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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. Tx for anaphylaxis
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
0.2-0.5mg aqueous EPI IM/SubQ
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

2. X-ray on knee?
Short-acting + 40mg prednisone x 10-14days
Diabetes - HTN - GN
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

3. 1st generation antihistamines
Diphenhydramine - chlorpheniramine - hydroxyzine
Monosodium urate crystals (gout)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Tdap - influenza - pneumovax

4. Four cardinal fetal movements
Flexion - internal rotation - extension - external rotation
110-160bpm
Ask - Advise - Assess - Assist - Arrange
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

5. Sx otitis media
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
0.2-0.5mg aqueous EPI IM/SubQ
Onset of labor until cervix dilation
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

6. Rod shaped - rhomboid - weakly positive birefringent
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
= LMP + 7 days - 3 months
Calcium pyrophosphate dehydrate crystals (pseudogout)

7. Electrolyte abnormality that increases the incidence of torsades de pointes
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Hypomagnesemia
Diabetes - HTN - GN

8. Causes of CKD
Diabetes - HTN - GN
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Measures strength of contractions
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

9. Fetal lie
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
NAC or IV NaHCO3
Patch - bupropion - varenicline
Long axis of fetus to long axis of mother (longitudinal or transverse)

10. Dx bacterial vaginosis
Ferrous sulfate 325mg tid
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

11. Nonfunctioning nodules > 1cm require _____
Biopsy
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Lung; SCC head & neck; RCC; breast; MM; prostate
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

12. Dx PID
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Anaphylaxis
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

13. Age by which child says 'mama' and 'dada'
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
6-9MO
Ferrous sulfate 325mg tid
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

14. medications causing hypercalcemia
Thiazdes; lithium
Nicotine inhaler - nasal spray - gum
Conrtaction monitoring along with fetal heart rate assessment
Onset of labor until cervix dilation

15. Mediators released in response to allergen
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Monosodium urate crystals (gout)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

16. MONA therapy
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Ampicillin/sulbactam AND doxycycline

17. Optimal time for trisomy screen
Calcium pyrophosphate dehydrate crystals (pseudogout)
16-18 weeks GA
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Patch - bupropion - varenicline

18. Bacteria causing chronic sinusitis
After delivery until delivery of placenta and membranes <30 mins
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Calcium pyrophosphate dehydrate crystals (pseudogout)
Metronidazole or clindamycin

19. Dx bacterial rhinosinusitis
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)
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

20. Recommendations for rear-facing car seat
<20lb - <1YO - Reacts to pain - Responds to noise
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Bathing - dressing - eating - transferring - continence - toileting
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

21. recognizes strangers
Conrtaction monitoring along with fetal heart rate assessment
Long axis of fetus to long axis of mother (longitudinal or transverse)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
6 mo - pincer - crawls - cruises - mamma - dada - byebye

22. bipyramidal - strongly positive birefringent
Steroids + bronchodilators
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Calcium oxalate crystals
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

23. causes of acute bronchitis
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Clindamycin AND gentamicin
Anterior shoulder cannot readily pass below the pubic symphysis.
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

24. Screened at 11-13 weeks GA for trisomy
6 yo
4 yo - copies triangle - catches ball - dresses self
Nuchal translucency - serum hCG - PAPP-A
Bupropion - varenicline - nicotine replacement

25. Nodular melanoma
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)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Most aggressive melanoma.

26. Tx otitis media
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Stridor - drooling - toxic appearance

27. ADL
Oxytocin (IV)
Bathing - dressing - eating - transferring - continence - toileting
Age-related sensorineural hearing loss (high frequency and speech discrimination)
1 mo - eyes follow object to midline - vocalizes

28. Estimated delivery date (Naegele's rule)
Colchicine
Tuberculosis; sarcoidosis; hodgkin disease
Ask - Advise - Assess - Assist - Arrange
= LMP + 7 days - 3 months

29. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
Patch - bupropion - varenicline
NAC or IV NaHCO3
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
MTX

30. Tx acute gout
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Colchicine
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

31. Granulomatous causes of hypercalcemia
Nicotine inhaler - nasal spray - gum
(cefotetan OR cefoxitin) AND doxycycline
Tuberculosis; sarcoidosis; hodgkin disease
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

32. Acral lentinous melanoma
After delivery until delivery of placenta and membranes <30 mins
MCC melanoma in Africans/Asians. Under nails - soles - palms.
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Diabetes - HTN - GN

33. Oral tx for PID
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Tdap - influenza - pneumovax
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Starts at contraction. caused by increased vagal tone from fetal head compression.

34. Sx epiglottitis
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Ceftriaxone 125mg IM
Stridor - drooling - toxic appearance
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

35. Tx acute sinusitis
After delivery until delivery of placenta and membranes <30 mins
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Esophagitis - gastritis - dysphagia

36. dyspnea - visceral edema - hypotension
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Anaphylaxis

37. Improve short-term outcomes in acute exacerbations of COPD - asthma
MCC melanoma. Radial growth.
Esophagitis - gastritis - dysphagia
Steroids + bronchodilators
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

38. Screened at 16-20 weeks GA for trisomy
Nicotine inhaler - nasal spray - gum
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Monosodium urate crystals (gout)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

39. Complications of GAS infxn
4 yo - copies triangle - catches ball - dresses self
Bathing - dressing - eating - transferring - continence - toileting
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
<20lb - <1YO - Reacts to pain - Responds to noise

40. How much radiation is associated with fetal harm?
5+ rads
Long axis of fetus to long axis of mother (longitudinal or transverse)
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)
Ofloxacin OR levofloxacin +/- metronidazole

41. X-ray of ankle?
Biopsy
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Normal mental status; no other injuries; seen within 10 days of injury
4mo - sits unsupported - hand transfer - babbles

42. Lentigo Maligna
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
110-160bpm

43. Tx bacterial vaginosis
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Most aggressive melanoma.
4 yo - copies triangle - catches ball - dresses self
Metronidazole or clindamycin

44. Smoking cessation agents
Bupropion - varenicline - nicotine replacement
Thiazdes; lithium
After delivery until delivery of placenta and membranes <30 mins
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

45. Tx of traveler's diarrhea
Bupropion - varenicline - nicotine replacement
Lung; SCC head & neck; RCC; breast; MM; prostate
Ampicillin/sulbactam AND doxycycline
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

46. social interaction
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
4 yo - copies triangle - catches ball - dresses self
Oxygen intervention 15h/d

47. Late deceleration
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Calcium hydroxyapatite crystals

48. Tx gonorrhea
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Ceftriaxone 125mg IM
MCC melanoma in Africans/Asians. Under nails - soles - palms.

49. writes name - counts 10 objects
Thiazdes; lithium
Diphenhydramine - chlorpheniramine - hydroxyzine
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
5 yo - draws person - ties shoes - skips

50. Corrected serum calcium =