MSN 624 UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS GRADED A+
✔✔Ages 25-64 Screening: LIPIDS - ✔✔men ages > 35 & women > 45; if normal, q 5
yrs. Screen sooner if high CHD risk
✔✔Ages 25-64 Screening gonorrhea or chlamydia - ✔✔female < 24 and sexually active
and if > 25 if at high risk; male: insufficient evidence to screen
✔✔Ages 25-64 Screening FOBT, colonoscopy or other testing measures - ✔✔50-75
years
✔✔Ages 25-64 Screening mammogram - ✔✔q 2 yrs age 50-74. Age 40-49: individual
decision to screen
✔✔Ages 25-64 Screening Pap - ✔✔Age 21-65 every 3 years; age 30-65 years may
increase screening interval to q 5 years with cytology and HPV co-testing
✔✔Adult Screening, Cont. - ✔✔Alcohol, tobacco use
Depression
HIV: age 15-65 or if at increased risk
Hepatitis B if adolescent or at increased risk
Tuberculosis if at increased risk
BRCA gene screening if appropriate family hx
Intimate partner violence if childbearing-aged female
Lung CA if age 55-80 with 30 pack-year hx or current/former smoker & quit in past 15
years
✔✔Ages 25-64 Counseling - ✔✔Counseling (USPSTF recommendations):
Alcohol and tobacco use
Diet/activity for overweight/obese with other CVD risk factors
Skin CA prevention 10-24 years of age: minimize UV exposure
Sexual Behavior: STD prevention
✔✔Folic acid supplementation - ✔✔0.4 - 0.8 mg qd, if capable of conceiving
✔✔Low-dose aspirin - ✔✔if 50-59 years of age with 10-year CVD risk of 10% or greater,
life expectancy of at least 10 years, and low risk for bleeding for prevention of CVD and
colorectal CA
, ✔✔Statins for primary prevention of CVD - ✔✔ages 40-75 years of age; who has
dyslipidemia, DM, HTN or smoker; and/or who has either a 10-year CVD risk of 10% or
greater or whose risk is 7.5% - 10%
✔✔Gardasil 9 Vaccine - ✔✔Vaccine for HPV
2 types: Gardasil (no longer distributed in the US) and Gardasil 9
✔✔gardasil given through age - ✔✔26 if female, 21 if male (some providers give to
males through age 26)
✔✔gardasil 9-14 years - ✔✔2 doses; second dose 6-12 months after first dose.
(Recommended at age 11-12 but can begin as early as age 9)
✔✔gardasil >15 - ✔✔3 doses: dose # 2 is given 1-2 months after first dose; dose #3
given 6 months after dose 1
Oct, 2018: FDA approves Gardasil 9 may be given to men and women ages 27 through
45!
✔✔Adult Immunizations (> 19 years) - ✔✔Goal of Healthy People 2020 is to reduce,
eliminate, or maintain the number of vaccine preventable diseases
✔✔Tetanus-Diphtheria-Pertusis booster vs Tetanus-Diphtheria: - ✔✔The pediatric
formulations usually have 3-5 times as much of the diphtheria component than what is
in the adult formulation. This is indicated by an upper-case "D" for the pediatric
formulation (i.e., DTaP, DT) and a lower case "d" for the adult formulation (Tdap, Td).
The amount of tetanus toxoid in each of the products is equivalent, so it remains an
upper-case "T."
Give 1 dose Tdap, then Td booster q 10 years
✔✔Pneumococcal: - ✔✔Give to immunocompetent adults aged 65 or older.
PCV 13 given first, followed by 1 dose of PCV 23 - 1 year later. if PCV 23 given first,
give PCV 13 - 1 year later.
✔✔Influenza: - ✔✔annually
✔✔Zoster: - ✔✔Shingrix age > 50, 2 doses given 2-6 months apart). Shingrix is a
recombinant zoster vaccine (RZV) regardless of past episode of zoster or receipt of live
zoster vaccine (ZVL)
If ZVL (live vaccine) previously received, administer 2 doses of RZV 2-6 months apart at
least 2 months after ZVL vaccine
Adults > 60 or older, give either RZV or ZVL (RZV preferred)
Contraindicated in pregnancy and anyone with severe immunodeficiency
SOLUTIONS GRADED A+
✔✔Ages 25-64 Screening: LIPIDS - ✔✔men ages > 35 & women > 45; if normal, q 5
yrs. Screen sooner if high CHD risk
✔✔Ages 25-64 Screening gonorrhea or chlamydia - ✔✔female < 24 and sexually active
and if > 25 if at high risk; male: insufficient evidence to screen
✔✔Ages 25-64 Screening FOBT, colonoscopy or other testing measures - ✔✔50-75
years
✔✔Ages 25-64 Screening mammogram - ✔✔q 2 yrs age 50-74. Age 40-49: individual
decision to screen
✔✔Ages 25-64 Screening Pap - ✔✔Age 21-65 every 3 years; age 30-65 years may
increase screening interval to q 5 years with cytology and HPV co-testing
✔✔Adult Screening, Cont. - ✔✔Alcohol, tobacco use
Depression
HIV: age 15-65 or if at increased risk
Hepatitis B if adolescent or at increased risk
Tuberculosis if at increased risk
BRCA gene screening if appropriate family hx
Intimate partner violence if childbearing-aged female
Lung CA if age 55-80 with 30 pack-year hx or current/former smoker & quit in past 15
years
✔✔Ages 25-64 Counseling - ✔✔Counseling (USPSTF recommendations):
Alcohol and tobacco use
Diet/activity for overweight/obese with other CVD risk factors
Skin CA prevention 10-24 years of age: minimize UV exposure
Sexual Behavior: STD prevention
✔✔Folic acid supplementation - ✔✔0.4 - 0.8 mg qd, if capable of conceiving
✔✔Low-dose aspirin - ✔✔if 50-59 years of age with 10-year CVD risk of 10% or greater,
life expectancy of at least 10 years, and low risk for bleeding for prevention of CVD and
colorectal CA
, ✔✔Statins for primary prevention of CVD - ✔✔ages 40-75 years of age; who has
dyslipidemia, DM, HTN or smoker; and/or who has either a 10-year CVD risk of 10% or
greater or whose risk is 7.5% - 10%
✔✔Gardasil 9 Vaccine - ✔✔Vaccine for HPV
2 types: Gardasil (no longer distributed in the US) and Gardasil 9
✔✔gardasil given through age - ✔✔26 if female, 21 if male (some providers give to
males through age 26)
✔✔gardasil 9-14 years - ✔✔2 doses; second dose 6-12 months after first dose.
(Recommended at age 11-12 but can begin as early as age 9)
✔✔gardasil >15 - ✔✔3 doses: dose # 2 is given 1-2 months after first dose; dose #3
given 6 months after dose 1
Oct, 2018: FDA approves Gardasil 9 may be given to men and women ages 27 through
45!
✔✔Adult Immunizations (> 19 years) - ✔✔Goal of Healthy People 2020 is to reduce,
eliminate, or maintain the number of vaccine preventable diseases
✔✔Tetanus-Diphtheria-Pertusis booster vs Tetanus-Diphtheria: - ✔✔The pediatric
formulations usually have 3-5 times as much of the diphtheria component than what is
in the adult formulation. This is indicated by an upper-case "D" for the pediatric
formulation (i.e., DTaP, DT) and a lower case "d" for the adult formulation (Tdap, Td).
The amount of tetanus toxoid in each of the products is equivalent, so it remains an
upper-case "T."
Give 1 dose Tdap, then Td booster q 10 years
✔✔Pneumococcal: - ✔✔Give to immunocompetent adults aged 65 or older.
PCV 13 given first, followed by 1 dose of PCV 23 - 1 year later. if PCV 23 given first,
give PCV 13 - 1 year later.
✔✔Influenza: - ✔✔annually
✔✔Zoster: - ✔✔Shingrix age > 50, 2 doses given 2-6 months apart). Shingrix is a
recombinant zoster vaccine (RZV) regardless of past episode of zoster or receipt of live
zoster vaccine (ZVL)
If ZVL (live vaccine) previously received, administer 2 doses of RZV 2-6 months apart at
least 2 months after ZVL vaccine
Adults > 60 or older, give either RZV or ZVL (RZV preferred)
Contraindicated in pregnancy and anyone with severe immunodeficiency
