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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. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Forearm
During 2nd - 3rd trimester
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

2. When can children sit in a booster seat?

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3. What is the most important way to screen for CAD in an asymptomatic patients?
HISTORY
0.4 - 0.8 mg/day for 1 month prior to conception
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
1000 IU/day

4. What tests are appropriate to order in an asymptomatic 57 yo male?
In all W < 24 who are sexually active - In W > 24 with increased risk
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Total cholesterol - FOBT
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 are the guidelines for visual screening?
2mo - 4mo - 6-18 mo and 4-6 yrs
Preschool children : 3-4 yo - Elderly patients: > 65 yo
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)

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

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7. What is the schedule for Hep B vaccine?
0.4 mg/day
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
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

8. How often do asplenic patients receive pneumococcal vaccine?
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...
Every 5 years
Exercise or physical therapy and vit D for patients > 65
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

9. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
Forearm
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
4 mg/day
In all W < 24 who are sexually active - In W > 24 with increased risk

10. What is USPSTF guideline for abdominal aortic aneurysm screening?
One time abdominal X-ray for all MALES who ever SMOKES
NEVER
Exercise or physical therapy and vit D for patients > 65
Starts at 50 (recommends against starting at 40) and every 2 years

11. Unopposed estrogen increases risks for what conditions?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Forearm
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
Stroke and DVT

12. What is the schedule for varicella vaccine?
One time abdominal X-ray for all MALES who ever SMOKES
Smoking - Alcoholism
Total cholesterol - FOBT
One dose at 12-15 mod - Booster at least 4-weeks after

13. If traveling to endemic areas - Why should one get a dose of live vaccine?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
To get IgA protection
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

14. When is area of induration > 15 mm considered TB positive?
Persons with no known risk factors
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
BP - Height - Weight
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

15. Who should get Tdap vaccine and how often?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
More than 15
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
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

16. When should pregnant women get a flu shot?
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
Rear facing
During 2nd - 3rd trimester
Adults > 60

17. What is the USPSTF guideline for DMT2 screening?
In adults with sustained BP > 135/80 mmHg
Exercise or physical therapy and vit D for patients > 65
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

18. In which group of patients should aspirin be given as primary prevention for stroke?
Total cholesterol - FOBT
Women 55 - 79 yo
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
> 2 yo and less than 40 lbs

19. What is HI law for booster seat?

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20. What are some safety issues you should counsel parents with young children?
1000 mg/day
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...
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

21. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
0.4 mg/day
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Every 5 years
> 2 yo and less than 40 lbs

22. 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
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

23. What is the schedule for polio vaccine?
2mo - 4mo - 6-18 mo and 4-6 yrs
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
Women 55 - 79 yo
Rear facing

24. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
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
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
Starts at 20 for both M and W

25. What is the schedule for Gardasil?
HISTORY
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
800 IU/ day

26. When is area of induration > 10 mm considered TB positive?
Starts at 20 for both M and W
2mo - 4 mo - 6mo and 12-15 mo
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
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

27. What is the schedule for Hib vaccine?
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
In all W < 24 who are sexually active - In W > 24 with increased risk
2mo - 4 mo - 6mo and 12-15 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

28. What kind of polio vaccine is preferred?
Meningitis and Epiglottitis
HISTORY
One time abdominal X-ray for all MALES who ever SMOKES
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)

29. What is the schedule for DTap vaccine?
Adults > 60
One time abdominal X-ray for all MALES who ever SMOKES
HISTORY
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

30. How much vit D should adults > 50 take?
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
1000 IU/day
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

31. What is the USPSTF guideline for chlamydial screening?
> 2 yo and less than 40 lbs
2mo - 4 mo - 6mo and 12-15 mo
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
In all W < 24 who are sexually active - In W > 24 with increased risk

32. Who should get shingles vaccine?
Adults > 60
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
To get IgA protection
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day

33. How much fluoride should military children in HI be given?
In adults with sustained BP > 135/80 mmHg
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
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients

34. How much calcium should adults (19 - 50) take?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Starts at 20 for both M and W
1000 mg/day
BP - Height - Weight

35. What is the schedule for rotavirus vaccine?
Starts at 20 for both M and W
Women 55 - 79 yo
Persons with no known risk factors
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

36. Who are at increased risk for adverse effect catching a flu?
Persons with no known risk factors
NEVER
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

37. How much flouride should non military children in the state of HI be given?
Men 45 - 79 yo
HISTORY
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
1200 mg/day

38. What is the NCEP III guideline for cholesterol screening?
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
800 IU/ day
2mo - 4mo - 6-18 mo and 4-6 yrs
Start at 20 for all M and W regardless of RFs

39. What are the USPSTF guidelines for mammogram?
Starts at 50 (recommends against starting at 40) and every 2 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)
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Persons with no known risk factors

40. Measurement of which anatomic structure is best predictor for hip fracture?
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
To get IgA protection
More than 15
Femoral neck

41. Some contraindications for aspirin
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
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks

42. What are some risk factors for CAD?
Starts at 50 (recommends against starting at 40) and every 2 years
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
In adults with sustained BP > 135/80 mmHg

43. When is intensive individualized home-based intervention recommended?
One time abdominal X-ray for all MALES who ever SMOKES
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
800 IU/ 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

44. What are the risks of combination HRT?
Breast CA - thromboembolic event - stroke and CAD
To get IgA protection
Women 55 - 79 yo
Smoking - Alcoholism

45. When should chest X-ray be used for screening?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
Preschool children : 3-4 yo - Elderly patients: > 65 yo
NEVER
Children up to 7 yo and < 5' should be placed in a booster seat.

46. In which group of patients should aspirin be given as primary prevention for MI?
NEVER
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)
Persons with no known risk factors
Men 45 - 79 yo

47. What can decrease fall in the elderly?
Exercise - Environmental hazard reduction - Close monitoring of medication
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
In adults with sustained BP > 135/80 mmHg

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

49. What are the guidelines for pap smear?
> 2 yo and less than 40 lbs
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
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)
Preschool children : 3-4 yo - Elderly patients: > 65 yo

50. What is the USPSTF guideline for fall prevention in the elderly?
Forearm
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
BP - Height - Weight
Exercise or physical therapy and vit D for patients > 65