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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. Smoking cessation agents
DTaP - hepB - Hib - rotavirus - inactivated polio
Bupropion - varenicline - nicotine replacement
Flexion - internal rotation - extension - external rotation
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

2. Screened at 16-20 weeks GA for trisomy
Anemia
Anaphylaxis
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

3. Late deceleration
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
MCC melanoma. Radial growth.

4. Rod shaped - rhomboid - weakly positive birefringent
6 yo
Age-related sensorineural hearing loss (high frequency and speech discrimination)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Calcium pyrophosphate dehydrate crystals (pseudogout)

5. Tx of traveler's diarrhea
Urticaria
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Ear pain - itching - inflammation/swollen canal - exudates/discharge

6. Tx hyperkalemia in CKD
Esophagitis - gastritis - dysphagia
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Measures strength of contractions

7. Immunizations at visit for 6MO
DTaP - hepB - Hib - rotavirus - inactivated polio
Tuberculosis; sarcoidosis; hodgkin disease
Prostatitis
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

8. Sx otitis media
9 mo - walks - throws - 1-3 words - 1-step commands
Tdap - influenza - pneumovax
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

9. variable deceleration
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

10. Large - irregularly shaped - prutitic - erythematous wheals
Urticaria
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)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Diabetes - HTN - GN

11. parallel play
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

12. Optimal time for trisomy screen
5 yo - draws person - ties shoes - skips
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
16-18 weeks GA
Thiazdes; lithium

13. medications causing hypercalcemia
Tuberculosis; sarcoidosis; hodgkin disease
Thiazdes; lithium
(ofloxacin OR levofloxacin) +/- metronidazole
Pneumovax - influenza

14. The five A's of smoking cessation
Biopsy
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Ask - Advise - Assess - Assist - Arrange
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

15. Bisphospohonates sfx
Esophagitis - gastritis - dysphagia
110-160bpm
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Urticaria

16. Superficial spreading melanoma
MCC melanoma. Radial growth.
3 yo - identify body part - copies square - hops - throws - past tense - story telling
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

17. shoulder dystocia
Thiazdes; lithium
Anterior shoulder cannot readily pass below the pubic symphysis.
Conrtaction monitoring along with fetal heart rate assessment
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

18. First stage of labor
16-18 weeks GA
5 yo - draws person - ties shoes - skips
Onset of labor until cervix dilation
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

19. presbycusis
Hypomagnesemia
Monosodium urate crystals (gout)
Age-related sensorineural hearing loss (high frequency and speech discrimination)
4mo - sits unsupported - hand transfer - babbles

20. Immunizations for adult 65YO+
Tdap - influenza - pneumovax
Clindamycin AND gentamicin
3 yo - identify body part - copies square - hops - throws - past tense - story telling
110-160bpm

21. Third stage of labor
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
After delivery until delivery of placenta and membranes <30 mins
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

22. Complications of PID
Patch - bupropion - varenicline
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Clindamycin AND gentamicin

23. Unstable angina vs MI Dx tests
Calcium oxalate crystals
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
MCC melanoma. Radial growth.
Stridor - drooling - toxic appearance

24. How much radiation is associated with fetal harm?
Hypomagnesemia
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
5+ rads

25. Bacteria causing chronic sinusitis
MTX
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

26. Dx bacterial rhinosinusitis
Calcium pyrophosphate dehydrate crystals (pseudogout)
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)
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

27. Immunizations for COPD patients
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Pneumovax - influenza
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

28. IADL
Lung; SCC head & neck; RCC; breast; MM; prostate
Hypomagnesemia
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
6 yo

29. Dx bacterial vaginosis
Pneumovax - influenza
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.
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

30. Early deceleration
Most aggressive melanoma.
Starts at contraction. caused by increased vagal tone from fetal head compression.
IV penicillin (or ampicillin)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

31. 2nd generation antihistamines
Loratadine - fexofenadine - cetirizine
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)
Fe deficient anemia
Angioedema

32. writes name - counts 10 objects
IV penicillin (or ampicillin)
5 yo - draws person - ties shoes - skips
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)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

33. Improve short-term outcomes in acute exacerbations of COPD - asthma
Steroids + bronchodilators
Diabetes - HTN - GN
Anterior shoulder cannot readily pass below the pubic symphysis.
MTX

34. Sx epiglottitis
Stridor - drooling - toxic appearance
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
6 yo

35. bacteria causing pharyngitis
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Ampicillin/sulbactam AND doxycycline
Age-related sensorineural hearing loss (high frequency and speech discrimination)

36. Only therapy to decrease mortality in stage IV COPD
Oxygen intervention 15h/d
110-160bpm
Biopsy
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

37. Tx for anaphylaxis
Nuchal translucency - serum hCG - PAPP-A
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Clindamycin AND gentamicin
0.2-0.5mg aqueous EPI IM/SubQ

38. Fetal heart rate range
110-160bpm
Calcium oxalate crystals
Pneumovax - influenza
Fluoroquinolones

39. Malignancies with hypercalcemia
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Lung; SCC head & neck; RCC; breast; MM; prostate

40. social smile - parent recognition
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)
Anaphylaxis
Ofloxacin OR levofloxacin +/- metronidazole
2 mo - eyes follow object past midline - rolls over - laughs - squeals

41. Sx of hypercalcemia
Calcium oxalate crystals
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Anemia

42. Tx RA (best long-term outcome)
MTX
Cataracts
Anemia
4mo - sits unsupported - hand transfer - babbles

43. Age by which child says 'mama' and 'dada'
4 yo - copies triangle - catches ball - dresses self
Age-related sensorineural hearing loss (high frequency and speech discrimination)
6-9MO
Clindamycin AND gentamicin

44. Tx acute sinusitis
Cataracts
Oxytocin (IV)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

45. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Anemia
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Measures strength of contractions

46. Tender - boggy prostate. Dx?
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Starts at contraction. caused by increased vagal tone from fetal head compression.
Prostatitis

47. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Cataracts
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Alpha-1 antitrypsin deficiency

48. Four cardinal fetal movements
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Flexion - internal rotation - extension - external rotation

49. Pflx for traveler's diarrhea
Fluoroquinolones
Ofloxacin OR levofloxacin +/- metronidazole
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
(ofloxacin OR levofloxacin) +/- metronidazole

50. Corrected serum calcium =