You are examining a normal-term newborn whose mother is hepatitis B virus (HBV) surface antigen positive. Which of the following protocols is recommended for the child? {{Ans- Hepatitis B vaccination and hepatitis B immune globulin within 12 hours of birth, a second dose of hepatitis B vaccine at 1 to 2 months, and a third dose of vaccine at 6 months. You are counseling a mother about her child's immunization schedule. She asks specifically if her child would benefit from the Haemophilus influenzae type b (Hib) vaccine. Which of the following statements is true about this vaccine? {{Ans- The vaccine is between 95% and 100?fective in preventing invasive Hib disease. You are discussing varicella-zoster vaccination with a 24-year-old US-born male health care worker who does not ever remember having chicken pox. He does not have any contraindications to vaccine administration. Which of the following statements is true? {{Ans- After vaccination, he may develop a varicella infection, but when it occurs, it does not appear to be contagious. A patient that you follow has recently started volunteering at a drug treatment hospital and requires hepatitis B vaccination. You find that he is hepatitis B surface antibody positive. Which of the following would be the best guideline to follow in this case? {{Ans-No vaccination is necessary based on his laboratory evaluation. You are caring for a 23-year-old healthy homosexual male who works as an accountant and lives alone. He had the "typical childhood vaccinations" and provides documentation of his immunization record. He is up-to-date on tetanus, and was primarily immunized against diphtheria, pertussis, polio, hepatitis B, measles, mumps, rubella, andH influenzae type b. Which of the following vaccinations is indicated for this patient? {{Ans- Hepatitis A In the prenatal workup for a 24-year-old patient, you discover she is not immune to rubella. When is the best time to vaccinate her against rubella? {{Ans-At least 4 weeks postpartum A 32-year-old woman comes to your office for a complete physical examination. When discussing her vaccinations, you discover thatshe received her primary tetanus series as a child, and her last tetanus booster was 11 years ago. Which of the following is true? {{Ans- The patient should receive a diphtheria-tetanus-pertussis (DTP) immunization. You are caring for a family and find that the mother would like her children vaccinated against influenza. Her children are aged 4 months, 24 months, and 5 years. Which of the following represents current immunization recommendations for influenza? {{Ans- The 24-month-old and the 5-year-old should be vaccinated. You care for a child whose mother wants him immunized against influenza. He is currently 18 months old and has never had the influenza vaccine in the past. Which of the following is correct regarding this situation? {{Ans- He should receive two doses of TIV. You are caring for a 2 1/2-year-old boy who is coming to your office for the first time. Reviewing his immunization record, you find that he has never received vaccination for invasive pneumococcal disease using the 7-valent pneumococcal conjugate vaccine. Which of the following is true regarding recommendations in his case? {{Ans- He should be vaccinated, but with a modified schedule for immunization. You are caring for a 30-year-old woman who asks you about the human papillomavirus (HPV) vaccination. She is recently divorced and not in a monogamous relationship. She has a history of genital warts, and had an abnormal Papanicolaou (Pap) test 2 years ago, for which she underwent colposcopy, biopsy, and cryotherapy. Subsequent Pap tests have been normal. Which of the following is true? {{Ans- Vaccination is not recommended for 30-year-old women. You are determining which of the patients in your practice should receive the quadrivalent HPV vaccination. This vaccine is inappropriate for which of the following patients? {{Ans- A pregnant 14-year-old A recently retired 67-year-old woman presents to you to establish care. She was a smoker for a long time, but quit 5 years ago. She is generally healthy, but her prior physician told her that she has "emphysema." She was prescribed an "inhaler" to use as-needed and only uses it rarely. She asks about necessary immunizations. Her social history indicates that she lives with her daughter and often cares for her infant granddaughter. Her chart indicates that she had a pneumococcal polysaccharide vaccine at age 63 and a Td shot at age 63. Which of the following vaccines should she receive? {{Ans- Tdap Of the following, which patient would be considered the most appropriate candidate for vaccination against herpes zoster? {{Ans- A 66-year-old man with a personal history of shingles at age 56 You are discussing preventive health screening with a 19-year-old college student. He has no family history of hypertension, coronary artery disease, diabetes, or cancer. At what age should you consider screening for lipid disorders? {{Ans- 35 years old You are seeing a 58-year-old smoker for a routine health examination. You have counseled him on discontinuing tobacco use, and he is considering that alternative. He denies coughing, shortness of breath, or hemoptysis. Which of the following is a recommended screen for lung cancer in this patient? {{Ans-No screening recommended You are seeing a healthy 26-year-old woman for a routine health visit. She mentions that she and her husband are thinking about starting a family soon. She has never been pregnant before. Which of the following interventions, if done prior to pregnancy, has been shown to have a clear beneficial outcome for this woman and her potential child? {{Ans- Prescribing 0.4 to 0.8 mg of folic acid daily You are discussing cancer screening with a patient. Her father was diagnosed with colorectal cancer at age 62. When should you recommend she begins colorectal cancer screening? {{Ans- 50 years (10 years before the relative was dx'd) You are discussing cancer screening with a female patient. She has no family history of breast cancer, and routine risk analysis indicates that she is not at increased risk for the disease. According to the US Preventive Services Task Force (USPSTF), at what age should she start getting routine mammograms? {{Ans- 50 years In a routine examination, a 33-year-old woman asks you about breast self-examination as a breast cancer screening method. Which of the following best represents the current American Academy of Family Physicians recommendations regarding breast self-examination (BSE)? {{Ans- Clinicians should not teach their female patients how to perform effective breast selfexaminations. A 52-year-old man comes to your office for a complete physical examination. He is interested in prostate cancer screening. Which of the following best represents current guidelines for prostate cancer screening? {{Ans- There is insufficient evidence to recommend for or against prostate cancer screening. During a routine appointment to discuss an upper respiratory infection, you find that your 18-year-old female patient has become sexually active for the first time. According to current guidelines, when should you begin cervical cancer screening on this patient? {{Ans- At the age of 21 You are seeing a 55-year-old patient for her annual physical examination. She has been married to her husband for 32 years and reports that both have been monogamous. Records indicate that she has had normal Pap smears every 1 to 2 years for the last 20 years, and has never had an abnormal Pap smear. At what age is it appropriate to discontinue Pap screening on this patient? {{Ans- 55 years You are caring for a healthy woman whose cousin was just diagnosed with unilateral breast cancer at age 33. Your patient has no other relatives with known histories of breast or ovarian cancer. Which of the following is true regarding the current recommendations for genetic screening for breast cancer mutations? {{Ans- The patient should not be offered testing . unless: • Two first-degree relatives with breast cancer, one of whom was diagnosed when younger than the age of 50. • A combination of three or more first- or second-degree relatives with breast cancer regardless of the age at diagnosis. • A combination of breast and ovarian cancer among first- and seconddegree relatives. • A first-degree relative with bilateral breast cancer. • A combination of two or more first- or second-degree relatives with ovarian cancer, regardless of age at diagnosis. • A first- or second-degree relative with both breast and ovarian cancer at any age. • A male relative with breast cancer. You are completing a preoperative evaluation on a 46-year-old woman who has recently been diagnosed with gall stones. She is generally healthy, and besides being obese has no chronic medical problems. Given her history, what is the potential surgical complication that would be most likely be lethal for her? {{Ans- Cardiac complications A 52-year-old generally healthy female patient of yours has recently been diagnosed with breast cancer. She is presenting for presurgical evaluation for her breast biopsy. What is the risk category associated with this surgery? {{Ans- Low risk You are doing a preoperative history and physical examination on a 58-year-old woman who will be undergoing a thyroidectomy later in the month. She is obese, sedentary with type 2 diabetes and hyperlipidemia. She reports that she is unable to walk two blocks without stopping to rest. She denies chest pain with activity. What type of cardiac evaluation should she have prior to undergoing her surgical procedure? {{Ans- She should have a noninvasive stress test prior to surgery. You are doing a preoperative clearance for a 60-year-old man undergoing an elective knee replacement. He has diabetes, hyperlipidemia, and a history of a prior myocardial infarction (MI) 4 months ago. After his heart attack, he had triple vessel bypass surgery. Since that time, he has done well and has been asymptomatic from a cardiac standpoint. Which of the following is true in this case? {{Ans- He should have a stress test prior to surgery. A 59-year-old male patient is presenting for preoperative testing before undergoing a hernia repair. He has a history of coronary artery disease and hyperlipidemia, but no other significant medical history. He had a positive stress test 4 years ago that was followed by an angioplasty. He has been asymptomatic ever since. Which of the following is the best answer regarding the type of cardiac evaluation should he have prior to undergoing his procedure? {{Ans- Surgery should be deferred. You are completing a preoperative evaluation on a 66-year-old man who will be undergoing prostate surgery. He has hypertension but no other diagnosed medical problems. He has smoked half pack of cigarettes daily since he was 21 years old. He denies dyspnea or cough. Which of the following is true regarding his preoperative evaluation {{Ans- No pulmonary evaluation is necessary. You are counseling one of your patients who is planning a trip overseas. He is concerned about becoming ill while traveling. Which of the following is the most common illness reported by international travelers? {{Ans- Diarrhea You are counseling a patient who is planning a trip with his wife to celebrate their 30th anniversary. They are going on an African safari, and wonder about health risks associated with international travel. What would you tell him is the most common cause of death among international travelers? {{Ans- Heart disease You are performing a physical examination on a student traveling to Mexico with her college Spanish class. She is concerned about traveler's diarrhea, and asks about antibiotic prophylaxis. Which of the following best represents the current guideline from the Centers for Disease Control and Prevention (CDC) for prevention of traveler's diarrhea? {{Ans- The CDC does not have an antibiotic guideline regarding antibiotic prophylaxis for traveler's diarrhea. You are discussing vaccinations for a patient who is traveling internationally. Because of a significant fear of needles, he is unwilling to obtain any vaccination unless it is required. Which of the following is the only mandatory travel vaccine? {{Ans- Yellow fever You are reevaluating a 32-year-old woman in your office. You started her on combination oral contraceptives (COCs) 3 months ago, and at each of three visits since then, her blood pressure has been elevated. Which of the following is the most appropriate next step? {{Ans- Discontinue the oral contraceptive and recommend a barrier method. You started a 20-year-old woman on COCs 2 months ago. She returns to your office asking to discontinue their use because of side effects. Statistically speaking, which side effect of COCs is most frequently cited as the reason for discontinuing their use? {{Ans- Irregular bleeding You are counseling a 23-year-old woman who is interested in starting COC pills. Which of the following is true regarding risks associated with COC use? {{Ans-Users of COC pills have an increased risk of venous thromboembolism. You are counseling a patient over the phone who has been taking oral contraceptives regularly for 2 years. Her husband surprised her with a weekend "get away" vacation, and she forgot to bring her pills. She therefore missed taking one active pill. She and her husband had intercourse during their trip, and