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Family Medicine/ambulatory 1

Subjects : health-sciences, family-medicine

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. Immunizations for adult 65YO+
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)
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Tdap - influenza - pneumovax

2. Early deceleration
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Starts at contraction. caused by increased vagal tone from fetal head compression.
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

3. Recommended folic acid daily dose
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Measures strength of contractions
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
NAC or IV NaHCO3

4. Tx gonorrhea
Ceftriaxone 125mg IM
5+ rads
110-160bpm
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

5. Complications of PID
(cefotetan OR cefoxitin) AND doxycycline
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Calcium oxalate crystals
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

6. Sx of hypercalcemia
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
MCC melanoma in Africans/Asians. Under nails - soles - palms.

7. Screened at 16-20 weeks GA for trisomy
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Ask - Advise - Assess - Assist - Arrange
Ampicillin/sulbactam AND doxycycline
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

8. Tx of traveler's diarrhea
Starts at contraction. caused by increased vagal tone from fetal head compression.
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Pneumovax - influenza
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

9. variable deceleration
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
(cefotetan OR cefoxitin) AND doxycycline
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

10. Improve short-term outcomes in acute exacerbations of COPD - asthma
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Steroids + bronchodilators
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Conrtaction monitoring along with fetal heart rate assessment

11. writes name - counts 10 objects
Anaphylaxis
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Clindamycin AND gentamicin
5 yo - draws person - ties shoes - skips

12. DOC for HTN in elderly
Urticaria
Thiazides
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Most aggressive melanoma.

13. Dx PID
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Prostatitis
DTaP - hepB - Hib - rotavirus - inactivated polio
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

14. ADL
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
After delivery until delivery of placenta and membranes <30 mins
Bathing - dressing - eating - transferring - continence - toileting

15. GBS tx
IV penicillin (or ampicillin)
Nuchal translucency - serum hCG - PAPP-A
Ofloxacin OR levofloxacin +/- metronidazole
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

16. Unstable angina vs MI Dx tests
Urticaria
Aortic aneurysm
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

17. tx shoulder dystocia

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18. Sx otitis media
(cefotetan OR cefoxitin) AND doxycycline
Long axis of fetus to long axis of mother (longitudinal or transverse)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Most aggressive melanoma.

19. Tx acute sinusitis
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Thiazides
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
DTaP - hepB - Hib - rotavirus - inactivated polio

20. Low serum iron - low MCV - low ferritin - +stool guaiac
Onset of labor until cervix dilation
9 mo - walks - throws - 1-3 words - 1-step commands
Clindamycin AND gentamicin
Fe deficient anemia

21. Tx for thyroid storm
Metronidazole or clindamycin
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

22. Sx epiglottitis
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
MTX
Stridor - drooling - toxic appearance
Anterior shoulder cannot readily pass below the pubic symphysis.

23. Sx peritonsillar abscess
Alpha-1 antitrypsin deficiency
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
MTX

24. IUPC (intrauterine pressure catheter)
Calcium oxalate crystals
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Conrtaction monitoring along with fetal heart rate assessment
Measures strength of contractions

25. social interaction
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
110-160bpm
4 yo - copies triangle - catches ball - dresses self
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

26. social smile - parent recognition
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
6 yo
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

27. Augments contractions
Oxytocin (IV)
Calcium hydroxyapatite crystals
Age-related sensorineural hearing loss (high frequency and speech discrimination)
6 yo

28. Regards human face - eye contact
Prostatitis
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Diabetes - HTN - GN
1 mo - eyes follow object to midline - vocalizes

29. Oral tx for PID
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
2 mo - eyes follow object past midline - rolls over - laughs - squeals
MTX
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

30. Malignancies with hypercalcemia
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Ampicillin/sulbactam AND doxycycline
5+ rads
Lung; SCC head & neck; RCC; breast; MM; prostate

31. Sx otitis externa
Age-related sensorineural hearing loss (high frequency and speech discrimination)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Ear pain - itching - inflammation/swollen canal - exudates/discharge

32. IV tx for PID
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Oxytocin (IV)
Ampicillin/sulbactam AND doxycycline
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

33. Tocodynamometer
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
9 mo - walks - throws - 1-3 words - 1-step commands
Conrtaction monitoring along with fetal heart rate assessment
Age-related sensorineural hearing loss (high frequency and speech discrimination)

34. DDX for geriatric hearing impairment
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
After delivery until delivery of placenta and membranes <30 mins
MCC melanoma. Radial growth.
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

35. stranger/separation anxiety
6-9MO
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Bathing - dressing - eating - transferring - continence - toileting
Ceftriaxone 125mg IM

36. Rod shaped - rhomboid - weakly positive birefringent
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Nuchal translucency - serum hCG - PAPP-A
Anaphylaxis
Calcium pyrophosphate dehydrate crystals (pseudogout)

37. Superficial spreading melanoma
Monosodium urate crystals (gout)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Cataracts
MCC melanoma. Radial growth.

38. group play - gender - knows name
6 yo
3 yo - identify body part - copies square - hops - throws - past tense - story telling
(cefotetan OR cefoxitin) AND doxycycline
Conrtaction monitoring along with fetal heart rate assessment

39. Other causes of hypercalcemia
(cefotetan OR cefoxitin) AND doxycycline
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Oxytocin (IV)
110-160bpm

40. Late deceleration
Ask - Advise - Assess - Assist - Arrange
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Ceftriaxone 125mg IM

41. Only therapy to decrease mortality in stage IV COPD
Ceftriaxone 125mg IM
Oxygen intervention 15h/d
Monosodium urate crystals (gout)
Thiazdes; lithium

42. Estimated delivery date (Naegele's rule)
= LMP + 7 days - 3 months
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
6 mo - pincer - crawls - cruises - mamma - dada - byebye
After delivery until delivery of placenta and membranes <30 mins

43. Tx for anaphylaxis
Esophagitis - gastritis - dysphagia
0.2-0.5mg aqueous EPI IM/SubQ
Calcium oxalate crystals
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

44. complications of otitis media
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
2 mo - eyes follow object past midline - rolls over - laughs - squeals
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Most aggressive melanoma.

45. shoulder dystocia
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Anterior shoulder cannot readily pass below the pubic symphysis.
MTX
Monosodium urate crystals (gout)

46. 1st generation antihistamines
IV penicillin (or ampicillin)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Long axis of fetus to long axis of mother (longitudinal or transverse)
Diphenhydramine - chlorpheniramine - hydroxyzine

47. MONA therapy
(cefotetan OR cefoxitin) AND doxycycline
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

48. Nonfunctioning nodules > 1cm require _____
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Biopsy
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Cataracts

49. Screened at 11-13 weeks GA for trisomy
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Nuchal translucency - serum hCG - PAPP-A
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)
Anterior shoulder cannot readily pass below the pubic symphysis.

50. IADL
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Nuchal translucency - serum hCG - PAPP-A
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
2 mo - eyes follow object past midline - rolls over - laughs - squeals

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Family Medicine/ambulatory 1

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