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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. What are the risks of combination HRT?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
1000 mg/day
Femoral neck
Breast CA - thromboembolic event - stroke and CAD

2. Who should get Tdap vaccine and how often?
During 2nd - 3rd trimester
To get IgA protection
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
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

3. What is HI law for booster seat?

4. What are some safety issues you should counsel parents with young children?
HISTORY
2mo - 4mo - 6-18 mo and 4-6 yrs
Rear facing
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...

5. When is area of induration > 15 mm considered TB positive?
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
1300 mg/day
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

6. What is the schedule for MMR vaccine?
Forearm
In all W < 24 who are sexually active - In W > 24 with increased risk
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

7. How much folate should all women of child bearing age take?
Femoral neck
0.4 mg/day
In all W < 24 who are sexually active - In W > 24 with increased risk
Rear facing

8. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Total cholesterol - FOBT
One time abdominal X-ray for all MALES who ever SMOKES
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

9. When is area of induration > 10 mm considered TB positive?
Femoral neck
Smoking - Alcoholism
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
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

10. What are 2 conditions that have been proven to be beneficial to screened for?
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
More than 15
Smoking - Alcoholism

11. What kind of car seat should children < 2 yo be placed in?
Rear facing
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
800 IU/ day

12. What is the schedule for Gardasil?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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
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
0.4 mg/day

13. How much vit D should adults > 50 take?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Every 5 years
Rear facing
1000 IU/day

14. What is the schedule for polio vaccine?
Starts at 50 (recommends against starting at 40) and every 2 years
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Stroke and DVT
2mo - 4mo - 6-18 mo and 4-6 yrs

15. What is the USPSTF guideline for chlamydial screening?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Preschool children : 3-4 yo - Elderly patients: > 65 yo
In all W < 24 who are sexually active - In W > 24 with increased risk

16. How much calcium should adolescents (9 -18) take?
1300 mg/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
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

17. What is the schedule for DTap vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
To get IgA protection
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)
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

18. At what age should women have DEXA scan?
One dose at 12-15 mod - Booster at least 4-weeks after
Meningitis and Epiglottitis
65 (earlier if have increased risk factors)
Adults > 60

19. How much flouride should non military children in the state of HI be given?
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
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Every 5 years

20. Who should get shingles vaccine?
Meningitis and Epiglottitis
Forearm
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Adults > 60

21. What is the ADA guideline for DMT2 screening?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
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
1200 mg/day

22. If traveling to endemic areas - Why should one get a dose of live vaccine?
To get IgA protection
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Exercise or physical therapy and vit D for patients > 65
1300 mg/day

23. 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
800 IU/ day
Femoral neck
12 - 23 mo - 2 doses are to be given 6 mo apart

24. 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)
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
Starts at 20 for both M and W

25. What is the schedule for Hep A vaccine?
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)
12 - 23 mo - 2 doses are to be given 6 mo apart
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

26. What is USPSTF guideline for abdominal aortic aneurysm screening?
One time abdominal X-ray for all MALES who ever SMOKES
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Exercise or physical therapy and vit D for patients > 65
Persons with no known risk factors

27. When should the meningococcal vaccine be given and to which group?
2mo - 4 mo - 6mo and 12-15 mo
When they are > 40 lbs and still less then 5'
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
1200 mg/day

28. What kind of sunscreen SPF is recommended for sun protection?
One dose at 12-15 mod - Booster at least 4-weeks after
Total cholesterol - FOBT
1000 mg/day
More than 15

29. When should chest X-ray be used for screening?
2mo - 4 mo - 6mo and 12-15 mo
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
Meningitis and Epiglottitis
NEVER

30. 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
2mo - 4 mo - 6mo and 12-15 mo
One dose at 12-15 mod - Booster at least 4-weeks after
During 2nd - 3rd trimester

31. 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
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
800 IU/ day
One time abdominal X-ray for all MALES who ever SMOKES

32. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
Smoking - Alcoholism
4 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
Adults > 60

33. What is the NCEP III guideline for cholesterol screening?
1000 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
Persons with no known risk factors
Start at 20 for all M and W regardless of RFs

34. What 3 things should always be done in an office visit?
BP - Height - Weight
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

35. When is area of induration > 5mm considered TB positive?
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
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
Starts at 50 (recommends against starting at 40) and every 2 years
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

36. How much calcium should adults (19 - 50) take?
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
1000 mg/day
> 2 yo and less than 40 lbs

37. What is the USPSTF guideline for DMT2 screening?
Breast CA - thromboembolic event - stroke and CAD
Meningitis and Epiglottitis
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
In adults with sustained BP > 135/80 mmHg

38. Some contraindications for aspirin
NEVER
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
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
4 mg/day

39. How much vit D should adults < 50 take?
Women 55 - 79 yo
800 IU/ day
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 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

40. What is the schedule for varicella vaccine?
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
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
One dose at 12-15 mod - Booster at least 4-weeks after

41. In which group of patients should aspirin be given as primary prevention for MI?
Adults > 60
Men 45 - 79 yo
Starts at 50 (recommends against starting at 40) and every 2 years
Exercise - Environmental hazard reduction - Close monitoring of medication

42. What can decrease fall in the elderly?
Every 5 years
Exercise - Environmental hazard reduction - Close monitoring of medication
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
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

43. Unopposed estrogen increases risks for what conditions?
During 2nd - 3rd trimester
Stroke and DVT
0.4 mg/day
> 2 yo and less than 40 lbs

44. Which children should use a semi-upright/forward facing carseat?
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)
> 2 yo and less than 40 lbs
Breast CA - thromboembolic event - stroke and CAD
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

45. In which group of patients should aspirin be given as primary prevention for stroke?
1300 mg/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
In all W < 24 who are sexually active - In W > 24 with increased risk
Women 55 - 79 yo

46. What tests are appropriate to order in an asymptomatic 57 yo male?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Total cholesterol - FOBT
NEVER
Femoral neck

47. When should pregnant women get a flu shot?
One time abdominal X-ray for all MALES who ever SMOKES
12 - 23 mo - 2 doses are to be given 6 mo apart
> 2 yo and less than 40 lbs
During 2nd - 3rd trimester

48. Measurement of which anatomic structure is best predictor for hip fracture?
Starts at 20 for both M and W
Exercise - Environmental hazard reduction - Close monitoring of medication
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

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

50. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
Starts at 20 for both M and W
Femoral neck
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 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