Family Medicine

Question 1

What are the recommendations for influenza vaccine?

Answer 1

Yearly starting at 6 months

Question 2

What are the recommendations for DTap/Td/Tdap?

Answer 2

DTap at 2, 4, 6, 15-18 months and 4-6 years Tdap 11-12 years Tdap in place of Td once between 19-65 years Td booster every 10 years

Question 3

What are the recommendations for the shingles vaccine?

Answer 3

Once at age 60+ Live attenuated vaccine so contraindicated in HIV, immunosuppressed

Question 4

What are the recommendations for the pneumococcal vaccines?

Answer 4

At age 65, one dose of PCV13 followed by one dose of PPSV23 one year later If younger than 65 and chronic cardiac, pulmonary, liver disease, alcoholism, diabetes, smoking, PPSV23 only; one-time revaccination with PPSV23 when older than 65 if first dose given more than 5 years previously If younger than 65 and asplenic, sickle cell, immunocompromised, PCV13 and first dose of PPSV23, second dose of PPSV23 5 years later

Question 5

What are USPSTF recommendations for colon cancer screening?

Answer 5

Screen between age 50-75 FOBT q1y Sigmoidoscopy q3y Colonoscopy q10y

Question 6

What are USPSTF recommendations for breast cancer screening?

Answer 6

40-49: consider mammography q2y after discussing with patient 50-74: mammography q2y Sooner and more frequent screening if high risk (genetics, family history, etc.)

Question 7

What are USPSTF recommendations for cervical cancer screening?

Answer 7

Start at age 21 or within 3 years of the onset of sexual activity (whichever comes first)

21-29: Pap q3y

30-64: Pap q3y or Pap + HPV q5y

Recommend 3 normal pap smears annually before spacing the interval

If partial hysterectomy (cervix still in place), paps q3y if five normal paps in a row

Don’t need to continue paps if the women had a total hysterectomy for a non-cancerous indication

Hysterectomy for dysplasia –> q1y paps

Can stop paps at age 65 if hysterectomy, no hx of CIN2 or worse and 3 consecutive negative paps or 2 consecutive negative co-tests

Question 8

What are USPSTF recommendations for lung cancer screening?

Answer 8

Annual low-dose CT scan if 30 pack-year smoking history and smoked within the past 15 years at age 55-79

Question 9

What are USPSTF recommendations for abdominal aortic aneurysm screening?

Answer 9

If ever smoked, one-time abdominal ultrasound at age 65-75 (MALES ONLY)

Question 10

What are USPSTF recommendations for high blood pressure screening?

Answer 10

Screen all adults q2y if 120/80

Question 11

What are USPSTF recommendations for high blood cholesterol screening?

Answer 11

All males > 35 All females > 45 All adults at increased risk TC, HDL, LDL q5y

Question 12

What are USPSTF recommendations for diabetes screening?

Answer 12

Adults with BP > 135/80 ADA recommends screening all adults > 45 and adults

Question 13

What are USPSTF recommendations for depression screening?

Answer 13

All adults if mechanisms in place for ensuring accurate diagnosis, treatment, and follow-up

Question 14

What are USPSTF recommendations for alcohol abuse screening?

Answer 14

All adults

Question 15

What are USPSTF recommendations for tobacco use screening?

Answer 15

All adults

Question 16

What are the recommendations for the Hepatitis B vaccine?

Answer 16

Birth 2 months 6 months Recommended for health-care workers, those exposed to blood products, dialysis patients, IVDU, persons with multiple sexual partners or recent STI, MSM

Question 17

What are the recommendations for the Hepatitis A vaccine?

Answer 17

12 months, second dose given 6-18 months later Recommended for persons with chornic liver disease, who use clotting factors, who have occupational exposure, IVDU, MSM, travel to areas where hepatitis A is endemic

Question 18

What are the recommendations for the meningococcal vaccine?

Answer 18

11-12 16 Recommended for college dormitory residents, military recruits, complement deficiencies, asplenia, travel to countries where it is endemic

Question 19

Gout

Answer 19

Excess uric acid leading to deposition of monosodium urate crystals in joints a/w alcohol and meat consumption, thiazide diuretics Dx: joint aspiration –> needle-like with negative birefringence Tx:

Question 20

Pseudogout

Answer 20

Joint pain and inflammation due to calcium pyrophosphate dehydrate crystals Dx: joint aspiration –> rhomboid crystals, weakly positive birefringence

Question 21

Septic arthritis vs. gout joint aspiration

Answer 21

Septic arthritis: 25,000-150,000 WBCs, > 90% neutrophils Gout: 2,000-60,000 WBCs,

Question 22

What are USPSTF recommendations for osteoporosis screening?

Answer 22

DEXA in women after 65 or after 60 if at higher risk of osteoporosis-related fractures

Question 23

Recommendations for HPV vaccine

Answer 23

All girls and women: 11-26

Boys and men: 9-21 (9-26 for MSM and HIV)

Question 24

FDA-approved first line treatments for smoking cessation

Answer 24

Nicotine replacement therapy

Varenicline (avoid if mood disorder, CVD)

Bupropion (contraindicaated with bulimia, seizures)