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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. Mediators released in response to allergen
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Loratadine - fexofenadine - cetirizine
Calcium hydroxyapatite crystals
6 mo - pincer - crawls - cruises - mamma - dada - byebye

2. X-ray of ankle?
Normal mental status; no other injuries; seen within 10 days of injury
Calcium pyrophosphate dehydrate crystals (pseudogout)
MTX
Nuchal translucency - serum hCG - PAPP-A

3. Granulomatous causes of hypercalcemia
Esophagitis - gastritis - dysphagia
Clindamycin AND gentamicin
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Tuberculosis; sarcoidosis; hodgkin disease

4. ADL
Calcium pyrophosphate dehydrate crystals (pseudogout)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Bathing - dressing - eating - transferring - continence - toileting

5. cystoplasmic inclusions - not birefringent
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Fe deficient anemia
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Calcium hydroxyapatite crystals

6. bipyramidal - strongly positive birefringent
Calcium oxalate crystals
Cataracts
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
MCC melanoma in Africans/Asians. Under nails - soles - palms.

7. Rod shaped - rhomboid - weakly positive birefringent
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Calcium pyrophosphate dehydrate crystals (pseudogout)

8. Tx for thyroid storm
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Colchicine

9. Sx otitis externa
3 yo - identify body part - copies square - hops - throws - past tense - story telling
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Thiazdes; lithium

10. Tx acute exacerbation COPD
Patch - bupropion - varenicline
Short-acting + 40mg prednisone x 10-14days
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

11. needles - strong negative birefringent (yellow crystals parallel light)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Ampicillin/sulbactam AND doxycycline
Ofloxacin OR levofloxacin +/- metronidazole
Monosodium urate crystals (gout)

12. Tx RA (best long-term outcome)
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
6 mo - pincer - crawls - cruises - mamma - dada - byebye
MTX

13. Malignancies with hypercalcemia
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Measures strength of contractions
Lung; SCC head & neck; RCC; breast; MM; prostate
Nicotine inhaler - nasal spray - gum

14. Only therapy to decrease mortality in stage IV COPD
Steroids + bronchodilators
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Oxygen intervention 15h/d
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

15. Lentigo Maligna
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Biopsy
4 yo - copies triangle - catches ball - dresses self
9 mo - walks - throws - 1-3 words - 1-step commands

16. Tx chlamydia
Urticaria
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Clindamycin AND gentamicin
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

17. complications of otitis media
Anaphylaxis
Anemia
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

18. Screening for 65-76YO male smoker
Fluoroquinolones
Aortic aneurysm
4 yo - copies triangle - catches ball - dresses self
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

19. stranger/separation anxiety
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
110-160bpm
(cefotetan OR cefoxitin) AND doxycycline
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

20. Pregnancy class D smoking cessation drugs
Nicotine inhaler - nasal spray - gum
Patch - bupropion - varenicline
Urticaria
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema

21. Tx acute gout
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Colchicine
Measures strength of contractions

22. Estimated delivery date (Naegele's rule)
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Metronidazole or clindamycin
Bathing - dressing - eating - transferring - continence - toileting
= LMP + 7 days - 3 months

23. group play - gender - knows name
<20lb - <1YO - Reacts to pain - Responds to noise
Ask - Advise - Assess - Assist - Arrange
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
3 yo - identify body part - copies square - hops - throws - past tense - story telling

24. social interaction
5+ rads
Most aggressive melanoma.
Oxygen intervention 15h/d
4 yo - copies triangle - catches ball - dresses self

25. Sx peritonsillar abscess
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

26. Superficial spreading melanoma
MCC melanoma. Radial growth.
9 mo - walks - throws - 1-3 words - 1-step commands
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Esophagitis - gastritis - dysphagia

27. Tx of traveler's diarrhea
Oxytocin (IV)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Normal mental status; no other injuries; seen within 10 days of injury
Calcium oxalate crystals

28. Dx bacterial rhinosinusitis
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
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)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
3 yo - identify body part - copies square - hops - throws - past tense - story telling

29. Oral tx for PID
(cefotetan OR cefoxitin) AND doxycycline
Bupropion - varenicline - nicotine replacement
(ofloxacin OR levofloxacin) +/- metronidazole
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

30. Tx bacterial vaginosis
Most aggressive melanoma.
Aortic aneurysm
Metronidazole or clindamycin
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

31. First stage of labor
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Onset of labor until cervix dilation
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Angioedema

32. IUPC (intrauterine pressure catheter)
Esophagitis - gastritis - dysphagia
(cefotetan OR cefoxitin) AND doxycycline
Measures strength of contractions
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

33. Tx for anaphylaxis
0.2-0.5mg aqueous EPI IM/SubQ
Normal mental status; no other injuries; seen within 10 days of injury
Colchicine
Calcium hydroxyapatite crystals

34. Smoking cessation agents
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)
Bupropion - varenicline - nicotine replacement
Calcium hydroxyapatite crystals
After delivery until delivery of placenta and membranes <30 mins

35. bacteria causing pharyngitis
Hypomagnesemia
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Flexion - internal rotation - extension - external rotation
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

36. Low serum iron - low MCV - low ferritin - +stool guaiac
Monosodium urate crystals (gout)
Fe deficient anemia
Urticaria
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

37. Dx criteria for RA
5+ rads
Nicotine inhaler - nasal spray - gum
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Calcium oxalate crystals

38. recognizes strangers
6 mo - pincer - crawls - cruises - mamma - dada - byebye
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Diabetes - HTN - GN
5+ rads

39. Dx bacterial vaginosis
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

40. DOC for HTN in elderly
MTX
Calcium hydroxyapatite crystals
5+ rads
Thiazides

41. Tocodynamometer
Conrtaction monitoring along with fetal heart rate assessment
(cefotetan OR cefoxitin) AND doxycycline
Prostatitis
2 mo - eyes follow object past midline - rolls over - laughs - squeals

42. Tx otitis media
Monosodium urate crystals (gout)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
(ofloxacin OR levofloxacin) +/- metronidazole
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

43. Fe deficient anemia tx
Ferrous sulfate 325mg tid
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

44. Augments contractions
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Tdap - influenza - pneumovax
Oxytocin (IV)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

45. Immunizations at visit for 6MO
6 mo - pincer - crawls - cruises - mamma - dada - byebye
(ofloxacin OR levofloxacin) +/- metronidazole
MCC melanoma. Radial growth.
DTaP - hepB - Hib - rotavirus - inactivated polio

46. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
NAC or IV NaHCO3

47. 2nd generation antihistamines
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Metronidazole or clindamycin
Loratadine - fexofenadine - cetirizine
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

48. dyspnea - visceral edema - hypotension
Short-acting + 40mg prednisone x 10-14days
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Calcium hydroxyapatite crystals
Anaphylaxis

49. Tx gonorrhea
Ceftriaxone 125mg IM
Stridor - drooling - toxic appearance
Thiazides
Anterior shoulder cannot readily pass below the pubic symphysis.

50. presbycusis
Age-related sensorineural hearing loss (high frequency and speech discrimination)
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Flexion - internal rotation - extension - external rotation
IV penicillin (or ampicillin)