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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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1. MONA therapy
Patch - bupropion - varenicline
6-9MO
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

2. Granulomatous causes of hypercalcemia
Stridor - drooling - toxic appearance
Tuberculosis; sarcoidosis; hodgkin disease
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Ampicillin/sulbactam AND doxycycline

3. Tx acute gout
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Colchicine
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

4. Second stage of labor
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Loratadine - fexofenadine - cetirizine

5. DDX for geriatric hearing impairment
Loratadine - fexofenadine - cetirizine
0.2-0.5mg aqueous EPI IM/SubQ
Oxygen intervention 15h/d
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

6. Tx GAS ifxn
After delivery until delivery of placenta and membranes <30 mins
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Thiazdes; lithium
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

7. Sx peritonsillar abscess
NAC or IV NaHCO3
Anterior shoulder cannot readily pass below the pubic symphysis.
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

8. Tx otitis media
2 mo - eyes follow object past midline - rolls over - laughs - squeals
4 yo - copies triangle - catches ball - dresses self
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
1 mo - eyes follow object to midline - vocalizes

9. bipyramidal - strongly positive birefringent
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Ceftriaxone 125mg IM
Calcium oxalate crystals
16-18 weeks GA

10. Dx PID
Calcium hydroxyapatite crystals
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)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Ampicillin/sulbactam AND doxycycline

11. Four cardinal fetal movements
Esophagitis - gastritis - dysphagia
6-9MO
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Flexion - internal rotation - extension - external rotation

12. Regards human face - eye contact
Bupropion - varenicline - nicotine replacement
Oxytocin (IV)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
1 mo - eyes follow object to midline - vocalizes

13. Dx bacterial vaginosis
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Lung; SCC head & neck; RCC; breast; MM; prostate
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

14. presbycusis
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
0.2-0.5mg aqueous EPI IM/SubQ
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Pneumovax - influenza

15. complications of otitis media
16-18 weeks GA
DTaP - hepB - Hib - rotavirus - inactivated polio
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Nuchal translucency - serum hCG - PAPP-A

16. Nodular melanoma
Most aggressive melanoma.
<20lb - <1YO - Reacts to pain - Responds to noise
Biopsy
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

17. Large - irregularly shaped - prutitic - erythematous wheals
Ofloxacin OR levofloxacin +/- metronidazole
Urticaria
Fe deficient anemia
Normal mental status; no other injuries; seen within 10 days of injury

18. Fetal heart rate range
110-160bpm
Conrtaction monitoring along with fetal heart rate assessment
(ofloxacin OR levofloxacin) +/- metronidazole
Ear pain - itching - inflammation/swollen canal - exudates/discharge

19. Corrected serum calcium =

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20. Tx gonorrhea
Pneumovax - influenza
<20lb - <1YO - Reacts to pain - Responds to noise
IV penicillin (or ampicillin)
Ceftriaxone 125mg IM

21. Optimal time for trisomy screen
16-18 weeks GA
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Measures strength of contractions
4 yo - copies triangle - catches ball - dresses self

22. Early deceleration
Ceftriaxone 125mg IM
Starts at contraction. caused by increased vagal tone from fetal head compression.
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

23. social interaction
Ceftriaxone 125mg IM
4 yo - copies triangle - catches ball - dresses self
Diabetes - HTN - GN
Age-related sensorineural hearing loss (high frequency and speech discrimination)

24. shoulder dystocia
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
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)
Anterior shoulder cannot readily pass below the pubic symphysis.

25. 1st generation antihistamines
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Thiazdes; lithium
NAC or IV NaHCO3
Diphenhydramine - chlorpheniramine - hydroxyzine

26. Oral tx for PID
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
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)
Urticaria

27. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Diphenhydramine - chlorpheniramine - hydroxyzine
DTaP - hepB - Hib - rotavirus - inactivated polio
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Anemia

28. Emphysema - <45YO - nonsmoker
NAC or IV NaHCO3
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Biopsy
Alpha-1 antitrypsin deficiency

29. Estimated delivery date (Naegele's rule)
Fe deficient anemia
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
= LMP + 7 days - 3 months
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

30. Improve short-term outcomes in acute exacerbations of COPD - asthma
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Steroids + bronchodilators
Loratadine - fexofenadine - cetirizine

31. Low serum iron - low MCV - low ferritin - +stool guaiac
MCC melanoma. Radial growth.
Fe deficient anemia
0.2-0.5mg aqueous EPI IM/SubQ
Urticaria

32. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
Anterior shoulder cannot readily pass below the pubic symphysis.
1 mo - eyes follow object to midline - vocalizes
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
NAC or IV NaHCO3

33. regards hand
Bupropion - varenicline - nicotine replacement
Clindamycin AND gentamicin
4mo - sits unsupported - hand transfer - babbles
4 yo - copies triangle - catches ball - dresses self

34. Tx of traveler's diarrhea
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Ask - Advise - Assess - Assist - Arrange
Stridor - drooling - toxic appearance
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

35. First stage of labor
Onset of labor until cervix dilation
3 yo - identify body part - copies square - hops - throws - past tense - story telling
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Age-related sensorineural hearing loss (high frequency and speech discrimination)

36. writes name - counts 10 objects
DTaP - hepB - Hib - rotavirus - inactivated polio
Angioedema
Anaphylaxis
5 yo - draws person - ties shoes - skips

37. Unstable angina vs MI Dx tests
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Steroids + bronchodilators
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

38. Recommended folic acid daily dose
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Thiazides
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

39. Electrolyte abnormality that increases the incidence of torsades de pointes
0.2-0.5mg aqueous EPI IM/SubQ
Hypomagnesemia
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

40. IUPC (intrauterine pressure catheter)
Measures strength of contractions
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Pneumovax - influenza
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

41. Tx bacterial vaginosis
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Metronidazole or clindamycin
Nuchal translucency - serum hCG - PAPP-A

42. DOC for HTN in elderly
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Thiazides
Clindamycin AND gentamicin
Steroids + bronchodilators

43. Sx otitis externa
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

44. Immunizations at visit for 6MO
DTaP - hepB - Hib - rotavirus - inactivated polio
Calcium pyrophosphate dehydrate crystals (pseudogout)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Thiazdes; lithium

45. Late deceleration
Fluoroquinolones
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Hypomagnesemia

46. Only therapy to decrease mortality in stage IV COPD
Oxygen intervention 15h/d
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)
Ampicillin/sulbactam AND doxycycline
Hypomagnesemia

47. 2nd generation antihistamines
Loratadine - fexofenadine - cetirizine
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
9 mo - walks - throws - 1-3 words - 1-step commands
0.2-0.5mg aqueous EPI IM/SubQ

48. Tx hyperkalemia in CKD
Alpha-1 antitrypsin deficiency
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
6 yo

49. MCC blindness worldwide
Calcium hydroxyapatite crystals
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Cataracts
16-18 weeks GA

50. IADL
DTaP - hepB - Hib - rotavirus - inactivated polio
Calcium pyrophosphate dehydrate crystals (pseudogout)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

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Family Medicine/ambulatory 1

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