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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 can children sit in a booster seat?

2. When is intensive individualized home-based intervention recommended?
Exercise or physical therapy and vit D for patients > 65
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
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
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

3. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
1200 mg/day
Starts at 20 for both M and W
0.4 mg/day
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

4. What type of illnesses does Hib vaccine prevent?
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
Exercise or physical therapy and vit D for patients > 65
Meningitis and Epiglottitis
1300 mg/day

5. What kind of sunscreen SPF is recommended for sun protection?
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...
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
More than 15
Adults > 60

6. What are the guidelines for pap smear?
Rear facing
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)
Smoking - Alcoholism
0.4 - 0.8 mg/day for 1 month prior to conception

7. Who should get shingles vaccine?
12 - 23 mo - 2 doses are to be given 6 mo apart
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 > 60
1300 mg/day

8. When is area of induration > 10 mm considered TB positive?
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
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
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
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

9. What is the USPSTF guideline for chlamydial screening?
Every 5 years
In all W < 24 who are sexually active - In W > 24 with increased risk
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
2mo - 4mo - 6-18 mo and 4-6 yrs

10. What are some safety issues you should counsel parents with young children?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
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 - Environmental hazard reduction - Close monitoring of medication
1200 mg/day

11. What are some RFs for DMT2?
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 45 - 79 yo
First dose at birth - Second dose at 1-2 mo - Third dose at 6 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

12. What is the USPSTF guideline for DMT2 screening?
In adults with sustained BP > 135/80 mmHg
More than 15
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Stroke and DVT

13. What are the guidelines for visual screening?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
More than 15
12 - 23 mo - 2 doses are to be given 6 mo apart

14. If traveling to endemic areas - Why should one get a dose of live vaccine?
In all W < 24 who are sexually active - In W > 24 with increased risk
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
To get IgA protection
0.4 mg/day

15. Who should get Tdap vaccine and how often?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Men 45 - 79 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
Children up to 7 yo and < 5' should be placed in a booster seat.

16. At what age should women have DEXA scan?
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...
65 (earlier if have increased risk factors)
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
More than 15

17. Measurement of which anatomic structure is best predictor for hip fracture?
0.4 mg/day
Femoral neck
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Men 45 - 79 yo

18. 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
Starts at 50 (recommends against starting at 40) and every 2 years
BP - Height - Weight
1300 mg/day

19. Some contraindications for aspirin
Smoking - Alcoholism
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
Children up to 7 yo and < 5' should be placed in a booster seat.

20. What is the schedule for Hep B vaccine?
When they are > 40 lbs and still less then 5'
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Femoral neck
Meningitis and Epiglottitis

21. 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
One dose at 12-15 mod - Booster at least 4-weeks after
Total cholesterol - FOBT
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

22. How much vit D should adults > 50 take?
65 (earlier if have increased risk factors)
> 2 yo and less than 40 lbs
4 mg/day
1000 IU/day

23. What is USPSTF guideline for abdominal aortic aneurysm screening?
Every 5 years
One time abdominal X-ray for all MALES who ever SMOKES
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

24. When is area of induration > 15 mm considered TB positive?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Persons with no known risk factors
Total cholesterol - FOBT
Starts at 20 for both M and W

25. How much calcium should women > 50 take?
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
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
1200 mg/day

26. How much vit D should adults < 50 take?
1200 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)
800 IU/ day
Men 45 - 79 yo

27. What are 2 conditions that have been proven to be beneficial to screened for?
In all W < 24 who are sexually active - In W > 24 with increased risk
Smoking - Alcoholism
Total cholesterol - FOBT
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

28. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Forearm
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...
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
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

29. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
4 mg/day
1300 mg/day
HISTORY

30. What tests are appropriate to order in an asymptomatic 57 yo male?
More than 15
Total cholesterol - FOBT
NEVER
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

31. What is HI law for booster seat?

32. What is the schedule for rotavirus 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)
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
1000 IU/day

33. How much folate should all women of child bearing age take?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
0.4 mg/day
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
> 2 yo and less than 40 lbs

34. What 3 things should always be done in an office visit?
Stroke and DVT
> 2 yo and less than 40 lbs
BP - Height - Weight
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)

35. What are the guidelines for colon cancer screening?
Women 55 - 79 yo
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
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

36. 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
NEVER
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
Persons with no known risk factors

37. What is the schedule for varicella vaccine?
Starts at 20 for both M and W
Forearm
One dose at 12-15 mod - Booster at least 4-weeks after
Adults > 60

38. Unopposed estrogen increases risks for what conditions?
Stroke and DVT
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
HISTORY
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

39. Who are at increased risk for adverse effect catching a flu?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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

40. What kind of car seat should children < 2 yo be placed in?
Smoking - Alcoholism
Rear facing
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

41. When should chest X-ray be used for screening?
Total cholesterol - FOBT
Exercise - Environmental hazard reduction - Close monitoring of medication
NEVER
During 2nd - 3rd trimester

42. Which children should use a semi-upright/forward facing carseat?
> 2 yo and less than 40 lbs
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
12 - 23 mo - 2 doses are to be given 6 mo apart

43. What is the schedule for polio vaccine?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
BP - Height - Weight
2mo - 4mo - 6-18 mo and 4-6 yrs
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

44. What kind of polio vaccine is preferred?
Smoking - Alcoholism
BP - Height - Weight
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
800 IU/ day

45. How much flouride should non military children in the state of HI be given?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
> 2 yo and less than 40 lbs
BP - Height - Weight

46. What is the USPSTF guideline for fall prevention in the elderly?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Exercise or physical therapy and vit D for patients > 65
Children up to 7 yo and < 5' should be placed in a booster seat.
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. When should tetanus immunoglobulin be given?
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
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

48. What is the schedule for Hep A vaccine?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
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
12 - 23 mo - 2 doses are to be given 6 mo apart

49. What is the NCEP III guideline for cholesterol screening?
BP - Height - Weight
Persons with no known risk factors
To get IgA protection
Start at 20 for all M and W regardless of RFs

50. When should the meningococcal vaccine be given and to which group?
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
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...
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose