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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 is intensive individualized home-based intervention recommended?
Stroke and DVT
Preschool children : 3-4 yo - Elderly patients: > 65 yo
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
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

2. What kind of polio vaccine is preferred?
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)
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
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
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

3. How much calcium should adolescents (9 -18) take?
1300 mg/day
> 2 yo and less than 40 lbs
Starts at 20 for both M and W
Starts at 50 (recommends against starting at 40) and every 2 years

4. 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
Start at 20 for all M and W regardless of RFs
One dose at 12-15 mod - Booster at least 4-weeks after
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

5. If traveling to endemic areas - Why should one get a dose of live vaccine?
Every 5 years
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
To get IgA protection
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. What is the ADA guideline for DMT2 screening?
Every 5 years
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
1300 mg/day

7. How much folate should all women of child bearing age take?
Adults > 60
Breast CA - thromboembolic event - stroke and CAD
0.4 mg/day
Femoral neck

8. At what age should women have DEXA scan?
Adults > 60
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
In adults with sustained BP > 135/80 mmHg
65 (earlier if have increased risk factors)

9. When can children sit in a booster seat?

10. What is the USPSTF guideline for chlamydial screening?
In all W < 24 who are sexually active - In W > 24 with increased risk
Start at 20 for all M and W regardless of 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
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

11. How often do asplenic patients receive pneumococcal vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
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
Every 5 years
To get IgA protection

12. What is HI law for booster seat?

13. What 3 things should always be done in an office visit?
BP - Height - Weight
Men 45 - 79 yo
Start at 20 for all M and W regardless of RFs
Women 55 - 79 yo

14. Who should get Tdap vaccine and how often?
Exercise or physical therapy and vit D for patients > 65
1000 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)
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 are some safety issues you should counsel parents with young children?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Stroke and DVT
Preschool children : 3-4 yo - Elderly patients: > 65 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...

16. What are some RFs for DMT2?
BP - Height - Weight
One time abdominal X-ray for all MALES who ever SMOKES
Breast CA - thromboembolic event - stroke and CAD
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

17. How much flouride should non military children in the state of HI 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
One time abdominal X-ray for all MALES who ever SMOKES
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

18. What is the schedule for Gardasil?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Children up to 7 yo and < 5' should be placed in a booster seat.
1000 IU/day
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

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

20. What is the schedule for varicella vaccine?
4 mg/day
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Breast CA - thromboembolic event - stroke and CAD
One dose at 12-15 mod - Booster at least 4-weeks after

21. How much calcium should adults (19 - 50) take?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
HISTORY
Starts at 20 for both M and W
1000 mg/day

22. What kind of sunscreen SPF is recommended for sun protection?
> 2 yo and less than 40 lbs
2mo - 4mo - 6-18 mo and 4-6 yrs
More than 15
Start at 20 for all M and W regardless of RFs

23. How much vit D should adults > 50 take?
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)
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
1000 IU/day
More than 15

24. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
Starts at 20 for both M and W
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
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
0.4 mg/day

25. What are the USPSTF guidelines for mammogram?
1300 mg/day
Starts at 50 (recommends against starting at 40) and every 2 years
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
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

26. What is the schedule for Hib vaccine?
During 2nd - 3rd trimester
In adults with sustained BP > 135/80 mmHg
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 - 4 mo - 6mo and 12-15 mo

27. What is the NCEP III guideline for cholesterol screening?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
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
Rear facing

28. What are the guidelines for visual screening?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
HISTORY
One dose at 12-15 mod - Booster at least 4-weeks after
Persons with no known risk factors

29. What are the risks of combination HRT?
1000 mg/day
2mo - 4 mo - 6mo and 12-15 mo
Breast CA - thromboembolic event - stroke and CAD
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

30. How much calcium should women > 50 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
1300 mg/day
1200 mg/day
0.4 - 0.8 mg/day for 1 month prior to conception

31. What are 2 conditions that have been proven to be beneficial to screened for?
Smoking - Alcoholism
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
Stroke and DVT
More than 15

32. What tests are appropriate to order in an asymptomatic 57 yo male?
Adults > 60
800 IU/ day
2mo - 4mo - 6-18 mo and 4-6 yrs
Total cholesterol - FOBT

33. What is the USPSTF guideline for DMT2 screening?
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
One time abdominal X-ray for all MALES who ever SMOKES
In adults with sustained BP > 135/80 mmHg

34. What is the schedule for Hep B vaccine?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Starts at 20 for both M and W
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Smoking - Alcoholism

35. What are some risk factors for CAD?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
1300 mg/day
0.4 - 0.8 mg/day for 1 month prior to conception
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

36. When is area of induration > 15 mm considered TB positive?
Persons with no known risk factors
Women 55 - 79 yo
Exercise - Environmental hazard reduction - Close monitoring of medication
Forearm

37. How much vit D should adults < 50 take?
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
Smoking - Alcoholism
800 IU/ day

38. What are the guidelines for colon cancer screening?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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
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

39. What type of illnesses does Hib vaccine prevent?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
During 2nd - 3rd trimester
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Meningitis and Epiglottitis

40. What is the most important way to screen for CAD in an asymptomatic patients?
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
HISTORY
Forearm
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

41. What are the guidelines for pap smear?
Meningitis and Epiglottitis
65 (earlier if have increased risk factors)
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)
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

42. When should chest X-ray be used for screening?
NEVER
HISTORY
One time abdominal X-ray for all MALES who ever SMOKES
Starts at 50 (recommends against starting at 40) and every 2 years

43. Measurement of which anatomic structure is best predictor for hip fracture?
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
During 2nd - 3rd trimester
Persons with no known risk factors
Femoral neck

44. What is the schedule for rotavirus vaccine?
Start at 20 for all M and W regardless of RFs
Persons with no known risk factors
Adults > 60
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

45. Some contraindications for aspirin
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
NEVER
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

46. What is the schedule for Hep A vaccine?
To get IgA protection
12 - 23 mo - 2 doses are to be given 6 mo apart
HISTORY
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

47. What is the schedule for DTap vaccine?
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...
When they are > 40 lbs and still less then 5'
One dose at 12-15 mod - Booster at least 4-weeks after
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

48. What is the schedule for polio 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
2mo - 4mo - 6-18 mo and 4-6 yrs
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
0.4 mg/day

49. Which children should use a semi-upright/forward facing carseat?
Adults > 60
In adults with sustained BP > 135/80 mmHg
> 2 yo and less than 40 lbs
1200 mg/day

50. 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.
1000 IU/day
Forearm
Meningitis and Epiglottitis