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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 is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
To get IgA protection
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

2. What are some risk factors for CAD?
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
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
4 mg/day
One time abdominal X-ray for all MALES who ever SMOKES

3. What is the USPSTF guideline for DMT2 screening?
In adults with sustained BP > 135/80 mmHg
To get IgA protection
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

4. When should tetanus immunoglobulin be given?
Meningitis and Epiglottitis
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Men 45 - 79 yo
In all W < 24 who are sexually active - In W > 24 with increased risk

5. What is the ADA guideline for DMT2 screening?
Starts at 50 (recommends against starting at 40) and every 2 years
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
BP - Height - Weight
During 2nd - 3rd trimester

6. When should the meningococcal vaccine be given and to which group?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 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
Rear facing
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

7. How much vit D should adults < 50 take?
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)
During 2nd - 3rd trimester
Meningitis and Epiglottitis

8. What is the schedule for Hep A vaccine?
2mo - 4 mo - 6mo and 12-15 mo
12 - 23 mo - 2 doses are to be given 6 mo apart
Men 45 - 79 yo
One time abdominal X-ray for all MALES who ever SMOKES

9. Some contraindications for aspirin
800 IU/ day
BP - Height - Weight
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

10. What is the schedule for rotavirus vaccine?
Breast CA - thromboembolic event - stroke and CAD
Forearm
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Femoral neck

11. 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
Femoral neck
Persons with no known risk factors
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. In which group of patients should aspirin be given as primary prevention for stroke?
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
Women 55 - 79 yo
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Start at 20 for all M and W regardless of RFs

13. What 3 things should always be done in an office visit?
HISTORY
In adults with sustained BP > 135/80 mmHg
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
BP - Height - Weight

14. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
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
Forearm
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

15. What are the guidelines for pap smear?
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)
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Children up to 7 yo and < 5' should be placed in a booster seat.

16. What can decrease fall in the elderly?
Exercise - Environmental hazard reduction - Close monitoring of medication
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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
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

17. How much calcium should women > 50 take?
During 2nd - 3rd trimester
1200 mg/day
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Persons with no known risk factors

18. What is the schedule for MMR vaccine?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
More than 15
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
4 mg/day

19. What is the most important way to screen for CAD in an asymptomatic patients?
Breast CA - thromboembolic event - stroke and CAD
HISTORY
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
During 2nd - 3rd trimester

20. When is intensive individualized home-based intervention recommended?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
65 (earlier if have increased 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
In adults with sustained BP > 135/80 mmHg

21. When is area of induration > 15 mm considered TB positive?
Women 55 - 79 yo
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Persons with no known risk factors
800 IU/ day

22. What is the USPSTF guideline for chlamydial screening?
Persons with no known risk factors
In all W < 24 who are sexually active - In W > 24 with increased risk
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 starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

23. What type of illnesses does Hib vaccine prevent?
2mo - 4 mo - 6mo and 12-15 mo
Meningitis and Epiglottitis
Femoral neck
More than 15

24. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
Starts at 20 for both M and W
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
In all W < 24 who are sexually active - In W > 24 with increased risk

25. What kind of polio vaccine is preferred?
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 age 50 for normal risk - age 40 for increased risk - FOBT every year - OR - Sigmodoiscopy every 3-5 years - OR - Colonoscopy every 10 years
Femoral neck
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

26. What are some RFs for DMT2?
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
Starts at 20 for both M and W
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

27. When is area of induration > 5mm considered TB positive?
4 mg/day
BP - Height - Weight
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
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

28. If traveling to endemic areas - Why should one get a dose of live vaccine?
To get IgA protection
Exercise or physical therapy and vit D for patients > 65
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Children up to 7 yo and < 5' should be placed in a booster seat.

29. At what age should women have DEXA scan?
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
65 (earlier if have increased risk factors)
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

30. What is the schedule for varicella vaccine?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
1200 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
One dose at 12-15 mod - Booster at least 4-weeks after

31. What is the schedule for Hep B vaccine?
Exercise or physical therapy and vit D for patients > 65
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
0.4 mg/day
Rear facing

32. When should Gardasil be given and for what purposes?
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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
1300 mg/day
Smoking - Alcoholism

33. Measurement of which anatomic structure is best predictor for 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
Femoral neck
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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

34. How much calcium should adolescents (9 -18) take?
HISTORY
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
1300 mg/day
Forearm

35. What tests are appropriate to order in an asymptomatic 57 yo male?
Total cholesterol - FOBT
1200 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
More than 15

36. What is the schedule for DTap 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)
Total cholesterol - FOBT
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Start at 20 for all M and W regardless of RFs

37. Who should get Tdap vaccine and how often?
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
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Starts at 20 for both M and W

38. What are 2 conditions that have been proven to be beneficial to screened for?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
0.4 - 0.8 mg/day for 1 month prior to conception
Smoking - Alcoholism
Children up to 7 yo and < 5' should be placed in a booster seat.

39. What are the guidelines for colon cancer screening?
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
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
Men 45 - 79 yo
One dose at 12-15 mod - Booster at least 4-weeks after

40. What are the guidelines for visual screening?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Children up to 7 yo and < 5' should be placed in a booster seat.
0.4 mg/day
One dose at 12-15 mod - Booster at least 4-weeks after

41. What is the schedule for Hib vaccine?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
One time abdominal X-ray for all MALES who ever SMOKES
Start at 20 for all M and W regardless of RFs
2mo - 4 mo - 6mo and 12-15 mo

42. Which children should use a semi-upright/forward facing carseat?
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
> 2 yo and less than 40 lbs
Femoral neck

43. Who should get shingles vaccine?
Femoral neck
1300 mg/day
Adults > 60
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

44. 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
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.
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 is the USPSTF guideline for fall prevention in the elderly?
0.4 - 0.8 mg/day for 1 month prior to conception
Exercise or physical therapy and vit D for patients > 65
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Every 5 years

46. When should pregnant women get a flu shot?
Every 5 years
During 2nd - 3rd trimester
Total cholesterol - FOBT
> 2 yo and less than 40 lbs

47. Who are at increased risk for adverse effect catching a flu?
12 - 23 mo - 2 doses are to be given 6 mo apart
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Exercise or physical therapy and vit D for patients > 65
Start at 20 for all M and W regardless of RFs

48. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
4 mg/day
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Men 45 - 79 yo
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

49. How much flouride should non military children in the state of HI be given?
Exercise - Environmental hazard reduction - Close monitoring of medication
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
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
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

50. What are some safety issues you should counsel parents with young children?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Breast CA - thromboembolic event - stroke and CAD
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...
1200 mg/day