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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.
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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. In which group of patients should aspirin be given as primary prevention for stroke?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Women 55 - 79 yo
To get IgA protection
Every 5 years

2. What is the most important way to screen for CAD in an asymptomatic patients?
BP - Height - Weight
HISTORY
2mo - 4 mo - 6mo and 12-15 mo
In all W < 24 who are sexually active - In W > 24 with increased risk

3. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
Stroke and DVT
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Femoral neck
4 mg/day

4. When should tetanus immunoglobulin be given?
Meningitis and Epiglottitis
In adults with sustained BP > 135/80 mmHg
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

5. When should Gardasil be given and for what purposes?
Exercise or physical therapy and vit D for patients > 65
1000 mg/day
2mo - 4 mo - 6mo and 12-15 mo
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 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
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
To get IgA protection
Smoking - Alcoholism

7. In which group of patients should aspirin be given as primary prevention for MI?
> 2 yo and less than 40 lbs
HISTORY
1200 mg/day
Men 45 - 79 yo

8. What is HI law for booster seat?

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9. What type of illnesses does Hib vaccine prevent?
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Breast CA - thromboembolic event - stroke and CAD
Forearm
Meningitis and Epiglottitis

10. What are some RFs for DMT2?
Exercise - Environmental hazard reduction - Close monitoring of medication
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
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 - 23 mo - 2 doses are to be given 6 mo apart

11. How much flouride should non military children in the state of HI be given?
Men 45 - 79 yo
1000 mg/day
Meningitis and Epiglottitis
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

12. At what age should women have DEXA scan?
Exercise or physical therapy and vit D for patients > 65
65 (earlier if have increased risk factors)
1200 mg/day
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

13. What is the schedule for Gardasil?
One time abdominal X-ray for all MALES who ever SMOKES
800 IU/ day
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

14. What is USPSTF guideline for abdominal aortic aneurysm screening?
One time abdominal X-ray for all MALES who ever SMOKES
Exercise or physical therapy and vit D for patients > 65
0.4 - 0.8 mg/day for 1 month prior to conception
BP - Height - Weight

15. What is the USPSTF guideline for DMT2 screening?
Women 55 - 79 yo
In adults with sustained BP > 135/80 mmHg
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

16. What is the USPSTF guideline for fall prevention in the elderly?
Exercise or physical therapy and vit D for patients > 65
One time abdominal X-ray for all MALES who ever SMOKES
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Starts at 20 for both M and W

17. What is the schedule for polio vaccine?
2mo - 4 mo - 6mo and 12-15 mo
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
1300 mg/day
2mo - 4mo - 6-18 mo and 4-6 yrs

18. Who should get Tdap vaccine and how often?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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
1000 mg/day
1300 mg/day

19. How much vit D should adults < 50 take?
In adults with sustained BP > 135/80 mmHg
Every 5 years
800 IU/ day
2mo - 4 mo - 6mo and 12-15 mo

20. What are the guidelines for visual screening?
Preschool children : 3-4 yo - Elderly patients: > 65 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...
2mo - 4mo - 6-18 mo and 4-6 yrs
Forearm

21. When is area of induration > 15 mm considered TB positive?
Persons with no known 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
Breast CA - thromboembolic event - stroke and CAD
0.4 - 0.8 mg/day for 1 month prior to conception

22. What kind of car seat should children < 2 yo be placed in?
4 mg/day
HISTORY
Rear facing
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

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

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24. Which children should use a semi-upright/forward facing carseat?
Smoking - Alcoholism
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
> 2 yo and less than 40 lbs

25. What is the schedule for varicella vaccine?
In all W < 24 who are sexually active - In W > 24 with increased risk
Femoral neck
1000 mg/day
One dose at 12-15 mod - Booster at least 4-weeks after

26. How much vit D should adults > 50 take?
Men 45 - 79 yo
1000 IU/day
Women 55 - 79 yo
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

27. What kind of polio vaccine is preferred?
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
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

28. Unopposed estrogen increases risks for what conditions?
Forearm
Stroke and DVT
BP - Height - Weight
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

29. What is the schedule for MMR vaccine?
NEVER
Starts at 20 for both M and W
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

30. What is the schedule for Hep A vaccine?
12 - 23 mo - 2 doses are to be given 6 mo apart
1000 IU/day
2mo - 4 mo - 6mo and 12-15 mo
65 (earlier if have increased risk factors)

31. How often do asplenic patients receive pneumococcal vaccine?
Every 5 years
Exercise - Environmental hazard reduction - Close monitoring of medication
800 IU/ day
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

32. 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
Exercise - Environmental hazard reduction - Close monitoring of medication
1000 mg/day
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

33. When is area of induration > 5mm considered TB positive?
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
1300 mg/day
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

34. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
1000 IU/day
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

35. What is the schedule for Hep B vaccine?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Breast CA - thromboembolic event - stroke and CAD
0.4 - 0.8 mg/day for 1 month prior to conception
Exercise - Environmental hazard reduction - Close monitoring of medication

36. How much calcium should adults (19 - 50) take?
Women 55 - 79 yo
4 mg/day
HISTORY
1000 mg/day

37. How much fluoride should military children in HI be given?
1000 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
One dose at 12-15 mod - Booster at least 4-weeks after
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

38. What are the USPSTF guidelines for mammogram?
Starts at 50 (recommends against starting at 40) and every 2 years
4 mg/day
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

39. What are the guidelines for colon cancer screening?
800 IU/ 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
Persons with no known risk factors
In adults with sustained BP > 135/80 mmHg

40. How much calcium should women > 50 take?
Every 5 years
Meningitis and Epiglottitis
Adults > 60
1200 mg/day

41. What 3 things should always be done in an office visit?
In adults with sustained BP > 135/80 mmHg
One dose at 12-15 mod - Booster at least 4-weeks after
Preschool children : 3-4 yo - Elderly patients: > 65 yo
BP - Height - Weight

42. 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)
Children up to 7 yo and < 5' should be placed in a booster seat.
800 IU/ day
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

43. What is the schedule for DTap vaccine?
Start at 20 for all M and W regardless of RFs
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
0.4 - 0.8 mg/day for 1 month prior to conception
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

44. What is the USPSTF guideline for chlamydial screening?
1000 IU/day
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Children up to 7 yo and < 5' should be placed in a booster seat.
In all W < 24 who are sexually active - In W > 24 with increased risk

45. When can children sit in a booster seat?

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46. Measurement of which anatomic structure is best predictor for hip fracture?
Femoral neck
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
2mo - 4 mo - 6mo and 12-15 mo

47. When should the meningococcal vaccine be given and to which group?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
One dose at 12-15 mod - Booster at least 4-weeks after
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
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

48. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
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 - 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
Start at 20 for all M and W regardless of RFs
Forearm

49. What can decrease fall in the elderly?
Adults > 60
Exercise - Environmental hazard reduction - Close monitoring of medication
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

50. Some contraindications for aspirin
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
When they are > 40 lbs and still less then 5'
Men 45 - 79 yo
HISTORY

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