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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.
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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. Dx criteria for RA
Anterior shoulder cannot readily pass below the pubic symphysis.
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Patch - bupropion - varenicline

2. group play - gender - knows name
(ofloxacin OR levofloxacin) +/- metronidazole
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Loratadine - fexofenadine - cetirizine

3. presbycusis
5+ rads
Age-related sensorineural hearing loss (high frequency and speech discrimination)
0.2-0.5mg aqueous EPI IM/SubQ
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

4. recognizes strangers
Anterior shoulder cannot readily pass below the pubic symphysis.
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Fe deficient anemia
After delivery until delivery of placenta and membranes <30 mins

5. bacteria causing pharyngitis
6 yo
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
4 yo - copies triangle - catches ball - dresses self

6. Superficial spreading melanoma
MCC melanoma. Radial growth.
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Stridor - drooling - toxic appearance
Ferrous sulfate 325mg tid

7. IADL
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Hypomagnesemia
Loratadine - fexofenadine - cetirizine
MCC melanoma in Africans/Asians. Under nails - soles - palms.

8. Malignancies with hypercalcemia
Lung; SCC head & neck; RCC; breast; MM; prostate
6-9MO
110-160bpm
Diabetes - HTN - GN

9. Signs of rupture of membranes

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10. writes name - counts 10 objects
6 yo
Patch - bupropion - varenicline
5 yo - draws person - ties shoes - skips
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

11. CKD Stages
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

12. Smoking cessation agents
3 yo - identify body part - copies square - hops - throws - past tense - story telling
(ofloxacin OR levofloxacin) +/- metronidazole
Colchicine
Bupropion - varenicline - nicotine replacement

13. Nodular melanoma
Most aggressive melanoma.
Steroids + bronchodilators
Tdap - influenza - pneumovax
Pneumovax - influenza

14. Bisphospohonates sfx
= LMP + 7 days - 3 months
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Stridor - drooling - toxic appearance
Esophagitis - gastritis - dysphagia

15. stranger/separation anxiety
MCC melanoma in Africans/Asians. Under nails - soles - palms.
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Alpha-1 antitrypsin deficiency
Urinary calcium. Hyper PTH (high) >> FHH (normal)

16. Early deceleration
5 yo - draws person - ties shoes - skips
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Starts at contraction. caused by increased vagal tone from fetal head compression.

17. Sx otitis externa
Oxygen intervention 15h/d
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Ear pain - itching - inflammation/swollen canal - exudates/discharge
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

18. dyspnea - visceral edema - hypotension
Anaphylaxis
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
6-9MO
Calcium oxalate crystals

19. GBS tx
IV penicillin (or ampicillin)
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

20. IV tx for PID
Clindamycin AND gentamicin
5+ rads
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Age-related sensorineural hearing loss (high frequency and speech discrimination)

21. Tx bacterial vaginosis
Metronidazole or clindamycin
4 yo - copies triangle - catches ball - dresses self
Short-acting + 40mg prednisone x 10-14days
Diphenhydramine - chlorpheniramine - hydroxyzine

22. bipyramidal - strongly positive birefringent
Angioedema
(ofloxacin OR levofloxacin) +/- metronidazole
Alpha-1 antitrypsin deficiency
Calcium oxalate crystals

23. Complications of GAS infxn
1 mo - eyes follow object to midline - vocalizes
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Most aggressive melanoma.
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

24. How much radiation is associated with fetal harm?
= LMP + 7 days - 3 months
Pneumovax - influenza
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
5+ rads

25. Fetal heart rate range
110-160bpm
Nuchal translucency - serum hCG - PAPP-A
5 yo - draws person - ties shoes - skips
Flexion - internal rotation - extension - external rotation

26. Sx peritonsillar abscess
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Thiazdes; lithium
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

27. Corrected serum calcium =

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28. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
MCC melanoma. Radial growth.
Colchicine
Tuberculosis; sarcoidosis; hodgkin disease
Urinary calcium. Hyper PTH (high) >> FHH (normal)

29. social interaction
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
4 yo - copies triangle - catches ball - dresses self
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Calcium hydroxyapatite crystals

30. IV tx for PID
<20lb - <1YO - Reacts to pain - Responds to noise
Ampicillin/sulbactam AND doxycycline
Colchicine
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

31. Screening for 65-76YO male smoker
Aortic aneurysm
Oxygen intervention 15h/d
<20lb - <1YO - Reacts to pain - Responds to noise
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

32. Cockcroft-Gault equation
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Starts at contraction. caused by increased vagal tone from fetal head compression.
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

33. Sx epiglottitis
6-9MO
Stridor - drooling - toxic appearance
Biopsy
Aortic aneurysm

34. parallel play
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

35. Four cardinal fetal movements
Cataracts
(ofloxacin OR levofloxacin) +/- metronidazole
Flexion - internal rotation - extension - external rotation
Ceftriaxone 125mg IM

36. social smile - parent recognition
Conrtaction monitoring along with fetal heart rate assessment
(ofloxacin OR levofloxacin) +/- metronidazole
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Long axis of fetus to long axis of mother (longitudinal or transverse)

37. Bacteria causing chronic sinusitis
IV penicillin (or ampicillin)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Anterior shoulder cannot readily pass below the pubic symphysis.
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

38. Tx for anaphylaxis
0.2-0.5mg aqueous EPI IM/SubQ
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Ferrous sulfate 325mg tid
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

39. Pflx for traveler's diarrhea
Fluoroquinolones
Alpha-1 antitrypsin deficiency
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

40. Tx chlamydia
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Loratadine - fexofenadine - cetirizine
Most aggressive melanoma.

41. Dx PID
2 mo - eyes follow object past midline - rolls over - laughs - squeals
0.2-0.5mg aqueous EPI IM/SubQ
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Lung; SCC head & neck; RCC; breast; MM; prostate

42. Other causes of hypercalcemia
Pneumovax - influenza
4 yo - copies triangle - catches ball - dresses self
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Normal mental status; no other injuries; seen within 10 days of injury

43. Tx GAS ifxn
Ofloxacin OR levofloxacin +/- metronidazole
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

44. Late deceleration
Alpha-1 antitrypsin deficiency
Urticaria
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
After delivery until delivery of placenta and membranes <30 mins

45. ADL
Colchicine
Oxygen intervention 15h/d
Bathing - dressing - eating - transferring - continence - toileting
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

46. Oral tx for PID
(ofloxacin OR levofloxacin) +/- metronidazole
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)
Aortic aneurysm
Diphenhydramine - chlorpheniramine - hydroxyzine

47. Tender - boggy prostate. Dx?
(ofloxacin OR levofloxacin) +/- metronidazole
Prostatitis
Onset of labor until cervix dilation
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

48. Tx acute exacerbation COPD
110-160bpm
Ofloxacin OR levofloxacin +/- metronidazole
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Short-acting + 40mg prednisone x 10-14days

49. 2nd generation antihistamines
Metronidazole or clindamycin
Stridor - drooling - toxic appearance
Loratadine - fexofenadine - cetirizine
Oxygen intervention 15h/d

50. Causes of CKD
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Ask - Advise - Assess - Assist - Arrange
Diabetes - HTN - GN
9 mo - walks - throws - 1-3 words - 1-step commands

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Family Medicine/ambulatory 1

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