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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 tests are appropriate to order in an asymptomatic 57 yo male?
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)
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
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. In which group of patients should aspirin be given as primary prevention for MI?
BP - Height - Weight
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Breast CA - thromboembolic event - stroke and CAD
Men 45 - 79 yo

3. Unopposed estrogen increases risks for what conditions?
Start at 20 for all M and W regardless of RFs
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Stroke and DVT
0.4 mg/day

4. How much vit D should adults < 50 take?
800 IU/ day
Men 45 - 79 yo
Children up to 7 yo and < 5' should be placed in a booster seat.
> 2 yo and less than 40 lbs

5. Which children should use a semi-upright/forward facing carseat?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
1200 mg/day
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
> 2 yo and less than 40 lbs

6. When is area of induration > 15 mm considered TB positive?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Persons with no known risk factors
Children up to 7 yo and < 5' should be placed in a booster seat.
HISTORY

7. When should tetanus immunoglobulin be given?
Persons with no known risk factors
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
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

8. What are some risk factors for CAD?
HISTORY
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
1000 IU/day

9. What is the schedule for DTap vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Persons with no known risk factors
When they are > 40 lbs and still less then 5'
65 (earlier if have increased risk factors)

10. How much fluoride should military children in HI be given?
0.4 - 0.8 mg/day for 1 month prior to conception
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Start at 20 for all M and W regardless of RFs

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
2mo - 4 mo - 6mo and 12-15 mo
In adults with sustained BP > 135/80 mmHg
800 IU/ day

12. If traveling to endemic areas - Why should one get a dose of live vaccine?
To get IgA protection
1000 mg/day
NEVER
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

13. What are the guidelines for visual screening?
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
Preschool children : 3-4 yo - Elderly patients: > 65 yo
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
In adults with sustained BP > 135/80 mmHg

14. What is the USPSTF guideline for DMT2 screening?
In adults with sustained BP > 135/80 mmHg
Forearm
1200 mg/day
During 2nd - 3rd trimester

15. What are 2 conditions that have been proven to be beneficial to screened for?
Smoking - Alcoholism
Starts at 50 (recommends against starting at 40) and every 2 years
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Rear facing

16. What can decrease fall in the elderly?
Every 5 years
0.4 mg/day
Exercise - Environmental hazard reduction - Close monitoring of medication
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

17. When should chest X-ray be used for screening?
0.4 mg/day
NEVER
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Adults > 60

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

19. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
In adults with sustained BP > 135/80 mmHg
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
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - 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)

20. What kind of sunscreen SPF is recommended for sun protection?
1200 mg/day
Start at 20 for all M and W regardless of RFs
More than 15
One dose at 12-15 mod - Booster at least 4-weeks after

21. What is the USPSTF guideline for chlamydial screening?
Femoral neck
When they are > 40 lbs and still less then 5'
In all W < 24 who are sexually active - In W > 24 with increased risk
12 - 23 mo - 2 doses are to be given 6 mo apart

22. Measurement of which anatomic structure is best predictor for hip fracture?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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
Femoral neck
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

23. What is the schedule for Hep B vaccine?
Breast CA - thromboembolic event - stroke and CAD
Starts at 50 (recommends against starting at 40) and every 2 years
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

24. How much calcium should adults (19 - 50) take?
Men 45 - 79 yo
65 (earlier if have increased risk factors)
1000 mg/day
Meningitis and Epiglottitis

25. At what age should women have DEXA scan?
Stroke and DVT
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
1000 mg/day
65 (earlier if have increased risk factors)

26. What is the schedule for varicella vaccine?
Meningitis and Epiglottitis
2mo - 4mo - 6-18 mo and 4-6 yrs
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
One dose at 12-15 mod - Booster at least 4-weeks after

27. What is the most important way to screen for CAD in an asymptomatic patients?
HISTORY
Adults > 60
Rear facing
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

28. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
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)
Starts at 20 for both M and W
1000 mg/day
One dose at 12-15 mod - Booster at least 4-weeks after

29. What 3 things should always be done in an office visit?
NEVER
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)
BP - Height - Weight

30. When is area of induration > 5mm 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)
1000 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
Starts at 20 for both M and W

31. What are some RFs for DMT2?
12 - 23 mo - 2 doses are to be given 6 mo apart
HISTORY
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
During 2nd - 3rd trimester

32. How much folate should all women of child bearing age take?
1000 IU/day
Forearm
0.4 mg/day
Adults > 60

33. 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
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
HISTORY
Femoral neck

34. Some contraindications for aspirin
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
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

35. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
4 mg/day
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...
Breast CA - thromboembolic event - stroke and CAD
NEVER

36. What are the guidelines for colon cancer screening?
Femoral neck
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
BP - Height - Weight
Rear facing

37. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
When they are > 40 lbs and still less then 5'
Forearm
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

38. In which group of patients should aspirin be given as primary prevention for stroke?
Women 55 - 79 yo
Adults > 60
4 mg/day
One dose at 12-15 mod - Booster at least 4-weeks after

39. How much vit D should adults > 50 take?
1000 IU/day
During 2nd - 3rd trimester
Starts at 50 (recommends against starting at 40) and every 2 years
65 (earlier if have increased risk factors)

40. What is the USPSTF guideline for fall prevention in the elderly?
Adults > 60
In all W < 24 who are sexually active - In W > 24 with increased risk
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...
Exercise or physical therapy and vit D for patients > 65

41. What is the NCEP III guideline for cholesterol screening?
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
Men 45 - 79 yo
Total cholesterol - FOBT

42. Who are at increased risk for adverse effect catching a flu?
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
NEVER
Women 55 - 79 yo
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

43. What is the schedule for Hep A vaccine?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Preschool children : 3-4 yo - Elderly patients: > 65 yo
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
12 - 23 mo - 2 doses are to be given 6 mo apart

44. What is the schedule for Hib vaccine?
HISTORY
Women 55 - 79 yo
2mo - 4 mo - 6mo and 12-15 mo
4 mg/day

45. How much folate and for How long should a woman take for planned pregnancy?
1200 mg/day
Starts at 50 (recommends against starting at 40) and every 2 years
HISTORY
0.4 - 0.8 mg/day for 1 month prior to conception

46. What kind of car seat should children < 2 yo be placed in?
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
Rear facing
When they are > 40 lbs and still less then 5'
NEVER

47. When should pregnant women get a flu shot?
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
During 2nd - 3rd trimester
Adults > 60
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

48. What is the ADA guideline for DMT2 screening?
In adults with sustained BP > 135/80 mmHg
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
During 2nd - 3rd trimester
65 (earlier if have increased risk factors)

49. How much calcium should adolescents (9 -18) take?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Starts at 20 for both M and W
1300 mg/day
Starts at 50 (recommends against starting at 40) and every 2 years

50. How much flouride should non military children in the state of HI be given?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
2mo - 4mo - 6-18 mo and 4-6 yrs
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