Family Medicine Health Maintenance

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 kind of car seat should children < 2 yo be placed in?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
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...
Rear facing
Exercise or physical therapy and vit D for patients > 65


2. What are 2 conditions that have been proven to be beneficial to screened for?
Smoking - Alcoholism
One dose at 12-15 mod - Booster at least 4-weeks after
BP - Height - Weight
HISTORY


3. What is the USPSTF guideline for chlamydial screening?
In all W < 24 who are sexually active - In W > 24 with increased risk
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
2mo - 4 mo - 6mo and 12-15 mo
Every 5 years


4. Which children should use a semi-upright/forward facing carseat?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Preschool children : 3-4 yo - Elderly patients: > 65 yo
> 2 yo and less than 40 lbs
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age


5. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
More than 15
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
4 mg/day
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs


6. What is the USPSTF guideline for fall prevention in the elderly?
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
More than 15
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo


7. What are some safety issues you should counsel parents with young children?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
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...
Smoking - Alcoholism
One dose at 12-15 mod - Booster at least 4-weeks after


8. In which group of patients should aspirin be given as primary prevention for MI?
Men 45 - 79 yo
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Breast CA - thromboembolic event - stroke and CAD
Start at 20 for all M and W regardless of RFs


9. What is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
HISTORY
In adults with sustained BP > 135/80 mmHg
Women 55 - 79 yo


10. In which group of patients should aspirin be given as primary prevention for stroke?
HISTORY
Persons with no known risk factors
Women 55 - 79 yo
Every 5 years


11. Measurement of which anatomic structure is best predictor for hip fracture?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
In adults with sustained BP > 135/80 mmHg
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Femoral neck


12. What kind of sunscreen SPF is recommended for sun protection?
To get IgA protection
More than 15
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years


13. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
0.4 mg/day
Starts at 20 for both M and W
Start at 20 for all M and W regardless of RFs


14. What tests are appropriate to order in an asymptomatic 57 yo male?
Total cholesterol - FOBT
Children up to 7 yo and < 5' should be placed in a booster seat.
Meningitis and Epiglottitis
> 2 yo and less than 40 lbs


15. What is the schedule for polio vaccine?
2mo - 4mo - 6-18 mo and 4-6 yrs
Children up to 7 yo and < 5' should be placed in a booster seat.
4 mg/day
Femoral neck


16. What is the schedule for Hep B vaccine?
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
Starts at 50 (recommends against starting at 40) and every 2 years
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman


17. Some contraindications for aspirin
Adults > 60
800 IU/ day
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
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...


18. If traveling to endemic areas - Why should one get a dose of live vaccine?
1300 mg/day
To get IgA protection
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)


19. How much vit D should adults < 50 take?
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
Smoking - Alcoholism
800 IU/ day


20. Who should get Tdap vaccine and how often?
HISTORY
Femoral neck
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
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


21. What are the USPSTF guidelines for mammogram?
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
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
Starts at 50 (recommends against starting at 40) and every 2 years
Start at 20 for all M and W regardless of RFs


22. What is the schedule for Hib vaccine?
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
Adults > 60
2mo - 4 mo - 6mo and 12-15 mo
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy


23. When is area of induration > 15 mm considered TB positive?
Exercise - Environmental hazard reduction - Close monitoring of medication
Persons with no known risk factors
Preschool children : 3-4 yo - Elderly patients: > 65 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)


24. At what age should women have DEXA scan?
2mo - 4 mo - 6mo and 12-15 mo
During 2nd - 3rd trimester
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)


25. How much flouride should non military children in the state of HI be given?
1300 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
One time abdominal X-ray for all MALES who ever SMOKES
Men 45 - 79 yo


26. What is the schedule for DTap vaccine?
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
Total cholesterol - FOBT
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs


27. Who should get shingles vaccine?
Adults > 60
1300 mg/day
When they are > 40 lbs and still less then 5'
Femoral neck


28. What is the USPSTF guideline for DMT2 screening?
When they are > 40 lbs and still less then 5'
Exercise or physical therapy and vit D for patients > 65
In adults with sustained BP > 135/80 mmHg
Smoking - Alcoholism


29. 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
When they are > 40 lbs and still less then 5'
Start at 20 for all M and W regardless of RFs


30. When should pregnant women get a flu shot?
To get IgA protection
65 (earlier if have increased risk factors)
During 2nd - 3rd trimester
Starts at 20 for both M and W


31. When should the meningococcal vaccine be given and to which group?
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
During 2nd - 3rd trimester
4 mg/day
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman


32. How much vit D should adults > 50 take?
1000 IU/day
1200 mg/day
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


33. What is the schedule for Hep A vaccine?
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
Total cholesterol - FOBT
More than 15
12 - 23 mo - 2 doses are to be given 6 mo apart


34. When is area of induration > 10 mm considered TB positive?
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
Women 55 - 79 yo
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


35. When is intensive individualized home-based intervention recommended?
Starts at 50 (recommends against starting at 40) and every 2 years
One dose at 12-15 mod - Booster at least 4-weeks after
Exercise - Environmental hazard reduction - Close monitoring of medication
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


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


37. How much calcium should adults (19 - 50) take?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
1000 mg/day
Meningitis and Epiglottitis


38. What are the guidelines for pap smear?
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 age 50 for normal risk - age 40 for increased risk - FOBT every year - OR - Sigmodoiscopy every 3-5 years - OR - Colonoscopy every 10 years
Smoking - Alcoholism
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)


39. What is the schedule for MMR vaccine?
> 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
One dose at 12-15 mod - Booster at least 4-weeks after
2mo - 4 mo - 6mo and 12-15 mo


40. What is the ADA guideline for DMT2 screening?
65 (earlier if have increased risk factors)
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
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
NEVER


41. How much folate and for How long should a woman take for planned pregnancy?
1000 IU/day
0.4 - 0.8 mg/day for 1 month prior to conception
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo


42. What is the schedule for Gardasil?
0.4 mg/day
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs


43. What is USPSTF guideline for abdominal aortic aneurysm screening?
NEVER
Total cholesterol - FOBT
One time abdominal X-ray for all MALES who ever SMOKES
Every 5 years


44. What is the schedule for varicella vaccine?
One dose at 12-15 mod - Booster at least 4-weeks after
4 mg/day
0.4 mg/day
Breast CA - thromboembolic event - stroke and CAD


45. What are the guidelines for colon cancer screening?
Total cholesterol - FOBT
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
Forearm


46. How often do asplenic patients receive pneumococcal vaccine?
During 2nd - 3rd trimester
2mo - 4 mo - 6mo and 12-15 mo
Every 5 years
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo


47. What type of illnesses does Hib vaccine prevent?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
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...
Meningitis and Epiglottitis


48. Unopposed estrogen increases risks for what conditions?
Stroke and DVT
4 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)


49. How much folate should all women of child bearing age take?
0.4 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
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Meningitis and Epiglottitis


50. What 3 things should always be done in an office visit?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
BP - Height - Weight
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
Smoking - Alcoholism