 years

49. 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
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
In adults with sustained BP > 135/80 mmHg
HISTORY

50. What can decrease fall in the elderly?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
800 IU/ day
Exercise - Environmental hazard reduction - Close monitoring of medication