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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. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Femoral neck
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Forearm
During 2nd - 3rd trimester

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

3. When is area of induration > 10 mm considered TB positive?
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
12 - 23 mo - 2 doses are to be given 6 mo apart
One time abdominal X-ray for all MALES who ever SMOKES

4. What are the USPSTF guidelines for mammogram?
Starts at 50 (recommends against starting at 40) and every 2 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)
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Adults > 60

5. What is the USPSTF guideline for chlamydial screening?
Smoking - Alcoholism
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
4 mg/day
In all W < 24 who are sexually active - In W > 24 with increased risk

6. 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
Children up to 7 yo and < 5' should be placed in a booster seat.
One time abdominal X-ray for all MALES who ever SMOKES
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

7. What is the USPSTF guideline for fall prevention in the elderly?
> 2 yo and less than 40 lbs
Women 55 - 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
Exercise or physical therapy and vit D for patients > 65

8. Who should get Tdap vaccine and how often?
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
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
65 (earlier if have increased risk factors)
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

9. What is the schedule for polio vaccine?
More than 15
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
2mo - 4mo - 6-18 mo and 4-6 yrs
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

10. How much vit D should adults > 50 take?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
1000 IU/day
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
4 mg/day

11. 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)
1000 IU/day
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
During 2nd - 3rd trimester

12. What are some safety issues you should counsel parents with young children?
Starts at 20 for both M and W
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...
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
0.4 mg/day

13. What are the guidelines for visual screening?
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
Preschool children : 3-4 yo - Elderly patients: > 65 yo
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
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

14. What is the schedule for Hep B vaccine?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Adults > 60
Rear facing

15. When should tetanus immunoglobulin be given?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Women 55 - 79 yo
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Adults > 60

16. What is the most important way to screen for CAD in an asymptomatic patients?
2mo - 4mo - 6-18 mo and 4-6 yrs
NEVER
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
HISTORY

17. What kind of polio vaccine is preferred?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Forearm
Every 5 years
1000 IU/day

18. At what age should women have DEXA scan?
Meningitis and Epiglottitis
1000 mg/day
0.4 mg/day
65 (earlier if have increased risk factors)

19. What is the schedule for MMR vaccine?
Men 45 - 79 yo
Women 55 - 79 yo
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

20. What is the schedule for Hib vaccine?
2mo - 4 mo - 6mo and 12-15 mo
Persons with no known risk factors
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

21. 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
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
Men 45 - 79 yo
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

22. Who should get shingles vaccine?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Adults > 60
Preschool children : 3-4 yo - Elderly patients: > 65 yo
In all W < 24 who are sexually active - In W > 24 with increased risk

23. How often do asplenic patients receive pneumococcal vaccine?
More than 15
Stroke and DVT
Every 5 years
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

24. When is area of induration > 15 mm considered TB positive?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Persons with no known risk factors
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)
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...

25. What 3 things should always be done in an office visit?
Rear facing
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
BP - Height - Weight
HISTORY

26. How much folate should all women of child bearing age take?
Stroke and DVT
Total cholesterol - FOBT
0.4 mg/day
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

27. Which children should use a semi-upright/forward facing carseat?
> 2 yo and less than 40 lbs
To get IgA protection
Starts at 50 (recommends against starting at 40) and every 2 years
Starts at 20 for both M and W

28. What is USPSTF guideline for abdominal aortic aneurysm screening?
One time abdominal X-ray for all MALES who ever SMOKES
Smoking - Alcoholism
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
65 (earlier if have increased risk factors)

29. How much folate and for How long should a woman take for planned pregnancy?
One dose at 12-15 mod - Booster at least 4-weeks after
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Starts at 20 for both M and W
0.4 - 0.8 mg/day for 1 month prior to conception

30. What type of illnesses does Hib vaccine prevent?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
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
HISTORY
Meningitis and Epiglottitis

31. When can children sit in a booster seat?

32. What tests are appropriate to order in an asymptomatic 57 yo male?
Exercise - Environmental hazard reduction - Close monitoring of medication
In adults with sustained BP > 135/80 mmHg
Total cholesterol - FOBT
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?
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
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

34. What is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
Rear facing
One time abdominal X-ray for all MALES who ever SMOKES
Starts at 20 for both M and W

35. What is the ADA guideline for DMT2 screening?
Starts at 50 (recommends against starting at 40) and every 2 years
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

36. How much flouride should non military children in the state of HI be given?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
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

37. What kind of car seat should children < 2 yo be placed in?
BP - Height - Weight
Rear facing
> 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

38. When should Gardasil be given and for what purposes?
4 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
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
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

39. Unopposed estrogen increases risks for what conditions?
1300 mg/day
Stroke and DVT
> 2 yo and less than 40 lbs
One time abdominal X-ray for all MALES who ever SMOKES

40. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
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
HISTORY
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

41. What is the USPSTF guideline for DMT2 screening?
4 mg/day
2mo - 4mo - 6-18 mo and 4-6 yrs
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

42. When should the meningococcal vaccine be given and to which group?
Total cholesterol - FOBT
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Men 45 - 79 yo

43. What is HI law for booster seat?

44. What is the schedule for rotavirus vaccine?
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Starts at 20 for both M and W
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Persons with no known risk factors

45. What are 2 conditions that have been proven to be beneficial to screened for?
Smoking - Alcoholism
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
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 50 (recommends against starting at 40) and every 2 years

46. How much calcium should adults (19 - 50) take?
1000 mg/day
More than 15
Forearm
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

47. What are some RFs for DMT2?
Exercise or physical therapy and vit D for patients > 65
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
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

48. In which group of patients should aspirin be given as primary prevention for MI?
HISTORY
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
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
Men 45 - 79 yo

49. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
Total cholesterol - FOBT
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
More than 15
4 mg/day

50. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
4 mg/day
During 2nd - 3rd trimester
Starts at 20 for both M and W
2mo - 4 mo - 6mo and 12-15 mo