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

2. What is the USPSTF guideline for DMT2 screening?
Smoking - Alcoholism
Total cholesterol - FOBT
In adults with sustained BP > 135/80 mmHg
Persons with no known risk factors

3. How often do asplenic patients receive pneumococcal vaccine?
Every 5 years
1200 mg/day
One time abdominal X-ray for all MALES who ever SMOKES
Stroke and DVT

4. How much vit D should adults < 50 take?
Exercise or physical therapy and vit D for patients > 65
800 IU/ 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
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

5. What is the schedule for Hib vaccine?
Children up to 7 yo and < 5' should be placed in a booster seat.
2mo - 4 mo - 6mo and 12-15 mo
During 2nd - 3rd trimester
In adults with sustained BP > 135/80 mmHg

6. When is intensive individualized home-based intervention recommended?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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
1000 IU/day
Persons with no known risk factors

7. What is HI law for booster seat?

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8. When should Gardasil be given and for what purposes?
In all W < 24 who are sexually active - In W > 24 with increased risk
NEVER
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
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

9. What is the ADA guideline for DMT2 screening?
BP - Height - Weight
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
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

10. How much calcium should adults (19 - 50) take?
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
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
Exercise or physical therapy and vit D for patients > 65

11. What is USPSTF guideline for abdominal aortic aneurysm screening?
Total cholesterol - FOBT
NEVER
One time abdominal X-ray for all MALES who ever SMOKES
2mo - 4mo - 6-18 mo and 4-6 yrs

12. Who should get shingles vaccine?
One time abdominal X-ray for all MALES who ever SMOKES
Men 45 - 79 yo
Adults > 60
Starts at 50 (recommends against starting at 40) and every 2 years

13. What is the schedule for Gardasil?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Smoking - Alcoholism
BP - Height - Weight
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

14. In which group of patients should aspirin be given as primary prevention for MI?
HISTORY
Exercise or physical therapy and vit D for patients > 65
1200 mg/day
Men 45 - 79 yo

15. What is the schedule for varicella vaccine?
Men 45 - 79 yo
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
One dose at 12-15 mod - Booster at least 4-weeks after
When they are > 40 lbs and still less then 5'

16. What are 2 conditions that have been proven to be beneficial to screened for?
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...
Smoking - Alcoholism
Children up to 7 yo and < 5' should be placed in a booster seat.
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

17. What are the guidelines for colon cancer screening?
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
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
> 2 yo and less than 40 lbs

18. What is the schedule for Hep B vaccine?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Starts at 50 (recommends against starting at 40) and every 2 years
Smoking - Alcoholism
4 mg/day

19. What are the USPSTF guidelines for mammogram?
Starts at 50 (recommends against starting at 40) and every 2 years
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.
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

20. When should tetanus immunoglobulin be given?
Persons with no known risk factors
Starts at 50 (recommends against starting at 40) and every 2 years
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
One time abdominal X-ray for all MALES who ever SMOKES

21. Which children should use a semi-upright/forward facing carseat?
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
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
> 2 yo and less than 40 lbs

22. How much calcium should women > 50 take?
1200 mg/day
Exercise or physical therapy and vit D for patients > 65
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Stroke and DVT

23. When should chest X-ray be used for screening?
Exercise or physical therapy and vit D for patients > 65
In adults with sustained BP > 135/80 mmHg
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
NEVER

24. When is area of induration > 10 mm considered TB positive?
More than 15
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
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...
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

25. Unopposed estrogen increases risks for what conditions?
1200 mg/day
Stroke and DVT
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
In all W < 24 who are sexually active - In W > 24 with increased risk

26. If traveling to endemic areas - Why should one get a dose of live vaccine?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
To get IgA protection
Children up to 7 yo and < 5' should be placed in a booster seat.
More than 15

27. When is area of induration > 15 mm considered TB positive?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
One time abdominal X-ray for all MALES who ever SMOKES
65 (earlier if have increased risk factors)
Persons with no known risk factors

28. How much calcium should adolescents (9 -18) take?
Stroke and DVT
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 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
1300 mg/day

29. How much fluoride should military children in HI be given?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
1200 mg/day
800 IU/ day
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

30. What is the USPSTF guideline for fall prevention in the elderly?
Exercise or physical therapy and vit D for patients > 65
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
1000 IU/day

31. What 3 things should always be done in an office visit?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
During 2nd - 3rd trimester
BP - Height - Weight
One time abdominal X-ray for all MALES who ever SMOKES

32. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
To get IgA protection
1000 mg/day
0.4 mg/day

33. What are the risks of combination HRT?
Smoking - Alcoholism
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
Breast CA - thromboembolic event - stroke and CAD

34. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
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)
Forearm
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

35. When can children sit in a booster seat?

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36. When is area of induration > 5mm considered TB positive?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
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
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. At what age should women have DEXA scan?
65 (earlier if have increased risk factors)
Exercise or physical therapy and vit D for patients > 65
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 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

38. What is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Smoking - Alcoholism
When they are > 40 lbs and still less then 5'

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

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40. When should pregnant women get a flu shot?
In all W < 24 who are sexually active - In W > 24 with increased risk
Stroke and DVT
During 2nd - 3rd trimester
More than 15

41. What are the guidelines for visual screening?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Smoking - Alcoholism
4 mg/day
To get IgA protection

42. In which group of patients should aspirin be given as primary prevention for stroke?
Women 55 - 79 yo
Every 5 years
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
Persons with no known risk factors

43. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
0.4 - 0.8 mg/day for 1 month prior to conception
Starts at 20 for both M and W
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
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

44. Some contraindications for aspirin
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Starts at 20 for both M and W
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
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

45. What are some safety issues you should counsel parents with young children?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
800 IU/ 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)
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...

46. What are some risk factors for CAD?
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
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
NEVER

47. How much vit D should adults > 50 take?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
1000 IU/day
HISTORY
Meningitis and Epiglottitis

48. 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
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)
800 IU/ day
1200 mg/day

49. Who should get Tdap vaccine and how often?
Exercise or physical therapy and vit D for patients > 65
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
When they are > 40 lbs and still less then 5'
0.4 mg/day

50. What is the schedule for Hep A vaccine?
One time abdominal X-ray for all MALES who ever SMOKES
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
12 - 23 mo - 2 doses are to be given 6 mo apart
4 mg/day

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