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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. Tx GAS ifxn
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

2. Fetal lie
6-9MO
Long axis of fetus to long axis of mother (longitudinal or transverse)
Prostatitis
Esophagitis - gastritis - dysphagia

3. Complications of PID
Prostatitis
<20lb - <1YO - Reacts to pain - Responds to noise
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

4. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Nuchal translucency - serum hCG - PAPP-A
16-18 weeks GA
(cefotetan OR cefoxitin) AND doxycycline

5. Tx for anaphylaxis
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
0.2-0.5mg aqueous EPI IM/SubQ
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Fe deficient anemia

6. Immunizations at visit for 6MO
Ceftriaxone 125mg IM
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
DTaP - hepB - Hib - rotavirus - inactivated polio
(ofloxacin OR levofloxacin) +/- metronidazole

7. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Anemia
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Calcium hydroxyapatite crystals
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

8. Electrolyte abnormality that increases the incidence of torsades de pointes
Hypomagnesemia
Ferrous sulfate 325mg tid
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
1 mo - eyes follow object to midline - vocalizes

9. Oral tx for PID
Prostatitis
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
IV penicillin (or ampicillin)
(ofloxacin OR levofloxacin) +/- metronidazole

10. Tocodynamometer
Conrtaction monitoring along with fetal heart rate assessment
4 yo - copies triangle - catches ball - dresses self
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

11. Causes of CKD
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Monosodium urate crystals (gout)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Diabetes - HTN - GN

12. DDX for geriatric hearing impairment
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

13. Only therapy to decrease mortality in stage IV COPD
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
MCC melanoma. Radial growth.
Oxygen intervention 15h/d
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

14. needles - strong negative birefringent (yellow crystals parallel light)
Monosodium urate crystals (gout)
Diphenhydramine - chlorpheniramine - hydroxyzine
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

15. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Thiazides
Urinary calcium. Hyper PTH (high) >> FHH (normal)
IV penicillin (or ampicillin)
Diphenhydramine - chlorpheniramine - hydroxyzine

16. Smoking cessation agents
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Bupropion - varenicline - nicotine replacement
Ferrous sulfate 325mg tid

17. painless - deep - subQ swelling (periorbital - circumoral - facial)
Angioedema
110-160bpm
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
MCC melanoma. Radial growth.

18. bipyramidal - strongly positive birefringent
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Calcium oxalate crystals
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Ear pain - itching - inflammation/swollen canal - exudates/discharge

19. Bisphospohonates sfx
Nicotine inhaler - nasal spray - gum
Esophagitis - gastritis - dysphagia
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

20. parallel play
Anterior shoulder cannot readily pass below the pubic symphysis.
Urticaria
Most aggressive melanoma.
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

21. First stage of labor
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Onset of labor until cervix dilation
1 mo - eyes follow object to midline - vocalizes
Aortic aneurysm

22. Recommendations for rear-facing car seat
<20lb - <1YO - Reacts to pain - Responds to noise
5+ rads
6 yo
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

23. medications causing hypercalcemia
Thiazdes; lithium
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Prostatitis

24. Fe deficient anemia tx
Alpha-1 antitrypsin deficiency
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Ferrous sulfate 325mg tid

25. Superficial spreading melanoma
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Nicotine inhaler - nasal spray - gum
MCC melanoma. Radial growth.
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

26. Pflx for traveler's diarrhea
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Fluoroquinolones
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

27. regards hand
MCC melanoma in Africans/Asians. Under nails - soles - palms.
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Esophagitis - gastritis - dysphagia
4mo - sits unsupported - hand transfer - babbles

28. shoulder dystocia
Anterior shoulder cannot readily pass below the pubic symphysis.
Biopsy
(cefotetan OR cefoxitin) AND doxycycline
IV penicillin (or ampicillin)

29. recognizes strangers
Loratadine - fexofenadine - cetirizine
6 mo - pincer - crawls - cruises - mamma - dada - byebye
After delivery until delivery of placenta and membranes <30 mins
16-18 weeks GA

30. DOC for HTN in elderly
Most aggressive melanoma.
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Nuchal translucency - serum hCG - PAPP-A
Thiazides

31. Improve short-term outcomes in acute exacerbations of COPD - asthma
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Fluoroquinolones
Ofloxacin OR levofloxacin +/- metronidazole
Steroids + bronchodilators

32. CKD Stages
16-18 weeks GA
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
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

33. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
NAC or IV NaHCO3
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Calcium oxalate crystals
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

34. Tx chlamydia
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
= LMP + 7 days - 3 months
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

35. Tender - boggy prostate. Dx?
Cataracts
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
(cefotetan OR cefoxitin) AND doxycycline
Prostatitis

36. Screened at 16-20 weeks GA for trisomy
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

37. Immunizations for COPD patients
Clindamycin AND gentamicin
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Pneumovax - influenza
Thiazides

38. Tx gonorrhea
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)
Measures strength of contractions
Ceftriaxone 125mg IM
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

39. Oral tx for PID
After delivery until delivery of placenta and membranes <30 mins
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Tdap - influenza - pneumovax

40. Tx RA (best long-term outcome)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Thiazdes; lithium
MTX

41. Granulomatous causes of hypercalcemia
Bathing - dressing - eating - transferring - continence - toileting
Tuberculosis; sarcoidosis; hodgkin disease
Nuchal translucency - serum hCG - PAPP-A
16-18 weeks GA

42. IADL
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Cataracts
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

43. IV tx for PID
(cefotetan OR cefoxitin) AND doxycycline
Clindamycin AND gentamicin
Ofloxacin OR levofloxacin +/- metronidazole
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

44. Dx PID
Onset of labor until cervix dilation
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Bathing - dressing - eating - transferring - continence - toileting
Clindamycin AND gentamicin

45. identifies left - right
Calcium hydroxyapatite crystals
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Thiazdes; lithium
6 yo

46. Corrected serum calcium =

47. X-ray of ankle?
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
After delivery until delivery of placenta and membranes <30 mins
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Normal mental status; no other injuries; seen within 10 days of injury

48. Complications of GAS infxn
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Pneumovax - influenza
Nuchal translucency - serum hCG - PAPP-A
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

49. causes of acute bronchitis
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Fluoroquinolones
After delivery until delivery of placenta and membranes <30 mins
6 mo - pincer - crawls - cruises - mamma - dada - byebye

50. Four cardinal fetal movements
Calcium hydroxyapatite crystals
Flexion - internal rotation - extension - external rotation
Esophagitis - gastritis - dysphagia
Metronidazole or clindamycin