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Family Medicine Health Maintenance

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
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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?
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
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
Femoral neck

2. How much vit D should adults < 50 take?
800 IU/ day
Exercise or physical therapy and vit D for patients > 65
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

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

4. What is the schedule for Hep A 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
HISTORY
12 - 23 mo - 2 doses are to be given 6 mo apart

5. What are some risk factors for CAD?
Adults > 60
2mo - 4mo - 6-18 mo and 4-6 yrs
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

6. What is the most important way to screen for CAD in an asymptomatic patients?
Femoral neck
HISTORY
Rear facing
2mo - 4mo - 6-18 mo and 4-6 yrs

7. 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
Every 5 years
In all W < 24 who are sexually active - In W > 24 with increased risk
Exercise or physical therapy and vit D for patients > 65

8. What are the USPSTF guidelines for mammogram?
Breast CA - thromboembolic event - stroke and CAD
Meningitis and Epiglottitis
Smoking - Alcoholism
Starts at 50 (recommends against starting at 40) and every 2 years

9. What can decrease fall in the elderly?
12 - 23 mo - 2 doses are to be given 6 mo apart
Exercise - Environmental hazard reduction - Close monitoring of medication
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Forearm

10. In which group of patients should aspirin be given as primary prevention for stroke?
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Women 55 - 79 yo
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. Unopposed estrogen increases risks for what conditions?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Stroke and DVT

12. Which children should use a semi-upright/forward facing carseat?
> 2 yo and less than 40 lbs
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)
Stroke and DVT

13. What tests are appropriate to order in an asymptomatic 57 yo male?
> 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
Total cholesterol - FOBT
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

14. When can children sit in a booster seat?

15. If traveling to endemic areas - Why should one get a dose of live vaccine?
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
In all W < 24 who are sexually active - In W > 24 with increased risk
Women 55 - 79 yo

16. When is area of induration > 10 mm considered TB positive?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
12 - 23 mo - 2 doses are to be given 6 mo apart
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
Rear facing

17. What is the schedule for MMR vaccine?
Total cholesterol - FOBT
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Starts at 50 (recommends against starting at 40) and every 2 years

18. How much flouride should non military children in the state of HI be given?
Starts at 20 for both M and W
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...
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

19. How much calcium should adolescents (9 -18) take?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
1000 mg/day
1300 mg/day
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. How much vit D should adults > 50 take?
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
1000 IU/day
Stroke and DVT
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

21. What is the ADA guideline for DMT2 screening?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Forearm
Every 5 years
1300 mg/day

22. In which group of patients should aspirin be given as primary prevention for MI?
Children up to 7 yo and < 5' should be placed in a booster seat.
More than 15
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Men 45 - 79 yo

23. What are 2 conditions that have been proven to be beneficial to screened for?
Starts at 50 (recommends against starting at 40) and every 2 years
In all W < 24 who are sexually active - In W > 24 with increased risk
Smoking - Alcoholism
BP - Height - Weight

24. Who are at increased risk for adverse effect catching a flu?
Meningitis and Epiglottitis
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)
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

25. How much calcium should women > 50 take?
1200 mg/day
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
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
Starts at 20 for both M and W

26. What are the guidelines for pap smear?
1000 IU/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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
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)

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

28. What are the guidelines for colon cancer 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
12 - 23 mo - 2 doses are to be given 6 mo apart
Men 45 - 79 yo
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

29. How much folate should all women of child bearing age take?
4 mg/day
0.4 mg/day
Men 45 - 79 yo
65 (earlier if have increased risk factors)

30. Measurement of which anatomic structure is best predictor for hip fracture?
1300 mg/day
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Femoral neck
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

31. What kind of sunscreen SPF is recommended for sun protection?
More than 15
One time abdominal X-ray for all MALES who ever SMOKES
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
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

32. What is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
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
4 mg/day

33. When should tetanus immunoglobulin be given?
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
During 2nd - 3rd trimester
Preschool children : 3-4 yo - Elderly patients: > 65 yo

34. 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...
More than 15
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
To get IgA protection

35. 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
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Exercise or physical therapy and vit D for patients > 65
Forearm

36. When is area of induration > 15 mm considered TB positive?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Persons with no known risk factors
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Femoral neck

37. What 3 things should always be done in an office visit?
One dose at 12-15 mod - Booster at least 4-weeks after
BP - Height - Weight
> 2 yo and less than 40 lbs
Forearm

38. What is USPSTF guideline for abdominal aortic aneurysm screening?
One time abdominal X-ray for all MALES who ever SMOKES
Femoral neck
0.4 mg/day
Adults > 60

39. At what age should women have DEXA scan?
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
65 (earlier if have increased risk factors)
When they are > 40 lbs and still less then 5'
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

40. How much calcium should adults (19 - 50) take?
1000 mg/day
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 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

41. What is the schedule for rotavirus vaccine?
1000 IU/day
Femoral neck
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
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

42. What are some RFs for DMT2?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
BP - Height - Weight

43. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
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
Forearm
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)

44. Who should get Tdap vaccine and how often?
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
12 - 23 mo - 2 doses are to be given 6 mo apart
0.4 mg/day
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

45. When should chest X-ray be used for screening?
Men 45 - 79 yo
Starts at 20 for both M and W
NEVER
Every 5 years

46. When should the meningococcal vaccine be given and to which group?
1000 IU/day
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
In adults with sustained BP > 135/80 mmHg
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

47. What is the schedule for varicella vaccine?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
One dose at 12-15 mod - Booster at least 4-weeks after
In all W < 24 who are sexually active - In W > 24 with increased risk
Preschool children : 3-4 yo - Elderly patients: > 65 yo

48. When is area of induration > 5mm considered TB positive?
> 2 yo and less than 40 lbs
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
1000 IU/day

49. 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
In adults with sustained BP > 135/80 mmHg
To get IgA protection
Women 55 - 79 yo

50. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
NEVER
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Starts at 20 for both M and W