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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. Bacteria causing chronic sinusitis
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Oxygen intervention 15h/d
Onset of labor until cervix dilation

2. IV tx for PID
Anterior shoulder cannot readily pass below the pubic symphysis.
Ofloxacin OR levofloxacin +/- metronidazole
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Alpha-1 antitrypsin deficiency

3. Rod shaped - rhomboid - weakly positive birefringent
Cataracts
Tdap - influenza - pneumovax
Oxytocin (IV)
Calcium pyrophosphate dehydrate crystals (pseudogout)

4. DOC for HTN in elderly
Nuchal translucency - serum hCG - PAPP-A
Thiazides
Calcium pyrophosphate dehydrate crystals (pseudogout)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

5. Complications of PID
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

6. Recommended folic acid daily dose
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Calcium oxalate crystals
4 yo - copies triangle - catches ball - dresses self

7. causes of acute bronchitis
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Tdap - influenza - pneumovax
Pneumovax - influenza
Starts at contraction. caused by increased vagal tone from fetal head compression.

8. Sx of hypercalcemia
Normal mental status; no other injuries; seen within 10 days of injury
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Ceftriaxone 125mg IM

9. Fetal lie
4mo - sits unsupported - hand transfer - babbles
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Long axis of fetus to long axis of mother (longitudinal or transverse)

10. Tx acute gout
Urticaria
After delivery until delivery of placenta and membranes <30 mins
Colchicine
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. DDX for geriatric hearing impairment
Pneumovax - influenza
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Anemia
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

12. Pregnancy class C smoking cessation drugs
(ofloxacin OR levofloxacin) +/- metronidazole
Patch - bupropion - varenicline
Ampicillin/sulbactam AND doxycycline
Most aggressive melanoma.

13. Tx RA (best long-term outcome)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Nicotine inhaler - nasal spray - gum
MTX

14. Oral tx for PID
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
After delivery until delivery of placenta and membranes <30 mins
Urinary calcium. Hyper PTH (high) >> FHH (normal)
MCC melanoma. Radial growth.

15. IV tx for PID
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
(cefotetan OR cefoxitin) AND doxycycline
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

16. social interaction
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
4 yo - copies triangle - catches ball - dresses self

17. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Long axis of fetus to long axis of mother (longitudinal or transverse)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

18. Granulomatous causes of hypercalcemia
Tuberculosis; sarcoidosis; hodgkin disease
Patch - bupropion - varenicline
Calcium pyrophosphate dehydrate crystals (pseudogout)
5+ rads

19. IV tx for PID
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Ampicillin/sulbactam AND doxycycline
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)

20. Corrected serum calcium =

21. presbycusis
Loratadine - fexofenadine - cetirizine
NAC or IV NaHCO3
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Age-related sensorineural hearing loss (high frequency and speech discrimination)

22. Signs of rupture of membranes

23. bipyramidal - strongly positive birefringent
Calcium oxalate crystals
Measures strength of contractions
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Pneumovax - influenza

24. Tx bacterial vaginosis
Pneumovax - influenza
Bathing - dressing - eating - transferring - continence - toileting
Metronidazole or clindamycin
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

25. 1st generation antihistamines
Monosodium urate crystals (gout)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Diphenhydramine - chlorpheniramine - hydroxyzine
Short-acting + 40mg prednisone x 10-14days

26. cystoplasmic inclusions - not birefringent
Long axis of fetus to long axis of mother (longitudinal or transverse)
Ask - Advise - Assess - Assist - Arrange
Calcium hydroxyapatite crystals
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

27. IV tx for PID
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Urticaria
Clindamycin AND gentamicin
Pneumovax - influenza

28. Optimal time for trisomy screen
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
5 yo - draws person - ties shoes - skips
= LMP + 7 days - 3 months
16-18 weeks GA

29. Four cardinal fetal movements
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Flexion - internal rotation - extension - external rotation
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
4mo - sits unsupported - hand transfer - babbles

30. painless - deep - subQ swelling (periorbital - circumoral - facial)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Angioedema
Ceftriaxone 125mg IM
4 yo - copies triangle - catches ball - dresses self

31. Nodular melanoma
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
MCC melanoma in Africans/Asians. Under nails - soles - palms.
= LMP + 7 days - 3 months
Most aggressive melanoma.

32. Regards human face - eye contact
<20lb - <1YO - Reacts to pain - Responds to noise
Ask - Advise - Assess - Assist - Arrange
1 mo - eyes follow object to midline - vocalizes
Clindamycin AND gentamicin

33. Improve short-term outcomes in acute exacerbations of COPD - asthma
Nuchal translucency - serum hCG - PAPP-A
Nicotine inhaler - nasal spray - gum
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Steroids + bronchodilators

34. CKD Stages
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
0.2-0.5mg aqueous EPI IM/SubQ
NAC or IV NaHCO3
Bupropion - varenicline - nicotine replacement

35. Sx otitis media
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Lung; SCC head & neck; RCC; breast; MM; prostate
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

36. Cockcroft-Gault equation
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Steroids + bronchodilators
Fluoroquinolones
Hypomagnesemia

37. Tx gonorrhea
4mo - sits unsupported - hand transfer - babbles
Ceftriaxone 125mg IM
Tdap - influenza - pneumovax
3 yo - identify body part - copies square - hops - throws - past tense - story telling

38. bacteria causing pharyngitis
Loratadine - fexofenadine - cetirizine
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

39. Sx epiglottitis
Thiazides
Biopsy
Short-acting + 40mg prednisone x 10-14days
Stridor - drooling - toxic appearance

40. Acral lentinous melanoma
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Short-acting + 40mg prednisone x 10-14days
MCC melanoma in Africans/Asians. Under nails - soles - palms.
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)

41. Recommendations for rear-facing car seat
<20lb - <1YO - Reacts to pain - Responds to noise
Bathing - dressing - eating - transferring - continence - toileting
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

42. How much radiation is associated with fetal harm?
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)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
5+ rads

43. Screened at 16-20 weeks GA for trisomy
<20lb - <1YO - Reacts to pain - Responds to noise
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Onset of labor until cervix dilation
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

44. parallel play
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Most aggressive melanoma.
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

45. Immunizations for adult 65YO+
Normal mental status; no other injuries; seen within 10 days of injury
Hypomagnesemia
Calcium oxalate crystals
Tdap - influenza - pneumovax

46. Third stage of labor
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Ear pain - itching - inflammation/swollen canal - exudates/discharge
After delivery until delivery of placenta and membranes <30 mins
Stridor - drooling - toxic appearance

47. tx shoulder dystocia

48. needles - strong negative birefringent (yellow crystals parallel light)
Metronidazole or clindamycin
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Monosodium urate crystals (gout)
DTaP - hepB - Hib - rotavirus - inactivated polio

49. identifies left - right
Ampicillin/sulbactam AND doxycycline
6 yo
Fluoroquinolones
Starts at contraction. caused by increased vagal tone from fetal head compression.

50. Smoking cessation agents
Diabetes - HTN - GN
Bupropion - varenicline - nicotine replacement
Bathing - dressing - eating - transferring - continence - toileting
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors