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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. Regards human face - eye contact
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
1 mo - eyes follow object to midline - vocalizes
Short-acting + 40mg prednisone x 10-14days
Ofloxacin OR levofloxacin +/- metronidazole

2. Acral lentinous melanoma
Biopsy
4 yo - copies triangle - catches ball - dresses self
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Monosodium urate crystals (gout)

3. Tx otitis media
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Anaphylaxis

4. Tx GAS ifxn
Anterior shoulder cannot readily pass below the pubic symphysis.
Most aggressive melanoma.
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

5. DDX for geriatric hearing impairment
Long axis of fetus to long axis of mother (longitudinal or transverse)
Calcium hydroxyapatite crystals
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Hypomagnesemia

6. 2nd generation antihistamines
Loratadine - fexofenadine - cetirizine
6 yo
Nicotine inhaler - nasal spray - gum
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

7. Smoking cessation agents
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Bupropion - varenicline - nicotine replacement

8. Fetal lie
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
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)
Urticaria

9. Dx PID
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
NAC or IV NaHCO3
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

10. Dx bacterial rhinosinusitis
Anemia
Fluoroquinolones
2 mo - eyes follow object past midline - rolls over - laughs - squeals
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)

11. Mediators released in response to allergen
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

12. Bisphospohonates sfx
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
After delivery until delivery of placenta and membranes <30 mins
Alpha-1 antitrypsin deficiency
Esophagitis - gastritis - dysphagia

13. Electrolyte abnormality that increases the incidence of torsades de pointes
Fe deficient anemia
Hypomagnesemia
Anterior shoulder cannot readily pass below the pubic symphysis.
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

14. Age by which child says 'mama' and 'dada'
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
6-9MO
(ofloxacin OR levofloxacin) +/- metronidazole
DTaP - hepB - Hib - rotavirus - inactivated polio

15. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
4mo - sits unsupported - hand transfer - babbles
Starts at contraction. caused by increased vagal tone from fetal head compression.
Calcium oxalate crystals

16. Tx for anaphylaxis
0.2-0.5mg aqueous EPI IM/SubQ
Nicotine inhaler - nasal spray - gum
Ceftriaxone 125mg IM
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

17. Pflx for traveler's diarrhea
Fluoroquinolones
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
4 yo - copies triangle - catches ball - dresses self

18. variable deceleration
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Long axis of fetus to long axis of mother (longitudinal or transverse)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Prostatitis

19. Screened at 16-20 weeks GA for trisomy
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Anterior shoulder cannot readily pass below the pubic symphysis.
5+ rads

20. Rod shaped - rhomboid - weakly positive birefringent
After delivery until delivery of placenta and membranes <30 mins
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Calcium pyrophosphate dehydrate crystals (pseudogout)
Esophagitis - gastritis - dysphagia

21. Tx acute exacerbation COPD
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Loratadine - fexofenadine - cetirizine
Short-acting + 40mg prednisone x 10-14days
Ofloxacin OR levofloxacin +/- metronidazole

22. Tender - boggy prostate. Dx?
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Prostatitis
Starts at contraction. caused by increased vagal tone from fetal head compression.
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

23. Tx acute sinusitis
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Patch - bupropion - varenicline

24. Complications of PID
MTX
Diabetes - HTN - GN
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

25. causes of acute bronchitis
Biopsy
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Metronidazole or clindamycin
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

26. Late deceleration
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Pneumovax - influenza
Tdap - influenza - pneumovax
Ask - Advise - Assess - Assist - Arrange

27. Granulomatous causes of hypercalcemia
Most aggressive melanoma.
Tuberculosis; sarcoidosis; hodgkin disease
Urticaria
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

28. Sx peritonsillar abscess
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Pneumovax - influenza

29. Four cardinal fetal movements
Prostatitis
Calcium oxalate crystals
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Flexion - internal rotation - extension - external rotation

30. dyspnea - visceral edema - hypotension
Steroids + bronchodilators
Anaphylaxis
16-18 weeks GA
Ask - Advise - Assess - Assist - Arrange

31. Estimated delivery date (Naegele's rule)
= LMP + 7 days - 3 months
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Diabetes - HTN - GN
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

32. social interaction
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Oxytocin (IV)
Bathing - dressing - eating - transferring - continence - toileting
4 yo - copies triangle - catches ball - dresses self

33. Tx gonorrhea
Ceftriaxone 125mg IM
Biopsy
Steroids + bronchodilators
Most aggressive melanoma.

34. medications causing hypercalcemia
Measures strength of contractions
6-9MO
Thiazdes; lithium
Ear pain - itching - inflammation/swollen canal - exudates/discharge

35. bacteria causing pharyngitis
16-18 weeks GA
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Prostatitis
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

36. 1st generation antihistamines
Diphenhydramine - chlorpheniramine - hydroxyzine
Esophagitis - gastritis - dysphagia
Monosodium urate crystals (gout)
6 yo

37. Augments contractions
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Esophagitis - gastritis - dysphagia
Oxytocin (IV)

38. bipyramidal - strongly positive birefringent
Calcium oxalate crystals
Stridor - drooling - toxic appearance
Oxytocin (IV)
Diabetes - HTN - GN

39. Tx RA (best long-term outcome)
MTX
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Fe deficient anemia
Oxytocin (IV)

40. shoulder dystocia
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Anterior shoulder cannot readily pass below the pubic symphysis.
Pneumovax - influenza
Thiazdes; lithium

41. IV tx for PID
Clindamycin AND gentamicin
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Calcium hydroxyapatite crystals
Anterior shoulder cannot readily pass below the pubic symphysis.

42. Third stage of labor
(ofloxacin OR levofloxacin) +/- metronidazole
Measures strength of contractions
After delivery until delivery of placenta and membranes <30 mins
9 mo - walks - throws - 1-3 words - 1-step commands

43. Pregnancy class C smoking cessation drugs
Patch - bupropion - varenicline
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)
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Urinary calcium. Hyper PTH (high) >> FHH (normal)

44. parallel play
Aortic aneurysm
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

45. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Urticaria
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

46. painless - deep - subQ swelling (periorbital - circumoral - facial)
110-160bpm
Angioedema
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Alpha-1 antitrypsin deficiency

47. DOC for HTN in elderly
Long axis of fetus to long axis of mother (longitudinal or transverse)
Bupropion - varenicline - nicotine replacement
Thiazides
MCC melanoma in Africans/Asians. Under nails - soles - palms.

48. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
NAC or IV NaHCO3
Onset of labor until cervix dilation
4 yo - copies triangle - catches ball - dresses self
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)

49. cystoplasmic inclusions - not birefringent
Angioedema
Tdap - influenza - pneumovax
MCC melanoma. Radial growth.
Calcium hydroxyapatite crystals

50. IADL
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
After delivery until delivery of placenta and membranes <30 mins
Thiazdes; lithium