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Family Medicine/ambulatory 2

Subjects : health-sciences, family-medicine

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Answer 50 questions in 15 minutes.
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1. Sx HoCM
Colonoscopy
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
10th postpartum day

2. Sx Lewy Body Dementia
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Phenelzine - tranylcypramine
Fasting blood glucose - LFTs - renal function - TSH

3. Causes of diverticular bleeding
Hemorrhoids > colorectal polyps > diverticulosis > CRC > UC - AVM - colonic strictures
Bacterial infxn of supraglottic tissue and surrounding areas
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
3 hours

4. Intussusception sx
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Furosemide - nitroglycerin - IV morphine sulphate
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion

5. Stable vtach tx
MVP
Furosemide - nitroglycerin - IV morphine sulphate
Amiodarone/lidocaine
SCFE (slipped capital femoral epiphysis)

6. Tx HTN + CHF
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
ACEI - ARB - B-blocker - diuretic - Spironolactone
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old
High K - high Ca - low Na

7. Dextroamphetamine
Obesity; increased NE release
Eikenella species
Halothane - succinylcholine
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing

8. Tx local - acute rxn to bee sting
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
SCFE (slipped capital femoral epiphysis)
Oral prednisone
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)

9. MAOI
Mass lesion - subdural hematoma - medication overuse
Phenelzine - tranylcypramine
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic

10. Tx uterine atony
Furosemide - nitroglycerin - IV morphine sulphate
PCP pneumonia
'thumb sign' (protrusion of into anterior wall of hypopharynx)
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

11. Malrotation sx
Neonate - infants - bilious vomiting - abdominal pain
Temporal arteritis - mass lesion
Bupriopion - amoxipine - trazodone
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV

12. atypical
Temporal arteritis - mass lesion
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
Amiodarone/lidocaine
Bupriopion - amoxipine - trazodone

13. Outpatient tx CHF
Mass lesion - pseudotumor cerebri - meningitis
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools
ACEI - ARB

14. Antihypertensives in suspected stroke
Dementia - incontinence - gait disturbance
Temporal arteritis - mass lesion
H. flu - S. pneumo - S. aureus - Strep A/B/C
IV labetalol - nicardipine - sodium nitroprusside

15. Cardiac Resynchronization Therapy (CRT) is warranted when ___
ACEI - ARB
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old
10th postpartum day
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy

16. Lochia
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.
Colonoscopy
Dicyclomine - hyoscyamine (antispasmodics)

17. Sudden-onset headache DDx
Amoxicillin-clavulanate (augmentin) p.o 7-14 days
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
Temporal arteritis - mass lesion
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)

18. MCC HTN in child
100% O2 6L/min - dihydroergotamine - triptans
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
Renal parenchymal disease

19. Headache post-head trauma DDx
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Alzheimer dementia

20. DDx pediatric intestinal obsutrction
ACEI - ARB - diuretic - Ca-blocker - B-blocker
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
SCFE (slipped capital femoral epiphysis)
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning

21. CAGE questionnaire
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
MVP
Legionella
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener

22. Test to best determine source of lower GI bleed
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Fasting blood glucose - LFTs - renal function - TSH
Colonoscopy
Foot/leg deficits - cognitive + personality changes

23. Tx mild/infrequent abd pain
'thumb sign' (protrusion of into anterior wall of hypopharynx)
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy
Dicyclomine - hyoscyamine (antispasmodics)
Verapamil - Li+ - divalproex sodium - methysergide - prednisone

24. Croup sx
S. aureus
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
High K - high Ca - low Na

25. Croup pathogens
MVP
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo

26. QTc
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
S. aureus
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone
= QT / sqrt(RR interval)

27. Rivastigmine
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
1st line: TZD
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
Alzheimer dementia

28. Tx HTN + CVA
5-HT blockers: tegasorad - alosetron
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
IV labetalol - nicardipine - sodium nitroprusside
ACEI - diuretic

29. Tacrine use/sfx
Colonoscopy
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction

30. MCA stroke sx
Renal parenchymal disease
Amiodarone/lidocaine
Furosemide - nitroglycerin - IV morphine sulphate
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze

31. Afib - Aflutter tx
Legionella
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
Digoxin (B-blockers as needed)

32. Donepezil use/sfx
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
H. flu - S. pneumo - S. aureus - Strep A/B/C
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
Verapamil - Li+ - divalproex sodium - methysergide - prednisone

33. Chance of pregnancy after a single act of coitus
8%
MVP
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance

34. Sx normal-pressure hydrocephalus
Renal parenchymal disease
Dementia - incontinence - gait disturbance
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener

35. Statins
Furosemide - nitroglycerin - IV morphine sulphate
= QT / sqrt(RR interval)
Cephalexin OR dicloxacillin
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)

36. Drugs causing fever
Lumbar puncture
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Neonate - infants - bilious vomiting - abdominal pain
B-blocker - Ca-channel blocker

37. Refer to cardiologist post-sports physical if ____
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
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
Meningitis - brain abscess - metastasis

38. DDx limp in infant/toddler
Septic arthritis - fractures - congenital hip dysplasia
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool
S. aureus
10th postpartum day

39. Bilateral 'ground glass' infiltrate on CXR
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
ACEI - B-blocker - diuretic - Ca-blocker
PCP pneumonia
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR

40. ROME IBS criteria
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
= QT / sqrt(RR interval)

41. Papilledema DDx
Mass lesion - pseudotumor cerebri - meningitis
S. aureus
1st line: TZD
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose

42. DASH diet plan
ACEI - diuretic
Cephalexin OR dicloxacillin
High K - high Ca - low Na
MVP

43. Tx HTN + CKD
ACEI - ARB
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer

44. Organism that causes pneumonia with diarrhea
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
Legionella
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.

45. Empiric CAP tx in hospitalized patient
Amitriptyline - propanolol - timolol - divalproex sodium
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old

46. SNRI
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Venlafaxine - duloxetine - mirtazapine
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity

47. Evaluating limp w/o pain in children
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
Alzheimer dementia
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B

48. Bite injury pflx
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Amoxicillin-clavulanate (augmentin) p.o 7-14 days
Digoxin (B-blockers as needed)
3rd month postpartum

49. If not breast-feeding - when does menstruation restart?
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
Venlafaxine - duloxetine - mirtazapine
3rd month postpartum
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache

50. GI 'alarm' features
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Fasting blood glucose - LFTs - renal function - TSH
Mass lesion - vascular malformation - stroke - collagen vascular disease

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Family Medicine/ambulatory 2

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