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Family Medicine/ambulatory 2

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
3 hours

2. Antihypertensives in suspected stroke
IV labetalol - nicardipine - sodium nitroprusside
Lumbar puncture
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia
Neonate - infants - bilious vomiting - abdominal pain

3. Sx endometritis
Neonate - infants - bilious vomiting - abdominal pain
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
Postpartum fever - uterine tenderness - foul-smelling lochia
8%

4. Pflx migraine
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
TCA's
Amitriptyline - propanolol - timolol - divalproex sodium
Bacterial infxn of supraglottic tissue and surrounding areas

5. Croup sx
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Mass lesion - pseudotumor cerebri - meningitis
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning

6. Cardiac Resynchronization Therapy (CRT) is warranted when ___
Dicyclomine - hyoscyamine (antispasmodics)
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning

7. Baby blues resolves by ______
100% O2 6L/min - dihydroergotamine - triptans
5-HT blockers: tegasorad - alosetron
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
10th postpartum day

8. Sx of pneumococcal pneumonia
= QT / sqrt(RR interval)
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
Aphasia (dom hemisphere) - contralateral hemiparesis - sensory loss - spatial neglect - contralateral impaired conjugate gaze
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test

9. Headache with sx systemic illness DDx
High K - high Ca - low Na
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)

10. Papilledema DDx
Meningitis - brain abscess - metastasis
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
Mass lesion - pseudotumor cerebri - meningitis

11. Tx HTN + CVA
Fever - sore throat - muffled voice - drooling - trismus - neck pain
'thumb sign' (protrusion of into anterior wall of hypopharynx)
ACEI - diuretic
Bupriopion - amoxipine - trazodone

12. MCC infxn in closed-fist injuries
Alzheimer dementia
Obesity (short/long term); inhibit pancreatic lipase; sfx: bloating - gas - oily stools
10th postpartum day
Eikenella species

13. Tx diverticulitis
S. aureus
High K - high Ca - low Na
Quinolone + metronidazole
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose

14. Croup X-ray

15. Tx HTN + CKD
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
100% O2 6L/min - dihydroergotamine - triptans
Colonoscopy
ACEI - ARB

16. Tx migraine
Foot/leg deficits - cognitive + personality changes
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;

17. Headaches increasing in severity + intensity DDx
1st line: TZD
Mass lesion - subdural hematoma - medication overuse
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Digoxin (B-blockers as needed)

18. Bile acid sequestrants (cholestyramine - colestipol - colesevelam)
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)

19. Tx HTN + post-MI
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
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
ACEI - B-blocker - spironolactone
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction

20. Chronic afib tx
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
Furosemide - nitroglycerin - IV morphine sulphate
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
Uterine atony

21. Sudden-onset headache DDx
Use: alzheimer dementia - sfx: hepatotoxicity - arrhythmias - bradycardia - urinary obstruction
100% O2 6L/min - dihydroergotamine - triptans
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone

22. Headache after 50 YO DDx
Temporal arteritis - mass lesion
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
Dementia - incontinence - gait disturbance

23. MCC HTN in child
3rd month postpartum
Renal parenchymal disease
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

24. Tx local - acute rxn to bee sting
Renal parenchymal disease
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
Oral prednisone
Septic arthritis - fractures - congenital hip dysplasia

25. Tx HTN
Septic arthritis - fractures - congenital hip dysplasia
3 hours
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
1st line: TZD

26. epiglottitis
Fasting blood glucose - LFTs - renal function - TSH
Bacterial infxn of supraglottic tissue and surrounding areas
Uterine atony
ACEI - ARB

27. rtPA should be used within ____ of stroke
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.
3 hours
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
ACEI - ARB - diuretic - Ca-blocker - B-blocker

28. Sx HoCM
Neonate - infants - bilious vomiting - abdominal pain
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
Fiber (e.g. psyllium)
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)

29. causes of malignant hyperthernia
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Halothane - succinylcholine
470ms+ in men - 480ms+ in women
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease

30. Commonly ingested foreign bodies
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
Flat disk - button - batteries
Halothane - succinylcholine
Uterine atony

31. Rivastigmine
Mass lesion - subdural hematoma - medication overuse
Alzheimer dementia
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
Colonoscopy

32. MAOI
Colonoscopy
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea
Phenelzine - tranylcypramine
Mass lesion - vascular malformation - stroke - collagen vascular disease

33. DDx postoperative fever
Fasting blood glucose - LFTs - renal function - TSH
Foot/leg deficits - cognitive + personality changes
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)

34. Peritonsillar abscess Sx
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
ACEI - diuretic
High K - high Ca - low Na
Fever - sore throat - muffled voice - drooling - trismus - neck pain

35. Diethylpropion
Obesity; NE-uptake inhibition
Bacterial infxn of supraglottic tissue and surrounding areas
Venlafaxine - duloxetine - mirtazapine
Obesity; increased NE release

36. DDx Limp w/o pain in children - orthopedic
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
S. aureus
Fasting blood glucose - LFTs - renal function - TSH

37. 1st line tx in IBS constipation
MVP
Fiber (e.g. psyllium)
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
Fever - sore throat - muffled voice - drooling - trismus - neck pain

38. QTc
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
H. flu - S. pneumo - S. aureus - Strep A/B/C
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
= QT / sqrt(RR interval)

39. Lubiprostone
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea
Renal parenchymal disease
Fever - sore throat - muffled voice - drooling - trismus - neck pain

40. Outpatient tx CHF
Amoxicillin-clavulanate (augmentin) p.o 7-14 days
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic

41. Standard workup for dyslipidemia
SCFE (slipped capital femoral epiphysis)
Flat disk - button - batteries
Fasting blood glucose - LFTs - renal function - TSH
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.

42. Cholesterol absorption blocker (ezetimibe)
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
Lumbar puncture
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome

43. Tx uterine atony
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia
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
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
10th postpartum day

44. Primary SVT tx
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Renal parenchymal disease
B-blocker - Ca-channel blocker
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

45. CAGE questionnaire
Mass lesion - vascular malformation - stroke - collagen vascular disease
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo
ACEI - diuretic

46. Tx mild/infrequent abd pain
Foot/leg deficits - cognitive + personality changes
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
Dicyclomine - hyoscyamine (antispasmodics)
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)

47. Dx subarachnoid hemorrhage with negative noncontrast CT
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
Lumbar puncture
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)

48. NMDA-R antagonist (memantine)
Moderate/severe alzheimer dementia
Obesity; increased NE release
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Mass lesion - vascular malformation - stroke - collagen vascular disease

49. Prolonged QT interval (QTc)
470ms+ in men - 480ms+ in women
Mass lesion - pseudotumor cerebri - meningitis
= QT / sqrt(RR interval)
Venlafaxine - duloxetine - mirtazapine

50. Mastitis tx
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Cephalexin OR dicloxacillin
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.