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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 is the schedule for polio vaccine?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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
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
2mo - 4mo - 6-18 mo and 4-6 yrs

2. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Forearm
One time abdominal X-ray for all MALES who ever SMOKES
To get IgA protection
1000 mg/day

3. 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
Total cholesterol - FOBT
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

4. How much calcium should adults (19 - 50) take?
1000 mg/day
Men 45 - 79 yo
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Persons with no known risk factors

5. Unopposed estrogen increases risks for what conditions?
In all W < 24 who are sexually active - In W > 24 with increased risk
Starts at 20 for both M and W
0.4 mg/day
Stroke and DVT

6. In which group of patients should aspirin be given as primary prevention for stroke?
Adults > 60
Women 55 - 79 yo
Total cholesterol - FOBT
To get IgA protection

7. What is the most important way to screen for CAD in an asymptomatic 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
HISTORY
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...
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

8. What are the guidelines for pap smear?
Total cholesterol - FOBT
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
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

9. What is the USPSTF guideline for DMT2 screening?
In adults with sustained BP > 135/80 mmHg
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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
NEVER

10. When is area of induration > 15 mm considered TB positive?
Persons with no known risk factors
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

11. When should Gardasil be given and for what purposes?
1200 mg/day
BP - Height - Weight
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
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

12. What are the risks of combination HRT?
Breast CA - thromboembolic event - stroke and CAD
Starts at 50 (recommends against starting at 40) and every 2 years
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

13. How much calcium should adolescents (9 -18) take?
1300 mg/day
Men 45 - 79 yo
Exercise - Environmental hazard reduction - Close monitoring of medication
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

14. Who should get Tdap vaccine and how often?
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
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

15. What is the USPSTF guideline for chlamydial screening?
During 2nd - 3rd trimester
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Persons with no known risk factors
In all W < 24 who are sexually active - In W > 24 with increased risk

16. What is the schedule for MMR vaccine?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
BP - Height - Weight

17. Which children should use a semi-upright/forward facing carseat?
In adults with sustained BP > 135/80 mmHg
HISTORY
> 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

18. What are some risk factors for CAD?
BP - Height - Weight
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
Breast CA - thromboembolic event - stroke and CAD

19. What are the guidelines for visual screening?
One time abdominal X-ray for all MALES who ever SMOKES
Exercise or physical therapy and vit D for patients > 65
Preschool children : 3-4 yo - Elderly patients: > 65 yo
800 IU/ day

20. What is the schedule for Hib vaccine?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Stroke and DVT
In all W < 24 who are sexually active - In W > 24 with increased risk
2mo - 4 mo - 6mo and 12-15 mo

21. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
1000 IU/day
Starts at 20 for both M and W
12 - 23 mo - 2 doses are to be given 6 mo apart
Exercise - Environmental hazard reduction - Close monitoring of medication

22. When is area of induration > 5mm considered TB positive?
Breast CA - thromboembolic event - stroke and CAD
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
0.4 mg/day
Women 55 - 79 yo

23. What is the schedule for DTap vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
In adults with sustained BP > 135/80 mmHg
4 mg/day
Adults > 60

24. Some contraindications for aspirin
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Children up to 7 yo and < 5' should be placed in a booster seat.

25. What is the schedule for Gardasil?
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...
Adults > 60
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

26. When can children sit in a booster seat?

27. What is the NCEP III guideline for cholesterol screening?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Rear facing
BP - Height - Weight
Start at 20 for all M and W regardless of RFs

28. When is area of induration > 10 mm considered TB positive?
More than 15
12 - 23 mo - 2 doses are to be given 6 mo apart
Stroke and DVT
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

29. What kind of car seat should children < 2 yo be placed in?
Stroke and DVT
Starts at 50 (recommends against starting at 40) and every 2 years
Total cholesterol - FOBT
Rear facing

30. How much calcium should women > 50 take?
One time abdominal X-ray for all MALES who ever SMOKES
1200 mg/day
More than 15
12 - 23 mo - 2 doses are to be given 6 mo apart

31. What is the schedule for rotavirus vaccine?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Forearm
Start at 20 for all M and W regardless of RFs
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

32. What is the USPSTF guideline for fall prevention in the elderly?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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

33. When is intensive individualized home-based intervention recommended?
2mo - 4mo - 6-18 mo and 4-6 yrs
Exercise or physical therapy and vit D for patients > 65
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 up to 7 yo and < 5' should be placed in a booster seat.

34. 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)
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
One dose at 12-15 mod - Booster at least 4-weeks after
1300 mg/day

35. What are the guidelines for colon cancer screening?
1300 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
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
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

36. Who should get shingles vaccine?
1000 mg/day
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
2mo - 4mo - 6-18 mo and 4-6 yrs
Adults > 60

37. What is the schedule for varicella vaccine?
More than 15
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
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

38. If traveling to endemic areas - Why should one get a dose of live vaccine?
In all W < 24 who are sexually active - In W > 24 with increased risk
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
To get IgA protection
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

39. How much fluoride should military children in HI be given?
0.4 mg/day
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Starts at 20 for both M and W

40. What are 2 conditions that have been proven to be beneficial to screened for?
Smoking - Alcoholism
Preschool children : 3-4 yo - Elderly patients: > 65 yo
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
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

41. How much vit D should adults > 50 take?
NEVER
1000 IU/day
Women 55 - 79 yo
1200 mg/day

42. What type of illnesses does Hib vaccine prevent?
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
Meningitis and Epiglottitis
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Exercise or physical therapy and vit D for patients > 65

43. What is HI law for booster seat?

44. When should tetanus immunoglobulin be given?
Exercise - Environmental hazard reduction - Close monitoring of medication
To get IgA protection
Femoral neck
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

45. What is the ADA guideline for DMT2 screening?
To get IgA protection
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
> 2 yo and less than 40 lbs
Exercise - Environmental hazard reduction - Close monitoring of medication

46. What can decrease fall in the elderly?
Exercise - Environmental hazard reduction - Close monitoring of medication
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 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
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

47. When should chest X-ray be used for screening?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Men 45 - 79 yo
NEVER
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

48. How much vit D should adults < 50 take?
To get IgA protection
800 IU/ day
BP - Height - Weight
More than 15

49. What tests are appropriate to order in an asymptomatic 57 yo male?
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
Total cholesterol - FOBT
Children up to 7 yo and < 5' should be placed in a booster seat.
1000 mg/day

50. What is the schedule for Hep A vaccine?
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
Meningitis and Epiglottitis
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 - 23 mo - 2 doses are to be given 6 mo apart