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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. bipyramidal - strongly positive birefringent
Diabetes - HTN - GN
Prostatitis
Calcium oxalate crystals
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

2. medications causing hypercalcemia
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Thiazdes; lithium
Prostatitis
Ceftriaxone 125mg IM

3. Tender - boggy prostate. Dx?
Hypomagnesemia
Starts at contraction. caused by increased vagal tone from fetal head compression.
Urticaria
Prostatitis

4. Other causes of hypercalcemia
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
DTaP - hepB - Hib - rotavirus - inactivated polio
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

5. Screened at 16-20 weeks GA for trisomy
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Cataracts
Calcium pyrophosphate dehydrate crystals (pseudogout)
Starts at contraction. caused by increased vagal tone from fetal head compression.

6. Fetal lie
Calcium hydroxyapatite crystals
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
0.2-0.5mg aqueous EPI IM/SubQ
Long axis of fetus to long axis of mother (longitudinal or transverse)

7. stranger/separation anxiety
= LMP + 7 days - 3 months
Nicotine inhaler - nasal spray - gum
4 yo - copies triangle - catches ball - dresses self
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

8. Emphysema - <45YO - nonsmoker
Alpha-1 antitrypsin deficiency
Anemia
Esophagitis - gastritis - dysphagia
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

9. Pregnancy class D smoking cessation drugs
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Nicotine inhaler - nasal spray - gum
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Urinary calcium. Hyper PTH (high) >> FHH (normal)

10. Improve short-term outcomes in acute exacerbations of COPD - asthma
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)
Steroids + bronchodilators
Normal mental status; no other injuries; seen within 10 days of injury
5 yo - draws person - ties shoes - skips

11. Immunizations for COPD patients
Lung; SCC head & neck; RCC; breast; MM; prostate
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Pneumovax - influenza

12. Tx of traveler's diarrhea
4 yo - copies triangle - catches ball - dresses self
Aortic aneurysm
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Bathing - dressing - eating - transferring - continence - toileting

13. Unstable angina vs MI Dx tests
Anaphylaxis
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Metronidazole or clindamycin

14. IV tx for PID
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Clindamycin AND gentamicin
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Measures strength of contractions

15. The five A's of smoking cessation
Flexion - internal rotation - extension - external rotation
(cefotetan OR cefoxitin) AND doxycycline
Ask - Advise - Assess - Assist - Arrange
Short-acting + 40mg prednisone x 10-14days

16. First stage of labor
Onset of labor until cervix dilation
Nicotine inhaler - nasal spray - gum
Urinary calcium. Hyper PTH (high) >> FHH (normal)
4 yo - copies triangle - catches ball - dresses self

17. Pflx for traveler's diarrhea
1 mo - eyes follow object to midline - vocalizes
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Fluoroquinolones
Esophagitis - gastritis - dysphagia

18. Augments contractions
Monosodium urate crystals (gout)
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Oxytocin (IV)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

19. Oral tx for PID
MCC melanoma. Radial growth.
Alpha-1 antitrypsin deficiency
Steroids + bronchodilators
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

20. Smoking cessation agents
Bupropion - varenicline - nicotine replacement
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Normal mental status; no other injuries; seen within 10 days of injury
MTX

21. bacteria causing pharyngitis
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Aortic aneurysm
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

22. Tx gonorrhea
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Ceftriaxone 125mg IM
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Aortic aneurysm

23. Only therapy to decrease mortality in stage IV COPD
Oxygen intervention 15h/d
Diphenhydramine - chlorpheniramine - hydroxyzine
Flexion - internal rotation - extension - external rotation
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

24. cystoplasmic inclusions - not birefringent
Colchicine
Calcium hydroxyapatite crystals
Ampicillin/sulbactam AND doxycycline
NAC or IV NaHCO3

25. Third stage of labor
Calcium hydroxyapatite crystals
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
16-18 weeks GA
After delivery until delivery of placenta and membranes <30 mins

26. writes name - counts 10 objects
Ask - Advise - Assess - Assist - Arrange
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
5 yo - draws person - ties shoes - skips
Hypomagnesemia

27. Cockcroft-Gault equation
Conrtaction monitoring along with fetal heart rate assessment
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Cataracts

28. Dx bacterial rhinosinusitis
MCC melanoma in Africans/Asians. Under nails - soles - palms.
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)
DTaP - hepB - Hib - rotavirus - inactivated polio
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

29. causes of acute bronchitis
MTX
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Tdap - influenza - pneumovax

30. Corrected serum calcium =

31. X-ray of ankle?
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Normal mental status; no other injuries; seen within 10 days of injury
Oxytocin (IV)

32. recognizes strangers
Nuchal translucency - serum hCG - PAPP-A
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Bathing - dressing - eating - transferring - continence - toileting
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

33. Large - irregularly shaped - prutitic - erythematous wheals
Oxygen intervention 15h/d
3 yo - identify body part - copies square - hops - throws - past tense - story telling
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Urticaria

34. painless - deep - subQ swelling (periorbital - circumoral - facial)
Angioedema
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Loratadine - fexofenadine - cetirizine
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

35. Tx acute sinusitis
Biopsy
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

36. Recommendations for rear-facing car seat
Diabetes - HTN - GN
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
<20lb - <1YO - Reacts to pain - Responds to noise
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

37. Age by which child says 'mama' and 'dada'
Ferrous sulfate 325mg tid
4 yo - copies triangle - catches ball - dresses self
6-9MO
Ask - Advise - Assess - Assist - Arrange

38. MCC blindness worldwide
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Cataracts
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

39. shoulder dystocia
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Monosodium urate crystals (gout)
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Anterior shoulder cannot readily pass below the pubic symphysis.

40. Dx PID
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Patch - bupropion - varenicline
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Thiazdes; lithium

41. Second stage of labor
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Angioedema
Ferrous sulfate 325mg tid
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

42. 2nd generation antihistamines
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Loratadine - fexofenadine - cetirizine
Fe deficient anemia
Hypomagnesemia

43. Immunizations for adult 65YO+
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Tdap - influenza - pneumovax
Anterior shoulder cannot readily pass below the pubic symphysis.
Urinary calcium. Hyper PTH (high) >> FHH (normal)

44. Tx RA (best long-term outcome)
MTX
Thiazides
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Anaphylaxis

45. Tx for thyroid storm
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Most aggressive melanoma.

46. GBS tx
Urticaria
Hypomagnesemia
IV penicillin (or ampicillin)
4mo - sits unsupported - hand transfer - babbles

47. DOC for HTN in elderly
Fe deficient anemia
Thiazides
5+ rads
Metronidazole or clindamycin

48. Granulomatous causes of hypercalcemia
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Hypomagnesemia
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Tuberculosis; sarcoidosis; hodgkin disease

49. Bacteria causing chronic sinusitis
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Normal mental status; no other injuries; seen within 10 days of injury

50. Complications of GAS infxn
16-18 weeks GA
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Starts at contraction. caused by increased vagal tone from fetal head compression.
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)