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Family Medicine/ambulatory 2

Subjects : health-sciences, family-medicine

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. New-onset headache in patient with HIV/cancer DDx
Meningitis - brain abscess - metastasis
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B

2. DASH diet plan
High K - high Ca - low Na
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
IV labetalol - nicardipine - sodium nitroprusside
Digoxin (B-blockers as needed)

3. Bile acid sequestrants (cholestyramine - colestipol - colesevelam)
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Dementia - incontinence - gait disturbance
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)

4. Sudden-onset headache DDx
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
High K - high Ca - low Na
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion

5. tx malignant hyperthermia
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Dantrolene IV - antipyretics - O2 - cooling blankets
100% O2 6L/min - dihydroergotamine - triptans

6. Croup pathogens
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction
Septic arthritis - fractures - congenital hip dysplasia
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo

7. Tx HTN + CHF
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
ACEI - ARB - B-blocker - diuretic - Spironolactone
Legionella
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)

8. Causes of diverticular bleeding
8%
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Viral infxn of the subglottis
Hemorrhoids > colorectal polyps > diverticulosis > CRC > UC - AVM - colonic strictures

9. Sx of pneumococcal pneumonia
Halothane - succinylcholine
3rd month postpartum
ACEI - ARB - B-blocker - diuretic - Spironolactone
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR

10. Headache with sx systemic illness DDx
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
H. flu - S. pneumo - S. aureus - Strep A/B/C
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
Dementia - incontinence - gait disturbance

11. MAOI
Obesity; increased NE release
Phenelzine - tranylcypramine
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
SCFE (slipped capital femoral epiphysis)

12. Tx HTN + CKD
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
TCA's
Barium enema
ACEI - ARB

13. If not breast-feeding - when does menstruation restart?
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Flat disk - button - batteries
'thumb sign' (protrusion of into anterior wall of hypopharynx)
3rd month postpartum

14. Tx acute pulmonary edema 2ndary to CHF
Amiodarone/lidocaine
Fiber (e.g. psyllium)
Furosemide - nitroglycerin - IV morphine sulphate
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose

15. Rivastigmine
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
ACEI - diuretic
Quinolone + metronidazole
Alzheimer dementia

16. rtPA should be used within ____ of stroke
Dementia - incontinence - gait disturbance
3 hours
Amitriptyline - propanolol - timolol - divalproex sodium
ACEI - ARB - B-blocker - diuretic - Spironolactone

17. Dx and Tx of intussception
Barium enema
'steeple-sign' (subglottic narrowing)
Postpartum fever - uterine tenderness - foul-smelling lochia
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.

18. Organism that causes pneumonia with diarrhea
= QT / sqrt(RR interval)
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
Legionella
Verapamil - Li+ - divalproex sodium - methysergide - prednisone

19. Cardiac Resynchronization Therapy (CRT) is warranted when ___
Fasting blood glucose - LFTs - renal function - TSH
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Oral prednisone
IV labetalol - nicardipine - sodium nitroprusside

20. Tacrine use/sfx
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction
ACEI - ARB - B-blocker - diuretic - Spironolactone
Amiodarone/lidocaine
PCP pneumonia

21. Tx HTN + CAD
B-blocker - Ca-channel blocker
Colonoscopy
ACEI - B-blocker - diuretic - Ca-blocker
Furosemide - nitroglycerin - IV morphine sulphate

22. Pyloric stenosis sx

23. DDx dementia
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
Moderate/severe alzheimer dementia
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV

24. contraindications to thrombolytic therapy
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia
Barium enema
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

25. Tx frequent/severe abd pain

26. Chance of pregnancy after a single act of coitus
Digoxin (B-blockers as needed)
8%
Fiber (e.g. psyllium)
Obesity; NE-uptake inhibition

27. Tx migraine
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
H. flu - S. pneumo - S. aureus - Strep A/B/C
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;

28. Retropharyngeal abscess Sx
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools
1st line: TZD

29. Lubiprostone
3 hours
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome

30. Empiric CAP tx in healthy person
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Amoxicillin-clavulanate (augmentin) p.o 7-14 days
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
1st line: TZD

31. IBS pain tx
Fever - sore throat - muffled voice - drooling - trismus - neck pain
470ms+ in men - 480ms+ in women
Digoxin (B-blockers as needed)
5-HT blockers: tegasorad - alosetron

32. Cluster headache pflx
Hemorrhoids > colorectal polyps > diverticulosis > CRC > UC - AVM - colonic strictures
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Renal parenchymal disease
ACEI - diuretic

33. Phentermine
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
Obesity; NE-uptake inhibition
Furosemide - nitroglycerin - IV morphine sulphate
1st line: TZD

34. Focal neurologic sx (other than aura) DDx
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
5-HT blockers: tegasorad - alosetron
Mass lesion - vascular malformation - stroke - collagen vascular disease
ACEI - B-blocker - spironolactone

35. Tx uterine atony
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
Obesity; increased NE release
Eikenella species
1st line: TZD

36. Sx endometritis
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Postpartum fever - uterine tenderness - foul-smelling lochia
High K - high Ca - low Na
S. aureus

37. Croup
Viral infxn of the subglottis
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
H. flu - S. pneumo - S. aureus - Strep A/B/C

38. MCA stroke sx
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Oral prednisone
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

39. malignant hyperthermia
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease

40. NMDA-R antagonist (memantine)
Moderate/severe alzheimer dementia
Amitriptyline - propanolol - timolol - divalproex sodium
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction
Obesity; increased NE release

41. SSRI's
= QT / sqrt(RR interval)
Phenelzine - tranylcypramine
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram

42. QTc
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
'steeple-sign' (subglottic narrowing)
= QT / sqrt(RR interval)

43. Headache after 50 YO DDx
100% O2 6L/min - dihydroergotamine - triptans
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Bacterial infxn of supraglottic tissue and surrounding areas
Temporal arteritis - mass lesion

44. Peritonsillar abscess Sx
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.

45. Organism that causes pneumonia post-influenza
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old
S. aureus
Amitriptyline - propanolol - timolol - divalproex sodium

46. DDx pediatric intestinal obsutrction
Meningitis - brain abscess - metastasis
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
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
Oral prednisone

47. Malrotation sx
Neonate - infants - bilious vomiting - abdominal pain
Barium enema
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
ACEI - ARB

48. Evaluating limp w/o pain in children
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener

49. Tx HTN
B-blocker - Ca-channel blocker
1st line: TZD
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Obesity; increased NE release

50. DDx postoperative fever
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Obesity; increased NE release
PCP pneumonia