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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. When should Gardasil be given and for what purposes?
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 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
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
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

2. When should tetanus immunoglobulin be given?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
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
In adults with sustained BP > 135/80 mmHg

3. What is the most important way to screen for CAD in an asymptomatic 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
HISTORY
Meningitis and Epiglottitis
Smoking - Alcoholism

4. How much calcium should adults (19 - 50) take?
Women 55 - 79 yo
> 2 yo and less than 40 lbs
When they are > 40 lbs and still less then 5'
1000 mg/day

5. What 3 things should always be done in an office visit?
BP - Height - Weight
Meningitis and Epiglottitis
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Stroke and DVT

6. Some contraindications for aspirin
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
One dose at 12-15 mod - Booster at least 4-weeks after
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

7. What are the USPSTF guidelines for mammogram?
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)
Starts at 50 (recommends against starting at 40) and every 2 years
0.4 - 0.8 mg/day for 1 month prior to conception
To get IgA protection

8. When should pregnant women get a flu shot?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
During 2nd - 3rd trimester
12 - 23 mo - 2 doses are to be given 6 mo apart
Men 45 - 79 yo

9. What are the guidelines for colon cancer screening?
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
When they are > 40 lbs and still less then 5'
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

10. What can decrease fall in the elderly?
One time abdominal X-ray for all MALES who ever SMOKES
To get IgA protection
Persons with no known risk factors
Exercise - Environmental hazard reduction - Close monitoring of medication

11. Who are at increased risk for adverse effect catching a flu?
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
2mo - 4mo - 6-18 mo and 4-6 yrs
Total cholesterol - FOBT
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

12. 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
Exercise or physical therapy and vit D for patients > 65
Every 5 years
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

13. What is the ADA guideline for DMT2 screening?
Starts at 50 (recommends against starting at 40) and every 2 years
Exercise - Environmental hazard reduction - Close monitoring of medication
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Stroke and DVT

14. What is the schedule for Gardasil?
During 2nd - 3rd trimester
4 mg/day
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

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

16. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
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
HISTORY
2mo - 4 mo - 6mo and 12-15 mo

17. When should the meningococcal vaccine be given and to which group?
1300 mg/day
Start at 20 for all M and W regardless of RFs
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
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

18. At what age should women have DEXA scan?
65 (earlier if have increased risk factors)
BP - Height - Weight
1300 mg/day
> 2 yo and less than 40 lbs

19. What are some risk factors for CAD?
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
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years

20. What tests are appropriate to order in an asymptomatic 57 yo male?
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
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
When they are > 40 lbs and still less then 5'
Total cholesterol - FOBT

21. When should chest X-ray be used for screening?
Starts at 50 (recommends against starting at 40) and every 2 years
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
800 IU/ day
NEVER

22. What is the USPSTF guideline for chlamydial 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
In all W < 24 who are sexually active - In W > 24 with increased risk
Women 55 - 79 yo
> 2 yo and less than 40 lbs

23. 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)
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
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

24. What is the NCEP III guideline for cholesterol screening?
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...
Start at 20 for all M and W regardless of RFs
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

25. What are the risks of combination HRT?
Stroke and DVT
HISTORY
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Breast CA - thromboembolic event - stroke and CAD

26. What kind of polio vaccine is preferred?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/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
Preschool children : 3-4 yo - Elderly patients: > 65 yo

27. How much vit D should adults < 50 take?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
800 IU/ day
4 mg/day
Preschool children : 3-4 yo - Elderly patients: > 65 yo

28. What is the schedule for rotavirus vaccine?
Total cholesterol - FOBT
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
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
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)

29. What is the schedule for Hep B vaccine?
Preschool children : 3-4 yo - Elderly patients: > 65 yo
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
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

30. What are 2 conditions that have been proven to be beneficial to screened for?
HISTORY
Persons with no known risk factors
More than 15
Smoking - Alcoholism

31. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Forearm
One dose at 12-15 mod - Booster at least 4-weeks after
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
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

32. If traveling to endemic areas - Why should one get a dose of live vaccine?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
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
To get IgA protection
2mo - 4 mo - 6mo and 12-15 mo

33. What is USPSTF guideline for abdominal aortic aneurysm screening?
Adults > 60
One time abdominal X-ray for all MALES who ever SMOKES
Meningitis and Epiglottitis
More than 15

34. When can children sit in a booster seat?

35. What is the schedule for DTap vaccine?
Men 45 - 79 yo
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
NEVER

36. What kind of car seat should children < 2 yo be placed in?
Rear facing
2mo - 4 mo - 6mo and 12-15 mo
Persons with no known risk factors
Start at 20 for all M and W regardless of RFs

37. How much calcium should women > 50 take?
Exercise - Environmental hazard reduction - Close monitoring of medication
More than 15
0.4 - 0.8 mg/day for 1 month prior to conception
1200 mg/day

38. What is the USPSTF guideline for fall prevention in the elderly?
2mo - 4 mo - 6mo and 12-15 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
Exercise or physical therapy and vit D for patients > 65
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

39. How much folate should all women of child bearing age take?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
0.4 mg/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
Starts at 50 (recommends against starting at 40) and every 2 years

40. What are some safety issues you should counsel parents with young children?
In adults with sustained BP > 135/80 mmHg
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...
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Total cholesterol - FOBT

41. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
Starts at 20 for both M and W
Smoking - Alcoholism
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...
Exercise or physical therapy and vit D for patients > 65

42. When is area of induration > 10 mm considered TB positive?
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
Adults > 60
Femoral neck

43. What is the USPSTF guideline for DMT2 screening?
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)
In adults with sustained BP > 135/80 mmHg
Stroke and DVT

44. Who should get Tdap vaccine and how often?
4 mg/day
> 2 yo and less than 40 lbs
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
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

45. What type of illnesses does Hib vaccine prevent?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Meningitis and Epiglottitis
One time abdominal X-ray for all MALES who ever SMOKES
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

46. What is the schedule for Hib vaccine?
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
2mo - 4 mo - 6mo and 12-15 mo
Women 55 - 79 yo

47. What kind of sunscreen SPF is recommended for sun 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
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
More than 15
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

48. How much vit D should adults > 50 take?
> 2 yo and less than 40 lbs
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
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
1000 IU/day

49. 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
0.4 mg/day
Men 45 - 79 yo
65 (earlier if have increased risk factors)

50. 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)
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
> 2 yo and less than 40 lbs
NEVER