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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. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
0.4 mg/day
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Adults > 60
Starts at 20 for both M and W

2. What are 2 conditions that have been proven to be beneficial to screened for?
1300 mg/day
Smoking - Alcoholism
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Exercise or physical therapy and vit D for patients > 65

3. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
When they are > 40 lbs and still less then 5'
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
During 2nd - 3rd trimester
Starts at 50 (recommends against starting at 40) and every 2 years

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

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5. What are some safety issues you should counsel parents with young children?
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...
0.4 mg/day
Starts at 50 (recommends against starting at 40) and every 2 years
Every 5 years

6. 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
Forearm
More than 15
Preschool children : 3-4 yo - Elderly patients: > 65 yo

7. What are the guidelines for visual screening?
12 - 23 mo - 2 doses are to be given 6 mo apart
Persons with no known risk factors
Breast CA - thromboembolic event - stroke and CAD
Preschool children : 3-4 yo - Elderly patients: > 65 yo

8. How much calcium should women > 50 take?
1300 mg/day
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
1200 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)

9. What type of illnesses does Hib vaccine prevent?
Men 45 - 79 yo
Meningitis and Epiglottitis
Starts at 50 (recommends against starting at 40) and every 2 years
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

10. What are the guidelines for colon cancer screening?
One dose at 12-15 mod - Booster at least 4-weeks after
> 2 yo and less than 40 lbs
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

11. What is the most important way to screen for CAD in an asymptomatic patients?
To get IgA protection
HISTORY
1300 mg/day
One dose at 12-15 mod - Booster at least 4-weeks after

12. When is area of induration > 10 mm considered TB positive?
0.4 mg/day
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
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)

13. What is the USPSTF guideline for chlamydial screening?
> 2 yo and less than 40 lbs
1000 mg/day
In all W < 24 who are sexually active - In W > 24 with increased risk
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

14. Unopposed estrogen increases risks for what conditions?
Femoral neck
Forearm
Stroke and DVT
0.4 - 0.8 mg/day for 1 month prior to conception

15. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
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
Femoral neck
4 mg/day
Total cholesterol - FOBT

16. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
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
Adults > 60
Forearm

17. Who should get shingles vaccine?
Adults > 60
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
Rear facing
More than 15

18. When should tetanus immunoglobulin be given?
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)
BP - Height - Weight
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Every 5 years

19. Who are at increased risk for adverse effect catching a flu?
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
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
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
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

20. What is the schedule for polio vaccine?
12 - 23 mo - 2 doses are to be given 6 mo apart
HISTORY
2mo - 4mo - 6-18 mo and 4-6 yrs
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

21. Measurement of which anatomic structure is best predictor for hip fracture?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Femoral neck
Smoking - Alcoholism
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

22. How much vit D should adults > 50 take?
1000 IU/day
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Smoking - Alcoholism
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

23. What tests are appropriate to order in an asymptomatic 57 yo male?
Persons with no known risk factors
Starts at 20 for both M and W
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

24. 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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
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)
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

25. When can children sit in a booster seat?

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26. What is the USPSTF guideline for fall prevention in the elderly?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Children up to 7 yo and < 5' should be placed in a booster seat.
1000 mg/day
Exercise or physical therapy and vit D for patients > 65

27. What is the schedule for rotavirus vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
One time abdominal X-ray for all MALES who ever SMOKES
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

28. What is USPSTF guideline for abdominal aortic aneurysm screening?
Every 5 years
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
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)

29. What is the schedule for Hib vaccine?
2mo - 4 mo - 6mo and 12-15 mo
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Children up to 7 yo and < 5' should be placed in a booster seat.
65 (earlier if have increased risk factors)

30. 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
Starts at 20 for both M and W
More than 15
0.4 - 0.8 mg/day for 1 month prior to conception

31. How much vit D should adults < 50 take?
Smoking - Alcoholism
One time abdominal X-ray for all MALES who ever SMOKES
800 IU/ 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

32. What is the schedule for MMR vaccine?
Persons with no known risk factors
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
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

33. What is the schedule for DTap vaccine?
1300 mg/day
During 2nd - 3rd trimester
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Smoking - Alcoholism

34. What are some RFs for DMT2?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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)
Men 45 - 79 yo

35. What is the ADA guideline for DMT2 screening?
Start at 20 for all M and W regardless of RFs
BP - Height - Weight
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

36. At what age should women have DEXA scan?
65 (earlier if have increased risk factors)
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Exercise or physical therapy and vit D for patients > 65
Adults > 60

37. What kind of car seat should children < 2 yo be placed in?
One dose at 12-15 mod - Booster at least 4-weeks after
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Rear facing
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

38. What kind of sunscreen SPF is recommended for sun protection?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
More than 15
1300 mg/day
One dose at 12-15 mod - Booster at least 4-weeks after

39. When is area of induration > 15 mm considered TB positive?
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Persons with no known risk factors
1200 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

40. When should pregnant women get a flu shot?
During 2nd - 3rd trimester
Exercise - Environmental hazard reduction - Close monitoring of medication
Men 45 - 79 yo
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

41. What is HI law for booster seat?

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42. How much calcium should adults (19 - 50) take?
1000 mg/day
One dose at 12-15 mod - Booster at least 4-weeks after
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Stroke and DVT

43. What is the schedule for Gardasil?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
2mo - 4 mo - 6mo and 12-15 mo
One dose at 12-15 mod - Booster at least 4-weeks after
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

44. What is the schedule for Hep A vaccine?
Starts at 50 (recommends against starting at 40) and every 2 years
Men 45 - 79 yo
12 - 23 mo - 2 doses are to be given 6 mo apart
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

45. How much calcium should adolescents (9 -18) take?
1300 mg/day
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
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

46. What is the USPSTF guideline for DMT2 screening?
In all W < 24 who are sexually active - In W > 24 with increased risk
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 - 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
In adults with sustained BP > 135/80 mmHg

47. What 3 things should always be done in an office visit?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
BP - Height - Weight
Rear facing
When they are > 40 lbs and still less then 5'

48. 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
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Total cholesterol - FOBT
65 (earlier if have increased risk factors)

49. When should the meningococcal vaccine be given and to which group?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
0.4 mg/day
1200 mg/day
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

50. What are the USPSTF guidelines for mammogram?
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...
Starts at 20 for both M and W
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

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