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

2. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Forearm
Starts at 20 for both M and W
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Exercise or physical therapy and vit D for patients > 65

3. What is the USPSTF guideline for chlamydial screening?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Stroke and DVT
More than 15
In all W < 24 who are sexually active - In W > 24 with increased risk

4. When should tetanus immunoglobulin be given?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
During 2nd - 3rd trimester
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
One time abdominal X-ray for all MALES who ever SMOKES

5. What are the risks of combination HRT?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
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)
Breast CA - thromboembolic event - stroke and CAD

6. What tests are appropriate to order in an asymptomatic 57 yo male?
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)
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
Total cholesterol - FOBT

7. What is the schedule for Hep A vaccine?
Stroke and DVT
65 (earlier if have increased risk factors)
To get IgA protection
12 - 23 mo - 2 doses are to be given 6 mo apart

8. When is area of induration > 15 mm considered TB positive?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Persons with no known risk factors
Start at 20 for all M and W regardless of RFs

9. What are some risk factors for CAD?
4 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
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

10. What kind of sunscreen SPF is recommended for sun protection?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
2mo - 4 mo - 6mo and 12-15 mo
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
More than 15

11. What is the schedule for rotavirus vaccine?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Women 55 - 79 yo
2mo - 4 mo - 6mo and 12-15 mo
One dose at 12-15 mod - Booster at least 4-weeks after

12. What are 2 conditions that have been proven to be beneficial to screened for?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Smoking - Alcoholism
Rear facing
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

13. When is area of induration > 10 mm considered TB positive?
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
Preschool children : 3-4 yo - Elderly patients: > 65 yo
One time abdominal X-ray for all MALES who ever SMOKES

14. How much fluoride should military children in HI be given?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
One time abdominal X-ray for all MALES who ever SMOKES
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 women > 50 take?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Stroke and DVT
Preschool children : 3-4 yo - Elderly patients: > 65 yo
1200 mg/day

16. How much vit D should adults > 50 take?
Exercise or physical therapy and vit D for patients > 65
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
1200 mg/day
1000 IU/day

17. Who should get shingles vaccine?
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
When they are > 40 lbs and still less then 5'
Preschool children : 3-4 yo - Elderly patients: > 65 yo

18. What is the most important way to screen for CAD in an asymptomatic patients?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
HISTORY
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

19. What is the schedule for DTap vaccine?
Every 5 years
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
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

20. 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...
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
NEVER
Preschool children : 3-4 yo - Elderly patients: > 65 yo

21. Some contraindications for aspirin
One time abdominal X-ray for all MALES who ever SMOKES
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
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
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

22. If traveling to endemic areas - Why should one get a dose of live vaccine?
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)
To get IgA protection
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
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

23. What is the schedule for polio vaccine?
4 mg/day
During 2nd - 3rd trimester
2mo - 4mo - 6-18 mo and 4-6 yrs
Starts at 20 for both M and W

24. When should the meningococcal vaccine be given and to which group?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
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
> 2 yo and less than 40 lbs

25. Which children should use a semi-upright/forward facing carseat?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
> 2 yo and less than 40 lbs
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
HISTORY

26. What is the schedule for Hib vaccine?
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
2mo - 4 mo - 6mo and 12-15 mo
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

27. When is area of induration > 5mm considered TB positive?
Women 55 - 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
0.4 - 0.8 mg/day for 1 month prior to conception
65 (earlier if have increased risk factors)

28. 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
4 mg/day
Exercise or physical therapy and vit D for patients > 65
Men 45 - 79 yo

29. What is HI law for booster seat?

30. In which group of patients should aspirin be given as primary prevention for stroke?
Exercise or physical therapy and vit D for patients > 65
Women 55 - 79 yo
Start at 20 for all M and W regardless of RFs
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

31. What are the guidelines for visual screening?
2mo - 4mo - 6-18 mo and 4-6 yrs
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Starts at 20 for both M and W
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 NCEP III guideline for cholesterol screening?
1300 mg/day
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Start at 20 for all M and W regardless of RFs

33. How much calcium should adults (19 - 50) take?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
65 (earlier if have increased risk factors)
One time abdominal X-ray for all MALES who ever SMOKES
1000 mg/day

34. What is the schedule for Hep B vaccine?
0.4 mg/day
1000 mg/day
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

35. What 3 things should always be done in an office visit?
Starts at 20 for both M and W
65 (earlier if have increased risk factors)
BP - Height - Weight
During 2nd - 3rd trimester

36. How much vit D should adults < 50 take?
800 IU/ day
More than 15
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)
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

37. When should pregnant women get a flu shot?
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
During 2nd - 3rd trimester
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

38. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
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
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
2mo - 4 mo - 6mo and 12-15 mo
Starts at 20 for both M and W

39. 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
HISTORY
4 mg/day
2mo - 4mo - 6-18 mo and 4-6 yrs

40. What is the USPSTF guideline for fall prevention in the elderly?
1000 mg/day
Stroke and DVT
Start at 20 for all M and W regardless of RFs
Exercise or physical therapy and vit D for patients > 65

41. How much flouride should non military children in the state of HI be given?
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
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
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

42. What is the ADA guideline for DMT2 screening?
When they are > 40 lbs and still less then 5'
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
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

43. When can children sit in a booster seat?

44. In which group of patients should aspirin be given as primary prevention for MI?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Men 45 - 79 yo
HISTORY
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

45. What type of illnesses does Hib vaccine prevent?
Starts at 50 (recommends against starting at 40) and every 2 years
Meningitis and Epiglottitis
0.4 mg/day
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

46. 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
Meningitis and Epiglottitis
0.4 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

47. How often do asplenic patients receive pneumococcal vaccine?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
1200 mg/day
Every 5 years
Women 55 - 79 yo

48. What are some RFs for DMT2?
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
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
When they are > 40 lbs and still less then 5'
BP - Height - Weight

49. Measurement of which anatomic structure is best predictor for hip fracture?
Stroke and DVT
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Femoral neck

50. When should Gardasil be given and for what purposes?
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
1300 mg/day
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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