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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 is the schedule for rotavirus 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
Femoral neck
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
During 2nd - 3rd trimester

2. How much fluoride should military children in HI be given?
To get IgA protection
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
1000 IU/day
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

3. What can decrease fall in the elderly?
Exercise - Environmental hazard reduction - Close monitoring of medication
Start at 20 for all M and W regardless of RFs
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
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

4. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
1000 mg/day
Stroke and DVT

5. What are the guidelines for visual screening?
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
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Starts at 20 for both M and W

6. How much vit D should adults > 50 take?
NEVER
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
When they are > 40 lbs and still less then 5'
1000 IU/day

7. When should Gardasil be given and for what purposes?
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 20 for both M and W
0.4 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

8. When is area of induration > 10 mm considered TB positive?
Starts at 20 for both M and W
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 up to 7 yo and < 5' should be placed in a booster seat.
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

9. What tests are appropriate to order in an asymptomatic 57 yo male?
Femoral neck
Total cholesterol - FOBT
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
NEVER

10. What is the schedule for Gardasil?
65 (earlier if have increased risk factors)
Starts at 20 for both M and W
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

11. How much flouride should non military children in the state of HI be given?
Rear facing
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Children up to 7 yo and < 5' should be placed in a booster seat.
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

12. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
More than 15
Meningitis and Epiglottitis
0.4 - 0.8 mg/day for 1 month prior to conception
Starts at 20 for both M and W

13. What is the USPSTF guideline for fall prevention in the elderly?
Exercise - Environmental hazard reduction - Close monitoring of medication
Exercise or physical therapy and vit D for patients > 65
Preschool children : 3-4 yo - Elderly patients: > 65 yo
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

14. What are the risks of combination HRT?
1000 IU/day
Breast CA - thromboembolic event - stroke and CAD
Stroke and DVT
Starts at 50 (recommends against starting at 40) and every 2 years

15. What kind of sunscreen SPF is recommended for sun protection?
Children up to 7 yo and < 5' should be placed in a booster seat.
Every 5 years
More than 15
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

16. When should the meningococcal vaccine be given and to which group?
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
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

17. What is the most important way to screen for CAD in an asymptomatic patients?
0.4 - 0.8 mg/day for 1 month prior to conception
One dose at 12-15 mod - Booster at least 4-weeks after
HISTORY
During 2nd - 3rd trimester

18. When should chest X-ray be used for screening?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
1200 mg/day
NEVER
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

19. How much calcium should women > 50 take?
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
1000 mg/day
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
1200 mg/day

20. What 3 things should always be done in an office visit?
To get IgA protection
Starts at 20 for both M and W
1200 mg/day
BP - Height - Weight

21. When is area of induration > 5mm considered TB positive?
Stroke and DVT
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
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

22. What is the schedule for polio vaccine?
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
2mo - 4mo - 6-18 mo and 4-6 yrs
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
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

23. Some contraindications for aspirin
When they are > 40 lbs and still less then 5'
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
1000 IU/day
1200 mg/day

24. What are the guidelines for colon cancer screening?
Men 45 - 79 yo
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
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

25. How much folate and for How long should a woman take for planned pregnancy?
Starts at 20 for both M and W
Persons with no known risk factors
0.4 - 0.8 mg/day for 1 month prior to conception
2mo - 4 mo - 6mo and 12-15 mo

26. If traveling to endemic areas - Why should one get a dose of live vaccine?
Exercise - Environmental hazard reduction - Close monitoring of medication
To get IgA protection
1000 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

27. When should pregnant women get a flu shot?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Persons with no known risk factors
During 2nd - 3rd trimester
In adults with sustained BP > 135/80 mmHg

28. What are the USPSTF guidelines for mammogram?
BP - Height - Weight
Women 55 - 79 yo
Starts at 50 (recommends against starting at 40) and every 2 years
To get IgA protection

29. What is the schedule for Hep B vaccine?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
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
Every 5 years
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo

30. Who should get shingles vaccine?
Every 5 years
Adults > 60
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Persons with no known risk factors

31. Which children should use a semi-upright/forward facing carseat?
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
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
> 2 yo and less than 40 lbs
Every 5 years

32. What is the NCEP III guideline for cholesterol screening?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
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
Women 55 - 79 yo
Start at 20 for all M and W regardless of RFs

33. What is the schedule for MMR vaccine?
2mo - 4mo - 6-18 mo and 4-6 yrs
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and 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
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

34. When should tetanus immunoglobulin be given?
Smoking - Alcoholism
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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...

35. When can children sit in a booster seat?

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

37. How much vit D should adults < 50 take?
During 2nd - 3rd trimester
800 IU/ day
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
65 (earlier if have increased risk factors)

38. Unopposed estrogen increases risks for what conditions?
Rear facing
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Children up to 7 yo and < 5' should be placed in a booster seat.
Stroke and DVT

39. What is the USPSTF guideline for chlamydial screening?
More than 15
In all W < 24 who are sexually active - In W > 24 with increased risk
Starts at 20 for both M and W
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

40. How much calcium should adults (19 - 50) take?
Women 55 - 79 yo
One dose at 12-15 mod - Booster at least 4-weeks after
1000 mg/day
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

41. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
Every 5 years
NEVER
4 mg/day
0.4 mg/day

42. What kind of car seat should children < 2 yo be placed in?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Rear facing
1000 IU/day
Breast CA - thromboembolic event - stroke and CAD

43. What are some risk factors for CAD?
BP - Height - Weight
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Rear facing
Exercise - Environmental hazard reduction - Close monitoring of medication

44. What is the USPSTF guideline for DMT2 screening?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
NEVER
In adults with sustained BP > 135/80 mmHg
During 2nd - 3rd trimester

45. What is the schedule for Hib vaccine?
2mo - 4 mo - 6mo and 12-15 mo
BP - Height - Weight
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
More than 15

46. When is area of induration > 15 mm considered TB positive?
Persons with no known risk factors
0.4 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
Every 5 years

47. Measurement of which anatomic structure is best predictor for hip fracture?
Femoral neck
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
1000 IU/day

48. What are 2 conditions that have been proven to be beneficial to screened for?
0.4 mg/day
Smoking - Alcoholism
65 (earlier if have increased risk factors)
Every 5 years

49. When is intensive individualized home-based intervention recommended?
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
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)
When they are > 40 lbs and still less then 5'

50. What is the schedule for Hep A vaccine?
One time abdominal X-ray for all MALES who ever SMOKES
Meningitis and Epiglottitis
0.4 - 0.8 mg/day for 1 month prior to conception
12 - 23 mo - 2 doses are to be given 6 mo apart

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