Family Medicine Health Maintenance

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. In which group of patients should aspirin be given as primary prevention for MI?
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
Every 5 years
Men 45 - 79 yo


2. Which children should use a semi-upright/forward facing carseat?
When they are > 40 lbs and still less then 5'
One dose at 12-15 mod - Booster at least 4-weeks after
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
> 2 yo and less than 40 lbs


3. What are the guidelines for visual screening?
12 - 23 mo - 2 doses are to be given 6 mo apart
More than 15
Preschool children : 3-4 yo - Elderly patients: > 65 yo
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years


4. What is the NCEP III guideline for cholesterol screening?
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
65 (earlier if have increased risk factors)
Start at 20 for all M and W regardless of RFs


5. What kind of polio vaccine is preferred?
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
65 (earlier if have increased risk factors)
> 2 yo and less than 40 lbs
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)


6. What 3 things should always be done in an office visit?
2mo - 4mo - 6-18 mo and 4-6 yrs
Stroke and DVT
BP - Height - Weight
In adults with sustained BP > 135/80 mmHg


7. When should pregnant women get a flu shot?
Stroke and DVT
During 2nd - 3rd trimester
Rear facing
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


8. How much calcium should adolescents (9 -18) take?
Women 55 - 79 yo
1000 mg/day
1300 mg/day
Rear facing


9. What is the schedule for MMR vaccine?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
800 IU/ day
Exercise - Environmental hazard reduction - Close monitoring of medication
12-15 mos and 4-6 yrs - MMR is live and contraindicated in pregnant women and immunocompromised patients


10. What are the USPSTF guidelines for cholesterol screening in people with normal risks?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
Starts at 50 (recommends against starting at 40) and every 2 years
1300 mg/day
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo


11. What kind of car seat should children < 2 yo be placed in?
Meningitis and Epiglottitis
Rear facing
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


12. What are the USPSTF guidelines for cholesterol screening in people with increased risks?
During 2nd - 3rd trimester
Starts at 20 for both M and W
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
Start at 20 for all M and W regardless of RFs


13. What are the USPSTF guidelines for mammogram?
Starts at 50 (recommends against starting at 40) and every 2 years
In adults with sustained BP > 135/80 mmHg
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
Exercise or physical therapy and vit D for patients > 65


14. What type of illnesses does Hib vaccine prevent?
0.4 mg/day
In adults with sustained BP > 135/80 mmHg
Meningitis and Epiglottitis
Children up to 7 yo and < 5' should be placed in a booster seat.


15. How much calcium should women > 50 take?
Persons with no known risk factors
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
1200 mg/day
Smoking - Alcoholism


16. How much folate and for How long should a woman take for planned pregnancy?
0.4 - 0.8 mg/day for 1 month prior to conception
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
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
BP - Height - Weight


17. How much fluoride should military children in HI be given?
Smoking - Alcoholism
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
NEVER


18. Who are at increased risk for adverse effect catching a flu?
Starts at 20 for both M and W
2mo - 4mo - 6-18 mo and 4-6 yrs
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity


19. In which group of patients should aspirin be given as primary prevention for stroke?
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
Stroke and DVT
Women 55 - 79 yo
Start at 20 for all M and W regardless of RFs


20. Who should get shingles vaccine?
2mo - 4 mo - 6mo and 12-15 mo
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
To get IgA protection
Adults > 60


21. What is the most important way to screen for CAD in an asymptomatic patients?
HISTORY
Meningitis and Epiglottitis
Start at 20 for all M and W regardless of RFs
800 IU/ day


22. What can decrease fall in the elderly?
Starts at 20 for both M and W
More than 15
Exercise - Environmental hazard reduction - Close monitoring of medication
Men 45 - 79 yo


23. How often do asplenic patients receive pneumococcal vaccine?
Children up to 7 yo and < 5' should be placed in a booster seat.
Every 5 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
2mo - 4 mo - 6mo and 12-15 mo


24. Who should get Tdap vaccine and how often?
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)
HISTORY
Men 45 - 79 yo
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


25. What is the schedule for Gardasil?
Men 45 - 79 yo
Stroke and DVT
65 (earlier if have increased risk factors)
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose


26. How much folate and for How long should a woman with hx of NTD take for planned pregnancy?
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
4 mg/day
0.4 - 0.8 mg/day for 1 month prior to conception


27. What are the guidelines for colon cancer screening?
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
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
More than 15
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs


28. How much vit D should adults > 50 take?
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
1000 IU/day


29. 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)
In all W < 24 who are sexually active - In W > 24 with increased risk
Every 5 years
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman


30. Some contraindications for aspirin
Rear facing
Children up to 7 yo and < 5' should be placed in a booster seat.
Subq (inactivated - Salk) - The oral kind (Sabin - is a live vaccine and can induced polio)
PUD - bleeding disorders - liver disease - kidney disease - ASA allergy - uncontrolled HTN - diabetic retinopathy


31. What is the schedule for DTap vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
Starts at 50 (recommends against starting at 40) and every 2 years
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


32. Measurement of which anatomic structure is best predictor for fractures elsewhere beside hip fracture?
Forearm
1000 mg/day
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound


33. When should chest X-ray be used for screening?
Starts at 50 (recommends against starting at 40) and every 2 years
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
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
NEVER


34. What is the schedule for Hep A vaccine?
Children < 7 yo - 2 mo - 4 mo - 6 mo - 15-18 mo and 4-5 yrs
To get IgA protection
12 - 23 mo - 2 doses are to be given 6 mo apart
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


35. When is area of induration > 15 mm considered TB positive?
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity
> 2 yo and less than 40 lbs
6 mos - 3 yrs : none - 3 yrs - 6 yrs: 0.25 mg/day - 6 yrs - 16 yrs : 0.5 mg/day
Persons with no known risk factors


36. What are the risks of combination HRT?
Persons with no known risk factors
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
Starts at 20 for both M and W


37. When is area of induration > 10 mm considered TB positive?
12 - 23 mo - 2 doses are to be given 6 mo apart
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
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman
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


38. At what age should women have DEXA scan?
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
12 - 23 mo - 2 doses are to be given 6 mo apart
Exercise or physical therapy and vit D for patients > 65


39. What are some risk factors for CAD?
Children up to 7 yo and < 5' should be placed in a booster seat.
One time abdominal X-ray for all MALES who ever SMOKES
1000 mg/day
Diabetes - non-coronary atherosclerosis - Family History of premature cardiac death ( M < 50 and W < 60) - Smokers - HTN - Obesity


40. What is the schedule for Hep B vaccine?
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
First dose at birth - Second dose at 1-2 mo - Third dose at 6 mo
First degree relative with DMT2 - GDM or baby > 9 lbs - Physical inactivity - Ethnicity (AA - Hawaiian - Native) - HTN - PCOS - Prediabetics ( HbA1C 5.7 - 6.4)


41. What is USPSTF guideline for abdominal aortic aneurysm screening?
More than 15
To get IgA protection
2nd dose 2 mo after 1st dose - 3rd dose 6 mo after 2nd dose
One time abdominal X-ray for all MALES who ever SMOKES


42. What tests are appropriate to order in an asymptomatic 57 yo male?
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
1000 mg/day
Total cholesterol - FOBT
0.4 mg/day


43. When should the meningococcal vaccine be given and to which group?
Men starting at 35 yo to 65 - Women starting at 45 yo to 65 - Every 5 years
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
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
11 - 12 yo - Unvaccinated adolescents at high school entry - Unvaccinated college freshman


44. Measurement of which anatomic structure is best predictor for hip fracture?
Femoral neck
65 (earlier if have increased risk factors)
800 IU/ day
Breast CA - thromboembolic event - stroke and CAD


45. What are 2 conditions that have been proven to be beneficial to screened for?
Adults > 60
Total cholesterol - FOBT
Smoking - Alcoholism
Children 6 mos - 18 yrs - Adults > 50 yo - Chronic cardiopulmonary diseases - Metabolic disease - Immunocompromised - Household contacts of people with increased risks


46. When is intensive individualized home-based intervention recommended?
Meningitis and Epiglottitis
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
Men 45 - 79 yo
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


47. What is the schedule for polio vaccine?
Stroke and DVT
2mo - 4 mo - 6mo and 12-15 mo
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


48. What is the schedule for rotavirus vaccine?
Starts at 50 (recommends against starting at 40) and every 2 years
For incompletely vaccinated patients (did not receive first three shots in series) with deep or contaminated wound
2mo - 4 mo and 6mo - Do not give 1st dose after 15 weeks of age - Do not give past 8mo of age
To get IgA protection


49. What is HI law for booster seat?


50. What is the ADA guideline for DMT2 screening?
Women 55 - 79 yo
Adults > 60
In overweight M and W > 45 - In overweight M and W < 45 with 1 or more RFs
Preschool children : 3-4 yo - Elderly patients: > 65 yo