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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.
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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. Regards human face - eye contact
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Starts at contraction. caused by increased vagal tone from fetal head compression.
1 mo - eyes follow object to midline - vocalizes
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

2. Pregnancy class C smoking cessation drugs
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Patch - bupropion - varenicline
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Ear pain - itching - inflammation/swollen canal - exudates/discharge

3. Oral tx for PID
Oxygen intervention 15h/d
(ofloxacin OR levofloxacin) +/- metronidazole
Thiazdes; lithium
Tuberculosis; sarcoidosis; hodgkin disease

4. Acral lentinous melanoma
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Oxytocin (IV)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

5. Recommended folic acid daily dose
After delivery until delivery of placenta and membranes <30 mins
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

6. medications causing hypercalcemia
Diphenhydramine - chlorpheniramine - hydroxyzine
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Colchicine
Thiazdes; lithium

7. Sx of hypercalcemia
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Calcium hydroxyapatite crystals

8. ADL
(ofloxacin OR levofloxacin) +/- metronidazole
Bathing - dressing - eating - transferring - continence - toileting
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Anemia

9. explorations
Ampicillin/sulbactam AND doxycycline
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
9 mo - walks - throws - 1-3 words - 1-step commands

10. Tx chlamydia
Onset of labor until cervix dilation
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Metronidazole or clindamycin
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

11. Fetal lie
Long axis of fetus to long axis of mother (longitudinal or transverse)
6 yo
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)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

12. Screening for 65-76YO male smoker
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)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Aortic aneurysm

13. Dx bacterial rhinosinusitis
1 mo - eyes follow object to midline - vocalizes
16-18 weeks GA
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)
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

14. Pflx for traveler's diarrhea
Calcium oxalate crystals
Ceftriaxone 125mg IM
Fluoroquinolones
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

15. Smoking cessation agents
Bupropion - varenicline - nicotine replacement
Measures strength of contractions
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Prostatitis

16. Sx otitis externa
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Nuchal translucency - serum hCG - PAPP-A
Ear pain - itching - inflammation/swollen canal - exudates/discharge
9 mo - walks - throws - 1-3 words - 1-step commands

17. shoulder dystocia
Aortic aneurysm
MTX
Anterior shoulder cannot readily pass below the pubic symphysis.
DTaP - hepB - Hib - rotavirus - inactivated polio

18. The five A's of smoking cessation
Ask - Advise - Assess - Assist - Arrange
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
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)
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

19. Sx otitis media
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Thiazides
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

20. identifies left - right
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)
6 yo
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

21. painless - deep - subQ swelling (periorbital - circumoral - facial)
<20lb - <1YO - Reacts to pain - Responds to noise
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Angioedema

22. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Colchicine

23. needles - strong negative birefringent (yellow crystals parallel light)
Nuchal translucency - serum hCG - PAPP-A
4mo - sits unsupported - hand transfer - babbles
Monosodium urate crystals (gout)
IV penicillin (or ampicillin)

24. Tx of traveler's diarrhea
Flexion - internal rotation - extension - external rotation
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

25. IV tx for PID
Patch - bupropion - varenicline
Bupropion - varenicline - nicotine replacement
Clindamycin AND gentamicin
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

26. Corrected serum calcium =

27. social interaction
4 yo - copies triangle - catches ball - dresses self
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Hypomagnesemia
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema

28. Sx epiglottitis
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Stridor - drooling - toxic appearance
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Anterior shoulder cannot readily pass below the pubic symphysis.

29. DDX for geriatric hearing impairment
Bupropion - varenicline - nicotine replacement
6 yo
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Diabetes - HTN - GN

30. complications of otitis media
Monosodium urate crystals (gout)
DTaP - hepB - Hib - rotavirus - inactivated polio
MTX
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

31. Screened at 16-20 weeks GA for trisomy
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Hypomagnesemia
(ofloxacin OR levofloxacin) +/- metronidazole
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

32. Unstable angina vs MI Dx tests
Fe deficient anemia
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Long axis of fetus to long axis of mother (longitudinal or transverse)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

33. Pregnancy class D smoking cessation drugs
9 mo - walks - throws - 1-3 words - 1-step commands
Nicotine inhaler - nasal spray - gum
Fe deficient anemia
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

34. Tx bacterial vaginosis
Ofloxacin OR levofloxacin +/- metronidazole
Metronidazole or clindamycin
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

35. X-ray on knee?
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Aortic aneurysm
Calcium hydroxyapatite crystals
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

36. tx shoulder dystocia

37. variable deceleration
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Ceftriaxone 125mg IM
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

38. Tx otitis media
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Onset of labor until cervix dilation
6-9MO
3 yo - identify body part - copies square - hops - throws - past tense - story telling

39. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Anemia
6 yo
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Alpha-1 antitrypsin deficiency

40. Second stage of labor
Hypomagnesemia
Ferrous sulfate 325mg tid
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Steroids + bronchodilators

41. IV tx for PID
6 mo - pincer - crawls - cruises - mamma - dada - byebye
MCC melanoma in Africans/Asians. Under nails - soles - palms.
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Ampicillin/sulbactam AND doxycycline

42. parallel play
Flexion - internal rotation - extension - external rotation
Calcium oxalate crystals
Tuberculosis; sarcoidosis; hodgkin disease
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

43. dyspnea - visceral edema - hypotension
Anaphylaxis
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
MTX
Metronidazole or clindamycin

44. Complications of GAS infxn
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Fluoroquinolones
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Colchicine

45. Tx acute gout
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Oxygen intervention 15h/d
NAC or IV NaHCO3
Colchicine

46. Tx for thyroid storm
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
0.2-0.5mg aqueous EPI IM/SubQ
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

47. Granulomatous causes of hypercalcemia
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Tuberculosis; sarcoidosis; hodgkin disease
Urticaria
Aortic aneurysm

48. Large - irregularly shaped - prutitic - erythematous wheals
Urticaria
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
(cefotetan OR cefoxitin) AND doxycycline
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

49. Immunizations for COPD patients
4mo - sits unsupported - hand transfer - babbles
Pneumovax - influenza
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Alpha-1 antitrypsin deficiency

50. Tx for anaphylaxis
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
0.2-0.5mg aqueous EPI IM/SubQ
Patch - bupropion - varenicline
Clindamycin AND gentamicin