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Family Medicine/ambulatory 1

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. presbycusis
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Age-related sensorineural hearing loss (high frequency and speech discrimination)
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
IV penicillin (or ampicillin)

2. Sx otitis externa
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
IV penicillin (or ampicillin)

3. Bisphospohonates sfx
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
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)
Esophagitis - gastritis - dysphagia
5+ rads

4. Tx RA (best long-term outcome)
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Nuchal translucency - serum hCG - PAPP-A
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
MTX

5. Low serum iron - low MCV - low ferritin - +stool guaiac
Ceftriaxone 125mg IM
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Flexion - internal rotation - extension - external rotation
Fe deficient anemia

6. DDX for geriatric hearing impairment
Colchicine
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Anterior shoulder cannot readily pass below the pubic symphysis.
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

7. causes of acute bronchitis
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

8. Oral tx for PID
(ofloxacin OR levofloxacin) +/- metronidazole
Clindamycin AND gentamicin
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Steroids + bronchodilators

9. IV tx for PID
Tdap - influenza - pneumovax
Ofloxacin OR levofloxacin +/- metronidazole
5+ rads
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

10. social smile - parent recognition
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Normal mental status; no other injuries; seen within 10 days of injury

11. social interaction
4 yo - copies triangle - catches ball - dresses self
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Age-related sensorineural hearing loss (high frequency and speech discrimination)

12. Immunizations at visit for 6MO
DTaP - hepB - Hib - rotavirus - inactivated polio
6 yo
MCC melanoma. Radial growth.
Nicotine inhaler - nasal spray - gum

13. Third stage of labor
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
After delivery until delivery of placenta and membranes <30 mins
Clindamycin AND gentamicin
Ofloxacin OR levofloxacin +/- metronidazole

14. Recommendations for rear-facing car seat
<20lb - <1YO - Reacts to pain - Responds to noise
Thiazdes; lithium
Patch - bupropion - varenicline
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

15. Pregnancy class C smoking cessation drugs
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
4 yo - copies triangle - catches ball - dresses self
Patch - bupropion - varenicline
Ask - Advise - Assess - Assist - Arrange

16. IADL
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

17. Dx bacterial rhinosinusitis
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)
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Diphenhydramine - chlorpheniramine - hydroxyzine
Conrtaction monitoring along with fetal heart rate assessment

18. GBS tx
IV penicillin (or ampicillin)
Urticaria
1 mo - eyes follow object to midline - vocalizes
3 yo - identify body part - copies square - hops - throws - past tense - story telling

19. shoulder dystocia
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Anterior shoulder cannot readily pass below the pubic symphysis.
Ferrous sulfate 325mg tid
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

20. stranger/separation anxiety
Loratadine - fexofenadine - cetirizine
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
1 mo - eyes follow object to midline - vocalizes

21. bacteria causing pharyngitis
Ofloxacin OR levofloxacin +/- metronidazole
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
5+ rads

22. Dx bacterial vaginosis
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

23. Tx acute gout
Colchicine
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Clindamycin AND gentamicin

24. Sx epiglottitis
6-9MO
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Hypomagnesemia
Stridor - drooling - toxic appearance

25. X-ray of ankle?
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
4 yo - copies triangle - catches ball - dresses self
Normal mental status; no other injuries; seen within 10 days of injury
NAC or IV NaHCO3

26. Nodular melanoma
After delivery until delivery of placenta and membranes <30 mins
Most aggressive melanoma.
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Calcium hydroxyapatite crystals

27. complications of otitis media
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
1 mo - eyes follow object to midline - vocalizes
Tdap - influenza - pneumovax
Alpha-1 antitrypsin deficiency

28. Other causes of hypercalcemia
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Short-acting + 40mg prednisone x 10-14days
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Measures strength of contractions

29. variable deceleration
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Angioedema
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Colchicine

30. 2nd generation antihistamines
9 mo - walks - throws - 1-3 words - 1-step commands
6-9MO
Loratadine - fexofenadine - cetirizine
Nicotine inhaler - nasal spray - gum

31. Tx chlamydia
<20lb - <1YO - Reacts to pain - Responds to noise
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
= LMP + 7 days - 3 months
Tdap - influenza - pneumovax

32. IV tx for PID
Clindamycin AND gentamicin
1 mo - eyes follow object to midline - vocalizes
5+ rads
(cefotetan OR cefoxitin) AND doxycycline

33. Oral tx for PID
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Onset of labor until cervix dilation
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
MCC melanoma in Africans/Asians. Under nails - soles - palms.

34. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Loratadine - fexofenadine - cetirizine
Long axis of fetus to long axis of mother (longitudinal or transverse)
Ceftriaxone 125mg IM

35. Second stage of labor
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Biopsy
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

36. Immunizations for adult 65YO+
Diphenhydramine - chlorpheniramine - hydroxyzine
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Ampicillin/sulbactam AND doxycycline
Tdap - influenza - pneumovax

37. Corrected serum calcium =

38. Rod shaped - rhomboid - weakly positive birefringent
Tdap - influenza - pneumovax
Calcium pyrophosphate dehydrate crystals (pseudogout)
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Esophagitis - gastritis - dysphagia

39. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Anemia
Stridor - drooling - toxic appearance
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

40. writes name - counts 10 objects
Tuberculosis; sarcoidosis; hodgkin disease
1 mo - eyes follow object to midline - vocalizes
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
5 yo - draws person - ties shoes - skips

41. Causes of CKD
After delivery until delivery of placenta and membranes <30 mins
Diabetes - HTN - GN
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

42. bipyramidal - strongly positive birefringent
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Calcium oxalate crystals
Cataracts
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

43. dyspnea - visceral edema - hypotension
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Anaphylaxis
Most aggressive melanoma.

44. Signs of rupture of membranes

45. regards hand
4mo - sits unsupported - hand transfer - babbles
Diabetes - HTN - GN
Metronidazole or clindamycin
Thiazdes; lithium

46. Fe deficient anemia tx
Ferrous sulfate 325mg tid
Ampicillin/sulbactam AND doxycycline
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Hypomagnesemia

47. Electrolyte abnormality that increases the incidence of torsades de pointes
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Hypomagnesemia
MTX
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

48. X-ray on knee?
Fe deficient anemia
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
0.2-0.5mg aqueous EPI IM/SubQ

49. Tx GAS ifxn
Normal mental status; no other injuries; seen within 10 days of injury
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
16-18 weeks GA
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

50. Tx otitis media
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Urinary calcium. Hyper PTH (high) >> FHH (normal)
5 yo - draws person - ties shoes - skips
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins