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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. Screened at 11-13 weeks GA for trisomy
Nuchal translucency - serum hCG - PAPP-A
Thiazides
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Stridor - drooling - toxic appearance

2. Low serum iron - low MCV - low ferritin - +stool guaiac
Fe deficient anemia
5 yo - draws person - ties shoes - skips
Angioedema
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

3. bipyramidal - strongly positive birefringent
Oxygen intervention 15h/d
Loratadine - fexofenadine - cetirizine
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Calcium oxalate crystals

4. Granulomatous causes of hypercalcemia
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Lung; SCC head & neck; RCC; breast; MM; prostate
Normal mental status; no other injuries; seen within 10 days of injury
Tuberculosis; sarcoidosis; hodgkin disease

5. Complications of PID
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
After delivery until delivery of placenta and membranes <30 mins
6-9MO

6. cystoplasmic inclusions - not birefringent
Calcium hydroxyapatite crystals
Ear pain - itching - inflammation/swollen canal - exudates/discharge
6 yo
Esophagitis - gastritis - dysphagia

7. Estimated delivery date (Naegele's rule)
= LMP + 7 days - 3 months
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Colchicine
Tdap - influenza - pneumovax

8. Acral lentinous melanoma
Pneumovax - influenza
0.2-0.5mg aqueous EPI IM/SubQ
Loratadine - fexofenadine - cetirizine
MCC melanoma in Africans/Asians. Under nails - soles - palms.

9. Rod shaped - rhomboid - weakly positive birefringent
Calcium pyrophosphate dehydrate crystals (pseudogout)
5+ rads
9 mo - walks - throws - 1-3 words - 1-step commands
NAC or IV NaHCO3

10. IV tx for PID
Ampicillin/sulbactam AND doxycycline
9 mo - walks - throws - 1-3 words - 1-step commands
4mo - sits unsupported - hand transfer - babbles
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

11. 1st generation antihistamines
Loratadine - fexofenadine - cetirizine
Normal mental status; no other injuries; seen within 10 days of injury
IV penicillin (or ampicillin)
Diphenhydramine - chlorpheniramine - hydroxyzine

12. Other causes of hypercalcemia
5+ rads
Lung; SCC head & neck; RCC; breast; MM; prostate
Ofloxacin OR levofloxacin +/- metronidazole
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

13. Oral tx for PID
(ofloxacin OR levofloxacin) +/- metronidazole
Ferrous sulfate 325mg tid
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Normal mental status; no other injuries; seen within 10 days of injury

14. Superficial spreading melanoma
MCC melanoma. Radial growth.
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
<20lb - <1YO - Reacts to pain - Responds to noise
Fluoroquinolones

15. Bacteria causing chronic sinusitis
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

16. How much radiation is associated with fetal harm?
Patch - bupropion - varenicline
5+ rads
Bupropion - varenicline - nicotine replacement
Aortic aneurysm

17. Pregnancy class C smoking cessation drugs
Normal mental status; no other injuries; seen within 10 days of injury
Patch - bupropion - varenicline
(cefotetan OR cefoxitin) AND doxycycline
Angioedema

18. regards hand
4mo - sits unsupported - hand transfer - babbles
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

19. Tx hyperkalemia in CKD
Conrtaction monitoring along with fetal heart rate assessment
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Starts at contraction. caused by increased vagal tone from fetal head compression.
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema

20. Tx acute exacerbation COPD
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
Short-acting + 40mg prednisone x 10-14days
Lung; SCC head & neck; RCC; breast; MM; prostate

21. Fe deficient anemia tx
Ferrous sulfate 325mg tid
Diabetes - HTN - GN
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Angioedema

22. Sx epiglottitis
Bupropion - varenicline - nicotine replacement
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)
Stridor - drooling - toxic appearance
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

23. complications of otitis media
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Metronidazole or clindamycin
Urticaria

24. Late deceleration
IV penicillin (or ampicillin)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Fe deficient anemia
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

25. Cockcroft-Gault equation
4 yo - copies triangle - catches ball - dresses self
Conrtaction monitoring along with fetal heart rate assessment
Anaphylaxis
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

26. 2nd generation antihistamines
Aortic aneurysm
Monosodium urate crystals (gout)
<20lb - <1YO - Reacts to pain - Responds to noise
Loratadine - fexofenadine - cetirizine

27. social interaction
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
4 yo - copies triangle - catches ball - dresses self
Most aggressive melanoma.
Anemia

28. X-ray on knee?
IV penicillin (or ampicillin)
Fe deficient anemia
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

29. Tender - boggy prostate. Dx?
Bupropion - varenicline - nicotine replacement
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Ofloxacin OR levofloxacin +/- metronidazole
Prostatitis

30. Pregnancy class D smoking cessation drugs
Nicotine inhaler - nasal spray - gum
Lung; SCC head & neck; RCC; breast; MM; prostate
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Diabetes - HTN - GN

31. First stage of labor
Aortic aneurysm
Onset of labor until cervix dilation
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

32. bacteria causing pharyngitis
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Bathing - dressing - eating - transferring - continence - toileting
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

33. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
6-9MO
Measures strength of contractions
110-160bpm

34. Unstable angina vs MI Dx tests
Calcium pyrophosphate dehydrate crystals (pseudogout)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
5 yo - draws person - ties shoes - skips
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

35. Second stage of labor
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Angioedema
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

36. Lentigo Maligna
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

37. ADL
Normal mental status; no other injuries; seen within 10 days of injury
Bathing - dressing - eating - transferring - continence - toileting
3 yo - identify body part - copies square - hops - throws - past tense - story telling
1 mo - eyes follow object to midline - vocalizes

38. stranger/separation anxiety
Ferrous sulfate 325mg tid
MCC melanoma in Africans/Asians. Under nails - soles - palms.
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Clindamycin AND gentamicin

39. Sx otitis externa
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Ofloxacin OR levofloxacin +/- metronidazole
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

40. DDX for geriatric hearing impairment
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Nicotine inhaler - nasal spray - gum
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Diphenhydramine - chlorpheniramine - hydroxyzine

41. Electrolyte abnormality that increases the incidence of torsades de pointes
Hypomagnesemia
Anemia
After delivery until delivery of placenta and membranes <30 mins
Nuchal translucency - serum hCG - PAPP-A

42. Improve short-term outcomes in acute exacerbations of COPD - asthma
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Steroids + bronchodilators
= LMP + 7 days - 3 months
6 mo - pincer - crawls - cruises - mamma - dada - byebye

43. Tx for anaphylaxis
Oxygen intervention 15h/d
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
0.2-0.5mg aqueous EPI IM/SubQ
Colchicine

44. Tx GAS ifxn
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Prostatitis
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

45. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

46. Screening for 65-76YO male smoker
Aortic aneurysm
After delivery until delivery of placenta and membranes <30 mins
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

47. identifies left - right
6 yo
4 yo - copies triangle - catches ball - dresses self
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

48. IADL
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Onset of labor until cervix dilation

49. shoulder dystocia
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Anterior shoulder cannot readily pass below the pubic symphysis.
Clindamycin AND gentamicin
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

50. Oral tx for PID
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Nicotine inhaler - nasal spray - gum
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)