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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 are the USPSTF guidelines for cholesterol screening in people with normal risks?
During 2nd - 3rd trimester
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Men 45 - 79 yo
12 - 23 mo - 2 doses are to be given 6 mo apart

2. When should the meningococcal vaccine be given and to which group?
Rear facing
> 2 yo and less than 40 lbs
0.4 - 0.8 mg/day for 1 month prior to conception
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman

3. When is intensive individualized home-based intervention recommended?
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)
Exercise - Environmental hazard reduction - Close monitoring of medication
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age

4. How often do asplenic patients receive pneumococcal vaccine?
BP - Height - Weight
During 2nd - 3rd trimester
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

5. Some contraindications for aspirin
Women 55 - 79 yo
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
1200 mg/day
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy

6. How much calcium should adults (19 - 50) take?
In all W < 24 who are sexually active - In W > 24 with increased risk
Start at 20 for all M and W regardless of RFs
1000 mg/day
In adults with sustained BP > 135/80 mmHg

7. What is the USPSTF guideline for fall prevention in the elderly?
Exercise or physical therapy and vit D for patients > 65
Total cholesterol - FOBT
800 IU/ day
In all W < 24 who are sexually active - In W > 24 with increased risk

8. What kind of polio vaccine is preferred?
65 (earlier if have increased risk factors)
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
0.4 - 0.8 mg/day for 1 month prior to conception
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

9. How much folate should all women of child bearing age take?
4 mg/day
NEVER
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

10. What are some risk factors for CAD?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
Meningitis and Epiglottitis

11. What can decrease fall in the elderly?
0.4 - 0.8 mg/day for 1 month prior to conception
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...
In adults with sustained BP > 135/80 mmHg
Exercise - Environmental hazard reduction - Close monitoring of medication

12. What are 2 conditions that have been proven to be beneficial to screened for?
Starts at 20 for both M and W
1000 IU/day
Smoking - Alcoholism
During 2nd - 3rd trimester

13. What is USPSTF guideline for abdominal aortic aneurysm screening?
One time abdominal X-ray for all MALES who ever SMOKES
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
Men 45 - 79 yo

14. What is HI law for booster seat?

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15. What tests are appropriate to order in an asymptomatic 57 yo male?
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Total cholesterol - FOBT
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
More than 15

16. Who should get shingles vaccine?
Adults > 60
1000 IU/day
Start at 20 for all M and W regardless of RFs
Children up to 7 yo and < 5' should be placed in a booster seat.

17. What is the schedule for MMR vaccine?
Every 5 years
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
0.4 mg/day
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity

18. What are the guidelines for visual screening?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Rear facing
12 - 23 mo - 2 doses are to be given 6 mo apart
Preschool children : 3-4 yo - Elderly patients: > 65 yo

19. What is the schedule for DTap vaccine?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
1300 mg/day
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

20. What kind of sunscreen SPF is recommended for sun protection?
Stroke and DVT
Forearm
More than 15
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...

21. Measurement of which anatomic structure is best predictor for hip fracture?
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
1200 mg/day
Femoral neck
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

22. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Forearm
12 - 23 mo - 2 doses are to be given 6 mo apart
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

23. What is the schedule for varicella vaccine?
One dose at 12-15 mod - Booster at least 4-weeks after
Exercise or physical therapy and vit D for patients > 65
Men 45 - 79 yo
1300 mg/day

24. When should pregnant women get a flu shot?
During 2nd - 3rd trimester
Meningitis and Epiglottitis
More than 15
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day

25. What are some RFs for DMT2?
Children up to 7 yo and < 5' should be placed in a booster seat.
1000 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)
BP - Height - Weight

26. When should tetanus immunoglobulin be given?
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
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
1200 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

27. What is the ADA guideline for DMT2 screening?
More than 15
1200 mg/day
NEVER
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs

28. When is area of induration > 10 mm considered TB positive?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
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
One dose at 12-15 mod - Booster at least 4-weeks after
HISTORY

29. How much flouride should non military children in the state of HI be given?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
More than 15
6 mos - 3 yrs : 0.25 mg/day - 3 yrs - 6 yrs: 0.5 mg/day - 6 yrs - 16 yrs : 1 mg/day
Women 55 - 79 yo

30. How much calcium should women > 50 take?
1200 mg/day
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
NEVER
In all W < 24 who are sexually active - In W > 24 with increased risk

31. When is area of induration > 5mm considered TB positive?
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
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...
65 (earlier if have increased risk factors)

32. What are the guidelines for pap smear?
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
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)
In adults with sustained BP > 135/80 mmHg

33. Which children should use a semi-upright/forward facing carseat?
4 mg/day
1200 mg/day
> 2 yo and less than 40 lbs
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs

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

35. In which group of patients should aspirin be given as primary prevention for MI?
During 2nd - 3rd trimester
One dose at 12-15 mod - Booster at least 4-weeks after
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
Men 45 - 79 yo

36. What is the schedule for Hep A vaccine?
0.4 mg/day
12 - 23 mo - 2 doses are to be given 6 mo apart
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...
During 2nd - 3rd trimester

37. How much fluoride should military children in HI be given?
0.4 - 0.8 mg/day for 1 month prior to conception
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/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)
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound

38. If traveling to endemic areas - Why should one get a dose of live vaccine?
1000 mg/day
0.4 - 0.8 mg/day for 1 month prior to conception
To get IgA protection
2mo - 4mo - 6-18 mo and 4-6 yrs

39. What kind of car seat should children < 2 yo be placed in?
0.4 - 0.8 mg/day for 1 month prior to conception
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
2mo - 4mo - 6-18 mo and 4-6 yrs
Rear facing

40. When can children sit in a booster seat?

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41. What is the schedule for Gardasil?
Meningitis and Epiglottitis
In adults with sustained BP > 135/80 mmHg
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
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

42. What are the risks of combination HRT?
4 mg/day
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients
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
Breast CA - thromboembolic event - stroke and CAD

43. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
When they are > 40 lbs and still less then 5'
1300 mg/day
Starts at 20 for both M and W

44. What is the NCEP III guideline for cholesterol screening?
Start at 20 for all M and W regardless of RFs
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
0.4 mg/day
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose

45. When is area of induration > 15 mm considered TB positive?
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
Men 45 - 79 yo
To get IgA protection
Persons with no known risk factors

46. When should chest X-ray be used for screening?
NEVER
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
More than 15
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)

47. What are the guidelines for colon cancer screening?
Women 55 - 79 yo
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
To get IgA protection
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

48. What is the most important way to screen for CAD in an asymptomatic patients?
HISTORY
1200 mg/day
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
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

49. At what age should women have DEXA scan?
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...
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
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
65 (earlier if have increased risk factors)

50. How much vit D should adults < 50 take?
HISTORY
800 IU/ day
Adults > 60
12 - 23 mo - 2 doses are to be given 6 mo apart

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