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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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1. Mediators released in response to allergen
Onset of labor until cervix dilation
16-18 weeks GA
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

2. Rod shaped - rhomboid - weakly positive birefringent
Calcium pyrophosphate dehydrate crystals (pseudogout)
1 mo - eyes follow object to midline - vocalizes
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Nuchal translucency - serum hCG - PAPP-A

3. Tx for thyroid storm
(cefotetan OR cefoxitin) AND doxycycline
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Calcium oxalate crystals

4. Other causes of hypercalcemia
9 mo - walks - throws - 1-3 words - 1-step commands
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
6-9MO

5. Tx otitis media
Fluoroquinolones
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Lung; SCC head & neck; RCC; breast; MM; prostate
Hypomagnesemia

6. Superficial spreading melanoma
Short-acting + 40mg prednisone x 10-14days
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
MCC melanoma. Radial growth.
(cefotetan OR cefoxitin) AND doxycycline

7. painless - deep - subQ swelling (periorbital - circumoral - facial)
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Angioedema
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Loratadine - fexofenadine - cetirizine

8. Tx GAS ifxn
Stridor - drooling - toxic appearance
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Pneumovax - influenza

9. shoulder dystocia
5+ rads
Flexion - internal rotation - extension - external rotation
(cefotetan OR cefoxitin) AND doxycycline
Anterior shoulder cannot readily pass below the pubic symphysis.

10. Dx criteria for RA
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Thiazides
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

11. Pregnancy class D smoking cessation drugs
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
6 yo
Nicotine inhaler - nasal spray - gum
Ferrous sulfate 325mg tid

12. Nodular melanoma
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Most aggressive melanoma.
(ofloxacin OR levofloxacin) +/- metronidazole
Fluoroquinolones

13. Improve short-term outcomes in acute exacerbations of COPD - asthma
DTaP - hepB - Hib - rotavirus - inactivated polio
After delivery until delivery of placenta and membranes <30 mins
Steroids + bronchodilators
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

14. Oral tx for PID
Tdap - influenza - pneumovax
Ask - Advise - Assess - Assist - Arrange
110-160bpm
(ofloxacin OR levofloxacin) +/- metronidazole

15. MCC blindness worldwide
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Cataracts
Aortic aneurysm
Metronidazole or clindamycin

16. Smoking cessation agents
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Esophagitis - gastritis - dysphagia
Bupropion - varenicline - nicotine replacement
Ofloxacin OR levofloxacin +/- metronidazole

17. Large - irregularly shaped - prutitic - erythematous wheals
Urticaria
Ask - Advise - Assess - Assist - Arrange
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Clindamycin AND gentamicin

18. regards hand
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
4mo - sits unsupported - hand transfer - babbles
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

19. Tocodynamometer
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
Conrtaction monitoring along with fetal heart rate assessment
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

20. Causes of CKD
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Ask - Advise - Assess - Assist - Arrange
Diabetes - HTN - GN
Aortic aneurysm

21. social smile - parent recognition
Colchicine
2 mo - eyes follow object past midline - rolls over - laughs - squeals
IV penicillin (or ampicillin)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

22. IV tx for PID
6-9MO
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Oxytocin (IV)
Clindamycin AND gentamicin

23. Tx RA (best long-term outcome)
Tdap - influenza - pneumovax
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
MTX
Anaphylaxis

24. recognizes strangers
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)
Oxygen intervention 15h/d
6 mo - pincer - crawls - cruises - mamma - dada - byebye
2 mo - eyes follow object past midline - rolls over - laughs - squeals

25. CKD Stages
Ear pain - itching - inflammation/swollen canal - exudates/discharge
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Clindamycin AND gentamicin
Conrtaction monitoring along with fetal heart rate assessment

26. Regards human face - eye contact
1 mo - eyes follow object to midline - vocalizes
Ofloxacin OR levofloxacin +/- metronidazole
6 yo
Long axis of fetus to long axis of mother (longitudinal or transverse)

27. Fetal heart rate range
(ofloxacin OR levofloxacin) +/- metronidazole
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
110-160bpm
(cefotetan OR cefoxitin) AND doxycycline

28. Bacteria causing chronic sinusitis
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Clindamycin AND gentamicin
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

29. Pflx for traveler's diarrhea
Fluoroquinolones
Normal mental status; no other injuries; seen within 10 days of injury
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
After delivery until delivery of placenta and membranes <30 mins

30. Sx otitis media
Calcium pyrophosphate dehydrate crystals (pseudogout)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Cataracts
Esophagitis - gastritis - dysphagia

31. group play - gender - knows name
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Prostatitis
(cefotetan OR cefoxitin) AND doxycycline
Nuchal translucency - serum hCG - PAPP-A

32. Complications of PID
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Colchicine
0.2-0.5mg aqueous EPI IM/SubQ

33. Tx acute sinusitis
Ofloxacin OR levofloxacin +/- metronidazole
After delivery until delivery of placenta and membranes <30 mins
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
5+ rads

34. Malignancies with hypercalcemia
Fluoroquinolones
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Lung; SCC head & neck; RCC; breast; MM; prostate
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

35. Augments contractions
Calcium hydroxyapatite crystals
Stridor - drooling - toxic appearance
Oxytocin (IV)
Oxygen intervention 15h/d

36. needles - strong negative birefringent (yellow crystals parallel light)
Monosodium urate crystals (gout)
9 mo - walks - throws - 1-3 words - 1-step commands
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
6-9MO

37. stranger/separation anxiety
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Ceftriaxone 125mg IM
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Hypomagnesemia

38. Sx epiglottitis
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Tuberculosis; sarcoidosis; hodgkin disease
Stridor - drooling - toxic appearance
Nicotine inhaler - nasal spray - gum

39. presbycusis
Most aggressive melanoma.
Ask - Advise - Assess - Assist - Arrange
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Age-related sensorineural hearing loss (high frequency and speech discrimination)

40. Sx of hypercalcemia
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Bathing - dressing - eating - transferring - continence - toileting
= LMP + 7 days - 3 months

41. Second stage of labor
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Metronidazole or clindamycin
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

42. medications causing hypercalcemia
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Long axis of fetus to long axis of mother (longitudinal or transverse)
Thiazdes; lithium
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)

43. Tx for anaphylaxis
0.2-0.5mg aqueous EPI IM/SubQ
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Ofloxacin OR levofloxacin +/- metronidazole

44. Dx PID
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Clindamycin AND gentamicin

45. 1st generation antihistamines
Diphenhydramine - chlorpheniramine - hydroxyzine
Ofloxacin OR levofloxacin +/- metronidazole
Aortic aneurysm
Conrtaction monitoring along with fetal heart rate assessment

46. Low serum iron - low MCV - low ferritin - +stool guaiac
NAC or IV NaHCO3
Oxytocin (IV)
Fe deficient anemia
= LMP + 7 days - 3 months

47. Optimal time for trisomy screen
16-18 weeks GA
Bupropion - varenicline - nicotine replacement
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Alpha-1 antitrypsin deficiency

48. Only therapy to decrease mortality in stage IV COPD
Oxygen intervention 15h/d
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Calcium oxalate crystals

49. Screened at 11-13 weeks GA for trisomy
Lung; SCC head & neck; RCC; breast; MM; prostate
Nuchal translucency - serum hCG - PAPP-A
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Thiazdes; lithium

50. Emphysema - <45YO - nonsmoker
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Anterior shoulder cannot readily pass below the pubic symphysis.
Alpha-1 antitrypsin deficiency
Nuchal translucency - serum hCG - PAPP-A

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Family Medicine/ambulatory 1

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