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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. Complications of PID
Bathing - dressing - eating - transferring - continence - toileting
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
DTaP - hepB - Hib - rotavirus - inactivated polio

2. Augments contractions
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Normal mental status; no other injuries; seen within 10 days of injury
Tdap - influenza - pneumovax
Oxytocin (IV)

3. Screened at 16-20 weeks GA for trisomy
Angioedema
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

4. shoulder dystocia
Hypomagnesemia
NAC or IV NaHCO3
Anterior shoulder cannot readily pass below the pubic symphysis.
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

5. regards hand
Stridor - drooling - toxic appearance
Calcium pyrophosphate dehydrate crystals (pseudogout)
4mo - sits unsupported - hand transfer - babbles
Ask - Advise - Assess - Assist - Arrange

6. GBS tx
IV penicillin (or ampicillin)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Alpha-1 antitrypsin deficiency
Ofloxacin OR levofloxacin +/- metronidazole

7. Oral tx for PID
Cataracts
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Ferrous sulfate 325mg tid

8. Fetal heart rate range
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Cataracts
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
110-160bpm

9. explorations
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
9 mo - walks - throws - 1-3 words - 1-step commands
Patch - bupropion - varenicline
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

10. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Bupropion - varenicline - nicotine replacement
Ceftriaxone 125mg IM
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. Tx gonorrhea
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Ceftriaxone 125mg IM
Alpha-1 antitrypsin deficiency
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

12. Sx otitis media
Biopsy
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Bupropion - varenicline - nicotine replacement
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

13. Fe deficient anemia tx
Ferrous sulfate 325mg tid
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
0.2-0.5mg aqueous EPI IM/SubQ
Lung; SCC head & neck; RCC; breast; MM; prostate

14. The five A's of smoking cessation
Oxytocin (IV)
Ask - Advise - Assess - Assist - Arrange
1 mo - eyes follow object to midline - vocalizes
= LMP + 7 days - 3 months

15. Immunizations at visit for 6MO
1 mo - eyes follow object to midline - vocalizes
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
DTaP - hepB - Hib - rotavirus - inactivated polio
Most aggressive melanoma.

16. Nonfunctioning nodules > 1cm require _____
Biopsy
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
4 yo - copies triangle - catches ball - dresses self
Age-related sensorineural hearing loss (high frequency and speech discrimination)

17. DDX for geriatric hearing impairment
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Metronidazole or clindamycin

18. Late deceleration
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Colchicine
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Nuchal translucency - serum hCG - PAPP-A

19. Sx of hypercalcemia
Anemia
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Metronidazole or clindamycin
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

20. Emphysema - <45YO - nonsmoker
Ferrous sulfate 325mg tid
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Hypomagnesemia
Alpha-1 antitrypsin deficiency

21. Corrected serum calcium =

22. Sx otitis externa
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Ceftriaxone 125mg IM
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Bathing - dressing - eating - transferring - continence - toileting

23. First stage of labor
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Onset of labor until cervix dilation
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

24. Cockcroft-Gault equation
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Stridor - drooling - toxic appearance
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

25. social smile - parent recognition
2 mo - eyes follow object past midline - rolls over - laughs - squeals
(ofloxacin OR levofloxacin) +/- metronidazole
Monosodium urate crystals (gout)
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

26. Four cardinal fetal movements
Anaphylaxis
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Flexion - internal rotation - extension - external rotation

27. Oral tx for PID
(ofloxacin OR levofloxacin) +/- metronidazole
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
5 yo - draws person - ties shoes - skips
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

28. CKD Stages
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Lung; SCC head & neck; RCC; breast; MM; prostate
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

29. DOC for HTN in elderly
Anterior shoulder cannot readily pass below the pubic symphysis.
Ask - Advise - Assess - Assist - Arrange
Thiazides
Clindamycin AND gentamicin

30. Tx chlamydia
Anemia
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Tdap - influenza - pneumovax

31. Bisphospohonates sfx
Diphenhydramine - chlorpheniramine - hydroxyzine
(cefotetan OR cefoxitin) AND doxycycline
Esophagitis - gastritis - dysphagia
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

32. Only therapy to decrease mortality in stage IV COPD
Ferrous sulfate 325mg tid
5+ rads
Calcium oxalate crystals
Oxygen intervention 15h/d

33. Acral lentinous melanoma
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Nuchal translucency - serum hCG - PAPP-A
Ferrous sulfate 325mg tid
MCC melanoma in Africans/Asians. Under nails - soles - palms.

34. Fetal lie
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Calcium pyrophosphate dehydrate crystals (pseudogout)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Long axis of fetus to long axis of mother (longitudinal or transverse)

35. Tx acute exacerbation COPD
MTX
Short-acting + 40mg prednisone x 10-14days
Pneumovax - influenza
5 yo - draws person - ties shoes - skips

36. variable deceleration
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Diabetes - HTN - GN
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Patch - bupropion - varenicline

37. Early deceleration
Steroids + bronchodilators
Starts at contraction. caused by increased vagal tone from fetal head compression.
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

38. Immunizations for COPD patients
Stridor - drooling - toxic appearance
MTX
Pneumovax - influenza
Nuchal translucency - serum hCG - PAPP-A

39. Sx epiglottitis
Loratadine - fexofenadine - cetirizine
Angioedema
Stridor - drooling - toxic appearance
<20lb - <1YO - Reacts to pain - Responds to noise

40. IADL
Nicotine inhaler - nasal spray - gum
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
6-9MO
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

41. Dx bacterial rhinosinusitis
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Nicotine inhaler - nasal spray - gum
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)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

42. causes of acute bronchitis
(ofloxacin OR levofloxacin) +/- metronidazole
Anterior shoulder cannot readily pass below the pubic symphysis.
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Angioedema

43. Malignancies with hypercalcemia
Lung; SCC head & neck; RCC; breast; MM; prostate
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Biopsy

44. Tx bacterial vaginosis
Metronidazole or clindamycin
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
<20lb - <1YO - Reacts to pain - Responds to noise
After delivery until delivery of placenta and membranes <30 mins

45. social interaction
9 mo - walks - throws - 1-3 words - 1-step commands
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
4 yo - copies triangle - catches ball - dresses self

46. Granulomatous causes of hypercalcemia
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
= LMP + 7 days - 3 months
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Tuberculosis; sarcoidosis; hodgkin disease

47. Unstable angina vs MI Dx tests
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Tuberculosis; sarcoidosis; hodgkin disease
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

48. Recommended folic acid daily dose
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Long axis of fetus to long axis of mother (longitudinal or transverse)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

49. Third stage of labor
After delivery until delivery of placenta and membranes <30 mins
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Cataracts
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

50. Tx acute sinusitis
Aortic aneurysm
5+ rads
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)