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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 should tetanus immunoglobulin be given?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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
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

2. How much fluoride should military children in HI be given?
2mo - 4 mo - 6mo and 12-15 mo
HISTORY
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
0.4 - 0.8 mg/day for 1 month prior to conception

3. 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...
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
65 (earlier if have increased risk factors)
BP - Height - Weight

4. If traveling to endemic areas - Why should one get a dose of live vaccine?
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
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Starts at 20 for both M and W

5. 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
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
Exercise or physical therapy and vit D for patients > 65

6. How much vit D should adults > 50 take?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
4 mg/day
1000 IU/day

7. What is the schedule for varicella vaccine?
800 IU/ day
One dose at 12-15 mod - Booster at least 4-weeks after
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Men 45 - 79 yo

8. What is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
During 2nd - 3rd trimester

9. Which children should use a semi-upright/forward facing carseat?
> 2 yo and less than 40 lbs
One time abdominal X-ray for all MALES who ever SMOKES
1200 mg/day
NEVER

10. 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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
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
Children up to 7 yo and < 5' should be placed in a booster seat.

11. What is the schedule for polio vaccine?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Women 55 - 79 yo
2mo - 4mo - 6-18 mo and 4-6 yrs
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

12. When should the meningococcal vaccine be given and to which group?
0.4 mg/day
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
BP - Height - Weight

13. How much flouride should non military children in the state of HI be given?
In all W < 24 who are sexually active - In W > 24 with increased risk
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
12 - 23 mo - 2 doses are to be given 6 mo apart
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...

14. How much folate should all women of child bearing age take?
0.4 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
In adults with sustained BP > 135/80 mmHg
HISTORY

15. What is the schedule for Hep B vaccine?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Men 45 - 79 yo
One dose at 12-15 mod - Booster at least 4-weeks after
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

16. What is the USPSTF guideline for DMT2 screening?
800 IU/ day
In adults with sustained BP > 135/80 mmHg
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...
Start at 20 for all M and W regardless of RFs

17. What can decrease fall in the elderly?
BP - Height - Weight
In all W < 24 who are sexually active - In W > 24 with increased risk
Men 45 - 79 yo
Exercise - Environmental hazard reduction - Close monitoring of medication

18. Who should get shingles vaccine?
Start at 20 for all M and W regardless of RFs
Adults > 60
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
Exercise - Environmental hazard reduction - Close monitoring of medication

19. What kind of polio vaccine is preferred?
800 IU/ day
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
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

20. What are 2 conditions that have been proven to be beneficial to screened for?
One dose at 12-15 mod - Booster at least 4-weeks after
Femoral neck
Smoking - Alcoholism
Women 55 - 79 yo

21. What is the USPSTF guideline for chlamydial screening?
Start at 20 for all M and W regardless of RFs
One time abdominal X-ray for all MALES who ever SMOKES
Stroke and DVT
In all W < 24 who are sexually active - In W > 24 with increased risk

22. How much calcium should adolescents (9 -18) take?
1300 mg/day
Rear facing
In all W < 24 who are sexually active - In W > 24 with increased risk
BP - Height - Weight

23. What is the schedule for Gardasil?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
0.4 mg/day
Stroke and DVT
1000 IU/day

24. What kind of sunscreen SPF is recommended for sun protection?
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
One time abdominal X-ray for all MALES who ever SMOKES
Start at 20 for all M and W regardless of RFs

25. What is the most important way to screen for CAD in an asymptomatic patients?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Forearm
HISTORY

26. When should pregnant women get a flu shot?
To get IgA protection
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
Start at 20 for all M and W regardless of RFs
During 2nd - 3rd trimester

27. What are the guidelines for visual screening?
0.4 mg/day
In all W < 24 who are sexually active - In W > 24 with increased risk
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Preschool children : 3-4 yo - Elderly patients: > 65 yo

28. Measurement of which anatomic structure is best predictor for hip fracture?
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...
Femoral neck
1000 mg/day
65 (earlier if have increased risk factors)

29. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
4 mg/day
> 2 yo and less than 40 lbs
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

30. What is the schedule for DTap vaccine?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Femoral neck
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
When they are > 40 lbs and still less then 5'

31. What is the USPSTF guideline for fall prevention in the elderly?
Exercise or physical therapy and vit D for patients > 65
12 - 23 mo - 2 doses are to be given 6 mo apart
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

32. In which group of patients should aspirin be given as primary prevention for MI?
Men 45 - 79 yo
4 mg/day
Starts at 50 (recommends against starting at 40) and every 2 years
1000 IU/day

33. What are the guidelines for colon cancer screening?
Persons with no known risk factors
65 (earlier if have increased risk factors)
Starts at 50 (recommends against starting at 40) and every 2 years
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

34. What is the schedule for rotavirus vaccine?
1200 mg/day
2mo - 4mo - 6-18 mo and 4-6 yrs
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
800 IU/ day

35. What is USPSTF guideline for abdominal aortic aneurysm screening?
One time abdominal X-ray for all MALES who ever SMOKES
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Starts at 20 for both M and W

36. How much vit D should adults < 50 take?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
800 IU/ day
65 (earlier if have increased risk factors)
Men 45 - 79 yo

37. Unopposed estrogen increases risks for what conditions?
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 - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Total cholesterol - FOBT
Stroke and DVT

38. When should Gardasil be given and for what purposes?
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
800 IU/ day
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Rear facing

39. What kind of car seat should children < 2 yo be placed in?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Rear facing
Starts at 20 for both M and W
Preschool children : 3-4 yo - Elderly patients: > 65 yo

40. What are the risks of combination HRT?
Breast CA - thromboembolic event - stroke and CAD
> 2 yo and less than 40 lbs
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

41. In which group of patients should aspirin be given as primary prevention for stroke?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
1300 mg/day
Women 55 - 79 yo

42. What tests are appropriate to order in an asymptomatic 57 yo male?
12 - 23 mo - 2 doses are to be given 6 mo apart
0.4 mg/day
Total cholesterol - FOBT
Every 5 years

43. 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
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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...
HISTORY

44. Who are at increased risk for adverse effect catching a flu?
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 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
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

45. What is HI law for booster seat?

46. 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
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
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
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

47. When can children sit in a booster seat?

48. When should chest X-ray be used for screening?
NEVER
Children up to 7 yo and < 5' should be placed in a booster seat.
> 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

49. What is the ADA guideline for DMT2 screening?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
2mo - 4 mo - 6mo and 12-15 mo
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

50. When is area of induration > 10 mm 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)
2mo - 4mo - 6-18 mo and 4-6 yrs
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
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