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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. How much fluoride should military children in HI be given?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
In all W < 24 who are sexually active - In W > 24 with increased risk
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
0.4 mg/day

2. What is the schedule for polio vaccine?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
2mo - 4mo - 6-18 mo and 4-6 yrs
2mo - 4 mo - 6mo and 12-15 mo

3. What is the schedule for Gardasil?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Stroke and DVT
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
In adults with sustained BP > 135/80 mmHg

4. What are the guidelines for visual screening?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
0.4 - 0.8 mg/day for 1 month prior to conception
2mo - 4mo - 6-18 mo and 4-6 yrs
0.4 mg/day

5. What are the guidelines for pap smear?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
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
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

6. What are the USPSTF guidelines for mammogram?
Starts at 50 (recommends against starting at 40) and every 2 years
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...
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
1200 mg/day

7. What 3 things should always be done in an office visit?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
BP - Height - Weight
Starts at 20 for both M and W
Exercise - Environmental hazard reduction - Close monitoring of medication

8. Who should get shingles vaccine?
More than 15
Adults > 60
Femoral neck
One dose at 12-15 mod - Booster at least 4-weeks after

9. When should tetanus immunoglobulin be given?
Total cholesterol - FOBT
In adults with sustained BP > 135/80 mmHg
When they are > 40 lbs and still less then 5'
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

10. What is the schedule for MMR vaccine?
HISTORY
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
1000 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

11. What is the schedule for DTap vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Breast CA - thromboembolic event - stroke and CAD
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
HISTORY

12. When should the meningococcal vaccine be given and to which group?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
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
Total cholesterol - FOBT

13. When can children sit in a booster seat?

14. When is area of induration > 5mm considered TB positive?
Every 5 years
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
NEVER
Forearm

15. What tests are appropriate to order in an asymptomatic 57 yo male?
Total cholesterol - FOBT
Persons with no known risk factors
Children up to 7 yo and < 5' should be placed in a booster seat.
Stroke and DVT

16. When should chest X-ray be used for screening?
In all W < 24 who are sexually active - In W > 24 with increased risk
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
NEVER
Rear facing

17. What can decrease fall in the elderly?
Exercise - Environmental hazard reduction - Close monitoring of medication
2mo - 4 mo - 6mo and 12-15 mo
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
65 (earlier if have increased risk factors)

18. 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
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
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
1000 mg/day

19. What are some safety issues you should counsel parents with young children?
In adults with sustained BP > 135/80 mmHg
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)
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...

20. What are some RFs for DMT2?
Persons with no known risk factors
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Starts at 50 (recommends against starting at 40) and every 2 years
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

21. What is the most important way to screen for CAD in an asymptomatic patients?
Adults > 60
Women 55 - 79 yo
BP - Height - Weight
HISTORY

22. Who are at increased risk for adverse effect catching a flu?
4 mg/day
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
One time abdominal X-ray for all MALES who ever SMOKES
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

23. How much folate should all women of child bearing age take?
0.4 mg/day
NEVER
12 - 23 mo - 2 doses are to be given 6 mo apart
2mo - 4mo - 6-18 mo and 4-6 yrs

24. How much vit D should adults > 50 take?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
NEVER
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
1000 IU/day

25. How often do asplenic patients receive pneumococcal vaccine?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Children up to 7 yo and < 5' should be placed in a booster seat.
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Every 5 years

26. What is the schedule for Hep B vaccine?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Meningitis and Epiglottitis
Adults > 60
Starts at 50 (recommends against starting at 40) and every 2 years

27. When should pregnant women get a flu shot?
Stroke and DVT
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
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
During 2nd - 3rd trimester

28. What is the schedule for varicella vaccine?
Breast CA - thromboembolic event - stroke and CAD
One dose at 12-15 mod - Booster at least 4-weeks after
During 2nd - 3rd trimester
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

29. What kind of sunscreen SPF is recommended for sun protection?
One dose at 12-15 mod - Booster at least 4-weeks after
More than 15
When they are > 40 lbs and still less then 5'
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

30. What are 2 conditions that have been proven to be beneficial to screened for?
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
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Femoral neck

31. In which group of patients should aspirin be given as primary prevention for MI?
Men 45 - 79 yo
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
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
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

32. What kind of polio vaccine is preferred?
To get IgA protection
4 mg/day
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Children up to 7 yo and < 5' should be placed in a booster seat.

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

34. Unopposed estrogen increases risks for what conditions?
Stroke and DVT
Adults > 60
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
NEVER

35. Measurement of which anatomic structure is best predictor for hip fracture?
Femoral neck
Children up to 7 yo and < 5' should be placed in a booster seat.
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
BP - Height - Weight

36. What are some risk factors for CAD?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
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
Persons with no known risk factors

37. Which children should use a semi-upright/forward facing carseat?
> 2 yo and less than 40 lbs
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
Exercise - Environmental hazard reduction - Close monitoring of medication
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

38. What is the schedule for Hib vaccine?
Exercise - Environmental hazard reduction - Close monitoring of medication
Meningitis and Epiglottitis
Men 45 - 79 yo
2mo - 4 mo - 6mo and 12-15 mo

39. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
65 (earlier if have increased risk factors)
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
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
NEVER

40. When is area of induration > 15 mm considered TB positive?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
1000 IU/day
Persons with no known risk factors
Starts at 20 for both M and W

41. What is the schedule for Hep A vaccine?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
1000 IU/day
12 - 23 mo - 2 doses are to be given 6 mo apart
Women 55 - 79 yo

42. Some contraindications for aspirin
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
4 mg/day
HISTORY
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

43. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
Starts at 20 for both M and W
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
1000 mg/day
HISTORY

44. 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
Meningitis and Epiglottitis
When they are > 40 lbs and still less then 5'
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

45. What is the NCEP III guideline for cholesterol screening?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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
Start at 20 for all M and W regardless of RFs

46. What is USPSTF guideline for abdominal aortic aneurysm screening?
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)
One time abdominal X-ray for all MALES who ever SMOKES
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Rear facing

47. What is the ADA guideline for DMT2 screening?
Rear facing
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Exercise or physical therapy and vit D for patients > 65
Every 5 years

48. What are the guidelines for colon cancer screening?
0.4 - 0.8 mg/day for 1 month prior to conception
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
Rear facing
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

49. What is the USPSTF guideline for DMT2 screening?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Every 5 years
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 adults with sustained BP > 135/80 mmHg

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