Family Medicine/ambulatory 1

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. Rod shaped - rhomboid - weakly positive birefringent
Patch - bupropion - varenicline
Metronidazole or clindamycin
Calcium pyrophosphate dehydrate crystals (pseudogout)
Ceftriaxone 125mg IM


2. identifies left - right
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Tdap - influenza - pneumovax
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
6 yo


3. Electrolyte abnormality that increases the incidence of torsades de pointes
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)
Fe deficient anemia
Hypomagnesemia


4. Tx RA (best long-term outcome)
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)
Loratadine - fexofenadine - cetirizine
6 mo - pincer - crawls - cruises - mamma - dada - byebye
MTX


5. How much radiation is associated with fetal harm?
Esophagitis - gastritis - dysphagia
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
5+ rads


6. Fe deficient anemia tx
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Calcium hydroxyapatite crystals
0.2-0.5mg aqueous EPI IM/SubQ
Ferrous sulfate 325mg tid


7. Emphysema - <45YO - nonsmoker
Anterior shoulder cannot readily pass below the pubic symphysis.
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Ampicillin/sulbactam AND doxycycline
Alpha-1 antitrypsin deficiency


8. IADL
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
1 mo - eyes follow object to midline - vocalizes
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Anemia


9. Tx acute exacerbation COPD
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Short-acting + 40mg prednisone x 10-14days
IV penicillin (or ampicillin)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency


10. group play - gender - knows name
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)


11. IUPC (intrauterine pressure catheter)
Measures strength of contractions
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Bupropion - varenicline - nicotine replacement


12. Sx peritonsillar abscess
6 yo
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Oxygen intervention 15h/d
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)


13. Only therapy to decrease mortality in stage IV COPD
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Bathing - dressing - eating - transferring - continence - toileting
Oxygen intervention 15h/d
Long axis of fetus to long axis of mother (longitudinal or transverse)


14. Sx otitis media
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
IV penicillin (or ampicillin)
Tuberculosis; sarcoidosis; hodgkin disease


15. Sx of hypercalcemia
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Monosodium urate crystals (gout)


16. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
Cataracts
Normal mental status; no other injuries; seen within 10 days of injury
Pneumovax - influenza
NAC or IV NaHCO3


17. Nonfunctioning nodules > 1cm require _____
Biopsy
Pneumovax - influenza
Monosodium urate crystals (gout)
Thiazides


18. Complications of PID
Calcium hydroxyapatite crystals
9 mo - walks - throws - 1-3 words - 1-step commands
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
(ofloxacin OR levofloxacin) +/- metronidazole


19. Tender - boggy prostate. Dx?
6 yo
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
(ofloxacin OR levofloxacin) +/- metronidazole
Prostatitis


20. Dx criteria for RA
Hypomagnesemia
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR


21. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Pneumovax - influenza
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Urinary calcium. Hyper PTH (high) >> FHH (normal)


22. Immunizations at visit for 6MO
DTaP - hepB - Hib - rotavirus - inactivated polio
Thiazdes; lithium
0.2-0.5mg aqueous EPI IM/SubQ
Fe deficient anemia


23. variable deceleration
Flexion - internal rotation - extension - external rotation
<20lb - <1YO - Reacts to pain - Responds to noise
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.


24. Unstable angina vs MI Dx tests
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Anterior shoulder cannot readily pass below the pubic symphysis.
Starts at contraction. caused by increased vagal tone from fetal head compression.
Angioedema


25. Recommended folic acid daily dose
Diphenhydramine - chlorpheniramine - hydroxyzine
Anaphylaxis
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Ear pain - itching - inflammation/swollen canal - exudates/discharge


26. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
0.2-0.5mg aqueous EPI IM/SubQ
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Anemia
Ferrous sulfate 325mg tid


27. IV tx for PID
5+ rads
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Conrtaction monitoring along with fetal heart rate assessment
Clindamycin AND gentamicin


28. Superficial spreading melanoma
Loratadine - fexofenadine - cetirizine
MCC melanoma. Radial growth.
Pneumovax - influenza
Diabetes - HTN - GN


29. Early deceleration
5+ rads
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Starts at contraction. caused by increased vagal tone from fetal head compression.


30. MCC blindness worldwide
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Cataracts
DTaP - hepB - Hib - rotavirus - inactivated polio
Fe deficient anemia


31. social smile - parent recognition
MCC melanoma. Radial growth.
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
2 mo - eyes follow object past midline - rolls over - laughs - squeals


32. Four cardinal fetal movements
4 yo - copies triangle - catches ball - dresses self
Flexion - internal rotation - extension - external rotation
Colchicine
Clindamycin AND gentamicin


33. Tx gonorrhea
Ceftriaxone 125mg IM
MTX
After delivery until delivery of placenta and membranes <30 mins
110-160bpm


34. Second stage of labor
Calcium oxalate crystals
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Measures strength of contractions
6-9MO


35. causes of acute bronchitis
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Ceftriaxone 125mg IM
Oxygen intervention 15h/d
Ofloxacin OR levofloxacin +/- metronidazole


36. parallel play
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Monosodium urate crystals (gout)
Anemia


37. Improve short-term outcomes in acute exacerbations of COPD - asthma
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Anterior shoulder cannot readily pass below the pubic symphysis.
Steroids + bronchodilators
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat


38. Recommendations for rear-facing car seat
<20lb - <1YO - Reacts to pain - Responds to noise
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Alpha-1 antitrypsin deficiency
Ask - Advise - Assess - Assist - Arrange


39. Fetal lie
1 mo - eyes follow object to midline - vocalizes
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Long axis of fetus to long axis of mother (longitudinal or transverse)
= LMP + 7 days - 3 months


40. IV tx for PID
Ampicillin/sulbactam AND doxycycline
Bathing - dressing - eating - transferring - continence - toileting
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
(ofloxacin OR levofloxacin) +/- metronidazole


41. Augments contractions
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Oxytocin (IV)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)


42. Tx for thyroid storm
Normal mental status; no other injuries; seen within 10 days of injury
110-160bpm
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Clindamycin AND gentamicin


43. shoulder dystocia
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Anterior shoulder cannot readily pass below the pubic symphysis.
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Nuchal translucency - serum hCG - PAPP-A


44. Dx PID
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Lung; SCC head & neck; RCC; breast; MM; prostate
Nuchal translucency - serum hCG - PAPP-A
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn


45. Tx hyperkalemia in CKD
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Biopsy
Angioedema


46. Tocodynamometer
Conrtaction monitoring along with fetal heart rate assessment
IV penicillin (or ampicillin)
Metronidazole or clindamycin
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps


47. painless - deep - subQ swelling (periorbital - circumoral - facial)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Angioedema
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)


48. complications of otitis media
5+ rads
5 yo - draws person - ties shoes - skips
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Lung; SCC head & neck; RCC; breast; MM; prostate


49. IV tx for PID
(cefotetan OR cefoxitin) AND doxycycline
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema


50. Acral lentinous melanoma
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Hypomagnesemia
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Normal mental status; no other injuries; seen within 10 days of injury