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Family Medicine/ambulatory 1

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. Second stage of labor
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Conrtaction monitoring along with fetal heart rate assessment
Colchicine

2. Improve short-term outcomes in acute exacerbations of COPD - asthma
Hypomagnesemia
Steroids + bronchodilators
Diabetes - HTN - GN
IV penicillin (or ampicillin)

3. Cockcroft-Gault equation
<20lb - <1YO - Reacts to pain - Responds to noise
Flexion - internal rotation - extension - external rotation
Onset of labor until cervix dilation
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

4. First stage of labor
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Onset of labor until cervix dilation
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Hypomagnesemia

5. Only therapy to decrease mortality in stage IV COPD
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Oxygen intervention 15h/d
Starts at contraction. caused by increased vagal tone from fetal head compression.
Clindamycin AND gentamicin

6. Electrolyte abnormality that increases the incidence of torsades de pointes
Ask - Advise - Assess - Assist - Arrange
<20lb - <1YO - Reacts to pain - Responds to noise
Hypomagnesemia
Normal mental status; no other injuries; seen within 10 days of injury

7. Complications of PID
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

8. Age by which child says 'mama' and 'dada'
6-9MO
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Calcium hydroxyapatite crystals
Bupropion - varenicline - nicotine replacement

9. Pregnancy class C smoking cessation drugs
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Urticaria
Ampicillin/sulbactam AND doxycycline
Patch - bupropion - varenicline

10. Nonfunctioning nodules > 1cm require _____
Biopsy
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Short-acting + 40mg prednisone x 10-14days

11. Tx gonorrhea
Ceftriaxone 125mg IM
Aortic aneurysm
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
5 yo - draws person - ties shoes - skips

12. Tx for anaphylaxis
0.2-0.5mg aqueous EPI IM/SubQ
Colchicine
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
After delivery until delivery of placenta and membranes <30 mins

13. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Patch - bupropion - varenicline
Measures strength of contractions
Anemia
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

14. Tx for thyroid storm
Anemia
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Conrtaction monitoring along with fetal heart rate assessment
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

15. IV tx for PID
Steroids + bronchodilators
Ofloxacin OR levofloxacin +/- metronidazole
Metronidazole or clindamycin
5 yo - draws person - ties shoes - skips

16. Nodular melanoma
Oxygen intervention 15h/d
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Most aggressive melanoma.
Prostatitis

17. Signs of rupture of membranes

18. shoulder dystocia
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Thiazides
Anterior shoulder cannot readily pass below the pubic symphysis.
0.2-0.5mg aqueous EPI IM/SubQ

19. Tender - boggy prostate. Dx?
7-10d sx: purulent nasal discharge - maxillary tooth or facial pain - unilateral maxillary sinus tenderness - worsening of Sx after initial improvement (post viral URI possibly)
Prostatitis
4 yo - copies triangle - catches ball - dresses self
16-18 weeks GA

20. Tocodynamometer
Cataracts
0.2-0.5mg aqueous EPI IM/SubQ
Alpha-1 antitrypsin deficiency
Conrtaction monitoring along with fetal heart rate assessment

21. Fetal heart rate range
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
110-160bpm
Nicotine inhaler - nasal spray - gum

22. MCC blindness worldwide
<20lb - <1YO - Reacts to pain - Responds to noise
Cataracts
Conrtaction monitoring along with fetal heart rate assessment
(ofloxacin OR levofloxacin) +/- metronidazole

23. Estimated delivery date (Naegele's rule)
5 yo - draws person - ties shoes - skips
= LMP + 7 days - 3 months
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

24. Recommended folic acid daily dose
Starts at contraction. caused by increased vagal tone from fetal head compression.
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
5+ rads
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

25. Bisphospohonates sfx
Calcium pyrophosphate dehydrate crystals (pseudogout)
Esophagitis - gastritis - dysphagia
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

26. Immunizations for adult 65YO+
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Tdap - influenza - pneumovax
Diabetes - HTN - GN
Urticaria

27. explorations
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Oxytocin (IV)
9 mo - walks - throws - 1-3 words - 1-step commands

28. Sx of hypercalcemia
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Clindamycin AND gentamicin

29. DOC for HTN in elderly
Ofloxacin OR levofloxacin +/- metronidazole
Colchicine
Thiazides
6 mo - pincer - crawls - cruises - mamma - dada - byebye

30. causes of acute bronchitis
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
5+ rads
Esophagitis - gastritis - dysphagia

31. parallel play
Ear pain - itching - inflammation/swollen canal - exudates/discharge
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
MCC melanoma. Radial growth.
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

32. needles - strong negative birefringent (yellow crystals parallel light)
Monosodium urate crystals (gout)
Calcium pyrophosphate dehydrate crystals (pseudogout)
6 yo
Thiazdes; lithium

33. Acral lentinous melanoma
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
MCC melanoma in Africans/Asians. Under nails - soles - palms.
2 mo - eyes follow object past midline - rolls over - laughs - squeals

34. Fe deficient anemia tx
Ferrous sulfate 325mg tid
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
MCC melanoma. Radial growth.

35. complications of otitis media
DTaP - hepB - Hib - rotavirus - inactivated polio
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

36. identifies left - right
6 yo
Diphenhydramine - chlorpheniramine - hydroxyzine
= LMP + 7 days - 3 months
(ofloxacin OR levofloxacin) +/- metronidazole

37. Sx otitis externa
Normal mental status; no other injuries; seen within 10 days of injury
Anemia
Ear pain - itching - inflammation/swollen canal - exudates/discharge
7-10d sx: purulent nasal discharge - maxillary tooth or facial pain - unilateral maxillary sinus tenderness - worsening of Sx after initial improvement (post viral URI possibly)

38. bacteria causing pharyngitis
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Lung; SCC head & neck; RCC; breast; MM; prostate
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Most aggressive melanoma.

39. Sx peritonsillar abscess
1 mo - eyes follow object to midline - vocalizes
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Stridor - drooling - toxic appearance

40. Immunizations at visit for 6MO
DTaP - hepB - Hib - rotavirus - inactivated polio
Calcium pyrophosphate dehydrate crystals (pseudogout)
Metronidazole or clindamycin
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

41. Dx bacterial vaginosis
4 yo - copies triangle - catches ball - dresses self
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Bathing - dressing - eating - transferring - continence - toileting
Alpha-1 antitrypsin deficiency

42. Malignancies with hypercalcemia
7-10d sx: purulent nasal discharge - maxillary tooth or facial pain - unilateral maxillary sinus tenderness - worsening of Sx after initial improvement (post viral URI possibly)
Lung; SCC head & neck; RCC; breast; MM; prostate
Loratadine - fexofenadine - cetirizine
Hypomagnesemia

43. Early deceleration
Age-related sensorineural hearing loss (high frequency and speech discrimination)
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Starts at contraction. caused by increased vagal tone from fetal head compression.
7-10d sx: purulent nasal discharge - maxillary tooth or facial pain - unilateral maxillary sinus tenderness - worsening of Sx after initial improvement (post viral URI possibly)

44. writes name - counts 10 objects
Oxytocin (IV)
Cataracts
Oxygen intervention 15h/d
5 yo - draws person - ties shoes - skips

45. DDX for geriatric hearing impairment
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Biopsy
Measures strength of contractions
Alpha-1 antitrypsin deficiency

46. X-ray of ankle?
0.2-0.5mg aqueous EPI IM/SubQ
Patch - bupropion - varenicline
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Normal mental status; no other injuries; seen within 10 days of injury

47. 1st generation antihistamines
Ampicillin/sulbactam AND doxycycline
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Diphenhydramine - chlorpheniramine - hydroxyzine
1 mo - eyes follow object to midline - vocalizes

48. Bacteria causing chronic sinusitis
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Calcium pyrophosphate dehydrate crystals (pseudogout)
Ampicillin/sulbactam AND doxycycline
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

49. Dx PID
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Onset of labor until cervix dilation
Thiazides
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

50. How much radiation is associated with fetal harm?
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
5+ rads
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Oxygen intervention 15h/d