Family Medicine/ambulatory 2

Instructions:

• Answer 50 questions in 15 minutes.
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• 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. contraindications to thrombolytic therapy
Moderate/severe alzheimer dementia
TCA's
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
PCP pneumonia


2. Antihypertensives in suspected stroke
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
3 hours
IV labetalol - nicardipine - sodium nitroprusside
Fasting blood glucose - LFTs - renal function - TSH


3. Tx HTN + CHF
1st line: IV oxytocin - bimanual uterine massage - 2nd line: methylergonovine IM (CI in HTN) - 3rd line: PGF2a (Hemabate) IM (CI in asthma) - 4th line: Misoprostol
TCA's
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
ACEI - ARB - B-blocker - diuretic - Spironolactone


4. CAGE questionnaire
5-HT blockers: tegasorad - alosetron
Venlafaxine - duloxetine - mirtazapine
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.


5. MCC infxn in closed-fist injuries
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Eikenella species
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
S. aureus


6. Mastitis tx
Cephalexin OR dicloxacillin
TCA's
ACEI - ARB - diuretic - Ca-blocker - B-blocker
Legionella


7. Chance of pregnancy after a single act of coitus
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
8%
ACEI - B-blocker - diuretic - Ca-blocker
Moderate/severe alzheimer dementia


8. Croup
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Viral infxn of the subglottis


9. Tx HTN + DM
ACEI - ARB
ACEI - diuretic
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
ACEI - ARB - diuretic - Ca-blocker - B-blocker


10. MCC HTN in child
3rd month postpartum
10th postpartum day
H. flu - S. pneumo - S. aureus - Strep A/B/C
Renal parenchymal disease


11. Tx HTN + CVA
ACEI - diuretic
Amiodarone/lidocaine
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
PCP pneumonia


12. Malrotation sx
Neonate - infants - bilious vomiting - abdominal pain
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Digoxin (B-blockers as needed)


13. most common valvular heart defect in USA
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
MVP
ACEI - diuretic
Bacterial infxn of supraglottic tissue and surrounding areas


14. Intussusception sx
Flat disk - button - batteries
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test


15. Chronic afib tx
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400


16. Orlistat
Eikenella species
ACEI - ARB - B-blocker - diuretic - Spironolactone
PCP pneumonia
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools


17. Rivastigmine
'steeple-sign' (subglottic narrowing)
3rd month postpartum
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
Alzheimer dementia


18. Retropharyngeal abscess Sx
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer
S. aureus
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress


19. Tx diverticulitis
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
ACEI - diuretic
Quinolone + metronidazole


20. Empiric CAP tx in healthy person
S. aureus
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Phenelzine - tranylcypramine
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance


21. Tx local - acute rxn to bee sting
Obesity; NE-uptake inhibition
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
Oral prednisone


22. Sudden-onset headache DDx
TCA's
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Amoxicillin-clavulanate (augmentin) p.o 7-14 days
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion


23. Sx of pneumococcal pneumonia
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze


24. X-ray epiglottitis


25. Peritonsillar abscess Sx
Lumbar puncture
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide


26. causes of malignant hyperthernia
1st line: TZD
Obesity; NE-uptake inhibition
H. flu - S. pneumo - S. aureus - Strep A/B/C
Halothane - succinylcholine


27. Focal neurologic sx (other than aura) DDx
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone
Mass lesion - vascular malformation - stroke - collagen vascular disease
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
3 hours


28. SSRI's
Dicyclomine - hyoscyamine (antispasmodics)
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic


29. QTc
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Fasting blood glucose - LFTs - renal function - TSH
= QT / sqrt(RR interval)


30. Tx acute pulmonary edema 2ndary to CHF
Obesity; increased NE release
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Furosemide - nitroglycerin - IV morphine sulphate
Mass lesion - pseudotumor cerebri - meningitis


31. MCC postpartum hemorrhage
Uterine atony
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction
Obesity; increased NE release
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement


32. Cardiac Resynchronization Therapy (CRT) is warranted when ___
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
Phenelzine - tranylcypramine
Obesity; NE-uptake inhibition


33. TCA
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Furosemide - nitroglycerin - IV morphine sulphate
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)


34. CXR of CHF
Eikenella species
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Dicyclomine - hyoscyamine (antispasmodics)


35. tx malignant hyperthermia
Cephalexin OR dicloxacillin
Dantrolene IV - antipyretics - O2 - cooling blankets
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion


36. Croup pathogens
Neonate - infants - bilious vomiting - abdominal pain
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo
Bacterial infxn of supraglottic tissue and surrounding areas
Fiber (e.g. psyllium)


37. Baby blues resolves by ______
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Viral infxn of the subglottis
10th postpartum day
Colonoscopy


38. If not breast-feeding - when does menstruation restart?
B-blocker - Ca-channel blocker
ACEI - ARB - diuretic - Ca-blocker - B-blocker
3rd month postpartum
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction


39. Phentermine
Obesity; NE-uptake inhibition
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
'thumb sign' (protrusion of into anterior wall of hypopharynx)


40. DDx Limp w/o pain in children - orthopedic
H. flu - S. pneumo - S. aureus - Strep A/B/C
S. aureus
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
Lumbar puncture


41. GI 'alarm' features
Hemorrhoids > colorectal polyps > diverticulosis > CRC > UC - AVM - colonic strictures
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
ACEI - ARB - B-blocker - diuretic - Spironolactone
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer


42. Sx Lewy Body Dementia
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
Obesity; increased NE release
MVP
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)


43. Metabolic syndrome
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
B-blocker - Ca-channel blocker
Quinolone + metronidazole


44. ACA stroke ssx
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Foot/leg deficits - cognitive + personality changes
Fiber (e.g. psyllium)
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)


45. Lochia
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.
Amoxicillin-clavulanate (augmentin) p.o 7-14 days
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
'steeple-sign' (subglottic narrowing)


46. Croup X-ray


47. Bilateral 'ground glass' infiltrate on CXR
PCP pneumonia
Legionella
Obesity; increased NE release
Fiber (e.g. psyllium)


48. Commonly ingested foreign bodies
Obesity; NE-uptake inhibition
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
Renal parenchymal disease
Flat disk - button - batteries


49. Headache post-head trauma DDx
Foot/leg deficits - cognitive + personality changes
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Venlafaxine - duloxetine - mirtazapine
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress


50. Outpatient tx CHF
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
ACEI - ARB - B-blocker - diuretic - Spironolactone
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;