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

2. When should Gardasil be given and for what purposes?
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
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)
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

3. What is the USPSTF guideline for chlamydial screening?
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
In all W < 24 who are sexually active - In W > 24 with increased risk
Total cholesterol - FOBT

4. 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
12 - 23 mo - 2 doses are to be given 6 mo apart
Children up to 7 yo and < 5' should be placed in a booster seat.
4 mg/day

5. How much vit D should adults < 50 take?
1000 IU/day
800 IU/ day
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
> 2 yo and less than 40 lbs

6. Which children should use a semi-upright/forward facing carseat?
Every 5 years
> 2 yo and less than 40 lbs
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 overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

7. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
One time abdominal X-ray for all MALES who ever SMOKES
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Starts at 20 for both M and W
2mo - 4 mo - 6mo and 12-15 mo

8. What is the schedule for rotavirus vaccine?
Total cholesterol - FOBT
Stroke and DVT
Men 45 - 79 yo
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

9. When should pregnant women get a flu shot?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
1000 IU/day
During 2nd - 3rd trimester
One time abdominal X-ray for all MALES who ever SMOKES

10. What is the schedule for DTap vaccine?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
1000 IU/day
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

11. What is the most important way to screen for CAD in an asymptomatic patients?
One time abdominal X-ray for all MALES who ever SMOKES
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
HISTORY
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

12. If traveling to endemic areas - Why should one get a dose of live vaccine?
One time abdominal X-ray for all MALES who ever SMOKES
Starts at 20 for both M and W
To get IgA protection
BP - Height - Weight

13. What is the schedule for MMR vaccine?
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
> 2 yo and less than 40 lbs
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
HISTORY

14. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Starts at 50 (recommends against starting at 40) and every 2 years
HISTORY
Forearm
1000 mg/day

15. When should tetanus immunoglobulin be given?
In all W < 24 who are sexually active - In W > 24 with increased risk
1200 mg/day
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Forearm

16. 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)
Adults > 60
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
One time abdominal X-ray for all MALES who ever SMOKES

17. What is the schedule for Hep B vaccine?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Exercise or physical therapy and vit D for patients > 65
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Exercise - Environmental hazard reduction - Close monitoring of medication

18. What are the USPSTF guidelines for mammogram?
2mo - 4mo - 6-18 mo and 4-6 yrs
Stroke and DVT
Every 5 years
Starts at 50 (recommends against starting at 40) and every 2 years

19. Who should get Tdap vaccine and how often?
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
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
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

20. When is intensive individualized home-based intervention recommended?
1000 mg/day
One dose at 12-15 mod - Booster at least 4-weeks after
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
Starts at 50 (recommends against starting at 40) and every 2 years

21. When is area of induration > 15 mm considered TB positive?
Persons with no known risk factors
Stroke and DVT
Starts at 20 for both M and W
Forearm

22. What can decrease fall in the elderly?
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
2mo - 4 mo - 6mo and 12-15 mo

23. What are the guidelines for visual 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
0.4 mg/day
12 - 23 mo - 2 doses are to be given 6 mo apart
Preschool children : 3-4 yo - Elderly patients: > 65 yo

24. What are 2 conditions that have been proven to be beneficial to screened for?
Smoking - Alcoholism
Breast CA - thromboembolic event - stroke and CAD
Women 55 - 79 yo
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

25. What is the schedule for polio vaccine?
1000 mg/day
2mo - 4mo - 6-18 mo and 4-6 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
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

26. What kind of car seat should children < 2 yo be placed in?
One dose at 12-15 mod - Booster at least 4-weeks after
Rear facing
Forearm
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

27. In which group of patients should aspirin be given as primary prevention for MI?
4 mg/day
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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

28. Who should get shingles vaccine?
Adults > 60
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Exercise - Environmental hazard reduction - Close monitoring of medication
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

29. When is area of induration > 10 mm considered TB positive?
During 2nd - 3rd trimester
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
> 2 yo and less than 40 lbs
One time abdominal X-ray for all MALES who ever SMOKES

30. How much calcium should adolescents (9 -18) take?
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
Exercise - Environmental hazard reduction - Close monitoring of medication
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
1300 mg/day

31. How much folate should all women of child bearing age take?
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
Starts at 20 for both M and W
65 (earlier if have increased risk factors)
0.4 mg/day

32. What is the USPSTF guideline for DMT2 screening?
In adults with sustained BP > 135/80 mmHg
1000 mg/day
Children up to 7 yo and < 5' should be placed in a booster seat.
65 (earlier if have increased risk factors)

33. How much calcium should women > 50 take?
1200 mg/day
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Persons with no known risk factors
More than 15

34. What are the guidelines for colon cancer screening?
Starts at 20 for both M and W
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
Exercise or physical therapy and vit D for patients > 65
0.4 - 0.8 mg/day for 1 month prior to conception

35. How much flouride should non military children in the state of HI be given?
NEVER
Adults > 60
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Total cholesterol - FOBT

36. What is HI law for booster seat?

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37. Some contraindications for aspirin
Breast CA - thromboembolic event - stroke and CAD
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
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

38. Unopposed estrogen increases risks for what conditions?
Smoking - Alcoholism
Stroke and DVT
1200 mg/day
Every 5 years

39. What are some safety issues you should counsel parents with young children?
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 mg/day
Forearm
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...

40. At what age should women have DEXA scan?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
2mo - 4mo - 6-18 mo and 4-6 yrs
Children up to 7 yo and < 5' should be placed in a booster seat.
65 (earlier if have increased risk factors)

41. How much folate and for How long should a woman take for planned pregnancy?
65 (earlier if have increased risk factors)
0.4 - 0.8 mg/day for 1 month prior to conception
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
1000 IU/day

42. What is USPSTF guideline for abdominal aortic aneurysm screening?
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)
HISTORY
One time abdominal X-ray for all MALES who ever SMOKES

43. What is the USPSTF guideline for fall prevention in the elderly?
Total cholesterol - FOBT
Exercise or physical therapy and vit D for patients > 65
One time abdominal X-ray for all MALES who ever SMOKES
4 mg/day

44. What type of illnesses does Hib vaccine prevent?
Persons with no known risk factors
Rear facing
Meningitis and Epiglottitis
When they are > 40 lbs and still less then 5'

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

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46. What is the ADA guideline for DMT2 screening?
Total cholesterol - FOBT
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
65 (earlier if have increased risk factors)
Preschool children : 3-4 yo - Elderly patients: > 65 yo

47. How much vit D should adults > 50 take?
More than 15
HISTORY
1200 mg/day
1000 IU/day

48. What is the schedule for varicella vaccine?
Every 5 years
0.4 - 0.8 mg/day for 1 month prior to conception
One dose at 12-15 mod - Booster at least 4-weeks after
Stroke and DVT

49. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
12 - 23 mo - 2 doses are to be given 6 mo apart
To get IgA protection
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
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

50. In which group of patients should aspirin be given as primary prevention for stroke?
4 mg/day
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Women 55 - 79 yo
Breast CA - thromboembolic event - stroke and CAD

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