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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. At what age should women have DEXA scan?
65 (earlier if have increased risk factors)
1000 IU/day
Men 45 - 79 yo
Exercise - Environmental hazard reduction - Close monitoring of medication

2. How much calcium should adults (19 - 50) take?
Meningitis and Epiglottitis
1000 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
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

3. What is the schedule for rotavirus vaccine?
65 (earlier if have increased risk factors)
1200 mg/day
Total cholesterol - FOBT
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

4. What is USPSTF guideline for abdominal aortic aneurysm screening?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
One time abdominal X-ray for all MALES who ever SMOKES
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
12 - 23 mo - 2 doses are to be given 6 mo apart

5. What are the risks of combination HRT?
Breast CA - thromboembolic event - stroke and CAD
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
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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. What is the schedule for DTap vaccine?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
In adults with sustained BP > 135/80 mmHg
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

7. What is the schedule for Hep A vaccine?
12 - 23 mo - 2 doses are to be given 6 mo apart
In all W < 24 who are sexually active - In W > 24 with increased risk
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Start at 20 for all M and W regardless of RFs

8. When should Gardasil be given and for what purposes?
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)
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
Forearm
1200 mg/day

9. What is the USPSTF guideline for DMT2 screening?
2mo - 4 mo - 6mo and 12-15 mo
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
When they are > 40 lbs and still less then 5'
In adults with sustained BP > 135/80 mmHg

10. What tests are appropriate to order in an asymptomatic 57 yo male?
Total cholesterol - FOBT
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
BP - Height - Weight
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

11. When is area of induration > 5mm considered TB positive?
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
Women 55 - 79 yo
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

12. What kind of polio vaccine is preferred?
12 - 23 mo - 2 doses are to be given 6 mo apart
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
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)
0.4 - 0.8 mg/day for 1 month prior to conception

13. When can children sit in a booster seat?

14. What is HI law for booster seat?

15. 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
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Smoking - Alcoholism
HISTORY

16. What are some risk factors for 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
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
To get IgA protection

17. Which children should use a semi-upright/forward facing carseat?
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
2mo - 4mo - 6-18 mo and 4-6 yrs
> 2 yo and less than 40 lbs
Meningitis and Epiglottitis

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

19. When is area of induration > 15 mm considered TB positive?
In all W < 24 who are sexually active - In W > 24 with increased risk
Starts at 50 (recommends against starting at 40) and every 2 years
Persons with no known risk factors
4 mg/day

20. How much flouride should non military children in the state of HI be given?
BP - Height - Weight
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 : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
800 IU/ day

21. What are some RFs for DMT2?
> 2 yo and less than 40 lbs
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)
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

22. How much vit D should adults < 50 take?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
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
800 IU/ day
Forearm

23. 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
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
1200 mg/day

24. Who are at increased risk for adverse effect catching a flu?
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
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Starts at 50 (recommends against starting at 40) and every 2 years

25. What kind of sunscreen SPF is recommended for sun protection?
Starts at 50 (recommends against starting at 40) and every 2 years
One time abdominal X-ray for all MALES who ever SMOKES
More than 15
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

26. What is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
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
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

27. When is area of induration > 10 mm considered TB positive?
> 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
HISTORY
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...

28. What is the schedule for Hib vaccine?
Stroke and DVT
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
2mo - 4 mo - 6mo and 12-15 mo

29. What are 2 conditions that have been proven to be beneficial to screened for?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
To get IgA protection
HISTORY
Smoking - Alcoholism

30. What can decrease fall in the elderly?
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)
When they are > 40 lbs and still less then 5'
Exercise - Environmental hazard reduction - Close monitoring of medication
1300 mg/day

31. How much calcium should women > 50 take?
1200 mg/day
2mo - 4mo - 6-18 mo and 4-6 yrs
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
65 (earlier if have increased risk factors)

32. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
4 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)
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Forearm

33. What is the USPSTF guideline for chlamydial screening?
12 - 23 mo - 2 doses are to be given 6 mo apart
0.4 - 0.8 mg/day for 1 month prior to conception
In all W < 24 who are sexually active - In W > 24 with increased risk
800 IU/ day

34. What are the guidelines for visual screening?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Every 5 years
Preschool children : 3-4 yo - Elderly patients: > 65 yo
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

35. What is the most important way to screen for CAD in an asymptomatic patients?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Stroke and DVT
HISTORY
Exercise - Environmental hazard reduction - Close monitoring of medication

36. How much folate should all women of child bearing age take?
Total cholesterol - FOBT
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
0.4 mg/day
> 2 yo and less than 40 lbs

37. What is the schedule for varicella vaccine?
4 mg/day
0.4 mg/day
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
One dose at 12-15 mod - Booster at least 4-weeks after

38. What is the schedule for Gardasil?
12 - 23 mo - 2 doses are to be given 6 mo apart
0.4 - 0.8 mg/day for 1 month prior to conception
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
1000 IU/day

39. What is the schedule for Hep B vaccine?
Every 5 years
Exercise or physical therapy and vit D for patients > 65
Smoking - Alcoholism
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

40. When should pregnant women get a flu shot?
Breast CA - thromboembolic event - stroke and CAD
During 2nd - 3rd trimester
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
One time abdominal X-ray for all MALES who ever SMOKES

41. What is the ADA guideline for DMT2 screening?
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
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

42. In which group of patients should aspirin be given as primary prevention for MI?
Men 45 - 79 yo
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
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

43. 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
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)
2mo - 4 mo - 6mo and 12-15 mo

44. What 3 things should always be done in an office visit?
Every 5 years
BP - Height - Weight
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Exercise - Environmental hazard reduction - Close monitoring of medication

45. What kind of car seat should children < 2 yo be placed in?
Rear facing
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 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)

46. What are the USPSTF guidelines for mammogram?
Starts at 50 (recommends against starting at 40) and every 2 years
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

47. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
1000 IU/day
Forearm
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. Who should get shingles vaccine?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Adults > 60
In adults with sustained BP > 135/80 mmHg
0.4 mg/day

49. In which group of patients should aspirin be given as primary prevention for stroke?
Women 55 - 79 yo
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...
800 IU/ day
Breast CA - thromboembolic event - stroke and CAD

50. How much fluoride should military children in HI be given?
NEVER
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
12 - 23 mo - 2 doses are to be given 6 mo apart
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age