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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. Tx of traveler's diarrhea
Normal mental status; no other injuries; seen within 10 days of injury
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
5 yo - draws person - ties shoes - skips

2. Recommended folic acid daily dose
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Thiazides
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
MTX

3. Tx acute gout
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Calcium oxalate crystals
(ofloxacin OR levofloxacin) +/- metronidazole
Colchicine

4. identifies left - right
Urticaria
6 yo
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Monosodium urate crystals (gout)

5. causes of acute bronchitis
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Measures strength of contractions
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

6. Augments contractions
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Oxytocin (IV)
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

7. Only therapy to decrease mortality in stage IV COPD
Tuberculosis; sarcoidosis; hodgkin disease
Aortic aneurysm
Oxygen intervention 15h/d
6 yo

8. regards hand
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Anaphylaxis
= LMP + 7 days - 3 months
4mo - sits unsupported - hand transfer - babbles

9. Screening for 65-76YO male smoker
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Aortic aneurysm
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Colchicine

10. Tx bacterial vaginosis
Metronidazole or clindamycin
Steroids + bronchodilators
Pneumovax - influenza
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

11. 2nd generation antihistamines
Loratadine - fexofenadine - cetirizine
Aortic aneurysm
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Clindamycin AND gentamicin

12. Bisphospohonates sfx
4mo - sits unsupported - hand transfer - babbles
Calcium oxalate crystals
Esophagitis - gastritis - dysphagia
Angioedema

13. writes name - counts 10 objects
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
5 yo - draws person - ties shoes - skips
Fluoroquinolones
Flexion - internal rotation - extension - external rotation

14. Tx RA (best long-term outcome)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
MTX

15. Electrolyte abnormality that increases the incidence of torsades de pointes
5+ rads
9 mo - walks - throws - 1-3 words - 1-step commands
Hypomagnesemia
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

16. medications causing hypercalcemia
Thiazdes; lithium
Colchicine
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

17. Other causes of hypercalcemia
Starts at contraction. caused by increased vagal tone from fetal head compression.
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

18. presbycusis
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Most aggressive melanoma.
Prostatitis
Calcium oxalate crystals

19. Sx otitis externa
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Patch - bupropion - varenicline
Ear pain - itching - inflammation/swollen canal - exudates/discharge
0.2-0.5mg aqueous EPI IM/SubQ

20. Immunizations for adult 65YO+
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
(ofloxacin OR levofloxacin) +/- metronidazole
9 mo - walks - throws - 1-3 words - 1-step commands
Tdap - influenza - pneumovax

21. explorations
(ofloxacin OR levofloxacin) +/- metronidazole
9 mo - walks - throws - 1-3 words - 1-step commands
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Urinary calcium. Hyper PTH (high) >> FHH (normal)

22. needles - strong negative birefringent (yellow crystals parallel light)
Starts at contraction. caused by increased vagal tone from fetal head compression.
Monosodium urate crystals (gout)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

23. Fetal heart rate range
110-160bpm
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
(cefotetan OR cefoxitin) AND doxycycline
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

24. Oral tx for PID
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
(ofloxacin OR levofloxacin) +/- metronidazole
Tuberculosis; sarcoidosis; hodgkin disease

25. dyspnea - visceral edema - hypotension
9 mo - walks - throws - 1-3 words - 1-step commands
Metronidazole or clindamycin
Steroids + bronchodilators
Anaphylaxis

26. painless - deep - subQ swelling (periorbital - circumoral - facial)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Angioedema

27. Sx peritonsillar abscess
Fe deficient anemia
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Normal mental status; no other injuries; seen within 10 days of injury

28. tx shoulder dystocia

29. Malignancies with hypercalcemia
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
NAC or IV NaHCO3
Calcium hydroxyapatite crystals
Lung; SCC head & neck; RCC; breast; MM; prostate

30. Dx criteria for RA
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Bupropion - varenicline - nicotine replacement
MTX
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

31. Tx acute sinusitis
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
6 yo

32. group play - gender - knows name
Metronidazole or clindamycin
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
= LMP + 7 days - 3 months
3 yo - identify body part - copies square - hops - throws - past tense - story telling

33. Tx otitis media
Bupropion - varenicline - nicotine replacement
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

34. IADL
After delivery until delivery of placenta and membranes <30 mins
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Anterior shoulder cannot readily pass below the pubic symphysis.

35. CKD Stages
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

36. Estimated delivery date (Naegele's rule)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Onset of labor until cervix dilation
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
= LMP + 7 days - 3 months

37. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Anemia
Alpha-1 antitrypsin deficiency
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Anterior shoulder cannot readily pass below the pubic symphysis.

38. Fe deficient anemia tx
Diphenhydramine - chlorpheniramine - hydroxyzine
Ferrous sulfate 325mg tid
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
After delivery until delivery of placenta and membranes <30 mins

39. ADL
Patch - bupropion - varenicline
Hypomagnesemia
Bathing - dressing - eating - transferring - continence - toileting
Aortic aneurysm

40. MCC blindness worldwide
Most aggressive melanoma.
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
MCC melanoma. Radial growth.
Cataracts

41. Tx gonorrhea
Ceftriaxone 125mg IM
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Cataracts

42. The five A's of smoking cessation
Ask - Advise - Assess - Assist - Arrange
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

43. IUPC (intrauterine pressure catheter)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
16-18 weeks GA
Measures strength of contractions
After delivery until delivery of placenta and membranes <30 mins

44. Cockcroft-Gault equation
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)
Bupropion - varenicline - nicotine replacement
Tdap - influenza - pneumovax
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

45. X-ray on knee?
6 yo
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Most aggressive melanoma.

46. cystoplasmic inclusions - not birefringent
Bathing - dressing - eating - transferring - continence - toileting
Nuchal translucency - serum hCG - PAPP-A
Conrtaction monitoring along with fetal heart rate assessment
Calcium hydroxyapatite crystals

47. Lentigo Maligna
6-9MO
Calcium pyrophosphate dehydrate crystals (pseudogout)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Oxygen intervention 15h/d

48. Nodular melanoma
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Long axis of fetus to long axis of mother (longitudinal or transverse)
Most aggressive melanoma.
9 mo - walks - throws - 1-3 words - 1-step commands

49. Optimal time for trisomy screen
Ceftriaxone 125mg IM
16-18 weeks GA
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
IV penicillin (or ampicillin)

50. Immunizations for COPD patients
Pneumovax - influenza
Stridor - drooling - toxic appearance
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
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)