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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. tx shoulder dystocia

2. Fe deficient anemia tx
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Bupropion - varenicline - nicotine replacement
Ferrous sulfate 325mg tid
Fluoroquinolones

3. Pregnancy class C smoking cessation drugs
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Patch - bupropion - varenicline
MTX
0.2-0.5mg aqueous EPI IM/SubQ

4. medications causing hypercalcemia
Oxytocin (IV)
Thiazdes; lithium
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Anterior shoulder cannot readily pass below the pubic symphysis.

5. stranger/separation anxiety
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Anterior shoulder cannot readily pass below the pubic symphysis.
Biopsy

6. Optimal time for trisomy screen
16-18 weeks GA
Anemia
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
IV penicillin (or ampicillin)

7. social smile - parent recognition
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
2 mo - eyes follow object past midline - rolls over - laughs - squeals

8. presbycusis
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
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)
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Age-related sensorineural hearing loss (high frequency and speech discrimination)

9. needles - strong negative birefringent (yellow crystals parallel light)
Short-acting + 40mg prednisone x 10-14days
DTaP - hepB - Hib - rotavirus - inactivated polio
MCC melanoma. Radial growth.
Monosodium urate crystals (gout)

10. IUPC (intrauterine pressure catheter)
Tdap - influenza - pneumovax
9 mo - walks - throws - 1-3 words - 1-step commands
Measures strength of contractions
Biopsy

11. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
6-9MO
0.2-0.5mg aqueous EPI IM/SubQ
NAC or IV NaHCO3

12. Recommended folic acid daily dose
Starts at contraction. caused by increased vagal tone from fetal head compression.
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Normal mental status; no other injuries; seen within 10 days of injury
NAC or IV NaHCO3

13. Immunizations for COPD patients
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Metronidazole or clindamycin
Monosodium urate crystals (gout)
Pneumovax - influenza

14. Sx otitis media
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Loratadine - fexofenadine - cetirizine
0.2-0.5mg aqueous EPI IM/SubQ
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

15. Third stage of labor
After delivery until delivery of placenta and membranes <30 mins
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Pneumovax - influenza
Urinary calcium. Hyper PTH (high) >> FHH (normal)

16. Age by which child says 'mama' and 'dada'
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
6-9MO
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

17. Dx bacterial vaginosis
Clindamycin AND gentamicin
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
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

18. parallel play
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Prostatitis
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Esophagitis - gastritis - dysphagia

19. IADL
16-18 weeks GA
Steroids + bronchodilators
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Fluoroquinolones

20. MCC blindness worldwide
Cataracts
Nicotine inhaler - nasal spray - gum
Calcium oxalate crystals
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

21. Causes of CKD
6-9MO
Diabetes - HTN - GN
Alpha-1 antitrypsin deficiency
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

22. Large - irregularly shaped - prutitic - erythematous wheals
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Most aggressive melanoma.
Urticaria
Lung; SCC head & neck; RCC; breast; MM; prostate

23. Tx acute sinusitis
Stridor - drooling - toxic appearance
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

24. Immunizations for adult 65YO+
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)
After delivery until delivery of placenta and membranes <30 mins
Tdap - influenza - pneumovax
Loratadine - fexofenadine - cetirizine

25. Tx for thyroid storm
Ask - Advise - Assess - Assist - Arrange
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Esophagitis - gastritis - dysphagia
(cefotetan OR cefoxitin) AND doxycycline

26. Estimated delivery date (Naegele's rule)
6 yo
9 mo - walks - throws - 1-3 words - 1-step commands
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
= LMP + 7 days - 3 months

27. Acral lentinous melanoma
6-9MO
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Biopsy

28. bipyramidal - strongly positive birefringent
Ampicillin/sulbactam AND doxycycline
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Calcium oxalate crystals
Thiazdes; lithium

29. Rod shaped - rhomboid - weakly positive birefringent
Calcium pyrophosphate dehydrate crystals (pseudogout)
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

30. The five A's of smoking cessation
Ceftriaxone 125mg IM
Steroids + bronchodilators
Ask - Advise - Assess - Assist - Arrange
Prostatitis

31. First stage of labor
Bupropion - varenicline - nicotine replacement
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Onset of labor until cervix dilation
Loratadine - fexofenadine - cetirizine

32. Screened at 11-13 weeks GA for trisomy
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Nuchal translucency - serum hCG - PAPP-A
6 mo - pincer - crawls - cruises - mamma - dada - byebye

33. How much radiation is associated with fetal harm?
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)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
5+ rads
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

34. complications of otitis media
Normal mental status; no other injuries; seen within 10 days of injury
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Calcium pyrophosphate dehydrate crystals (pseudogout)
NAC or IV NaHCO3

35. social interaction
4 yo - copies triangle - catches ball - dresses self
Long axis of fetus to long axis of mother (longitudinal or transverse)
Fluoroquinolones
Calcium hydroxyapatite crystals

36. Early deceleration
Ear pain - itching - inflammation/swollen canal - exudates/discharge
NAC or IV NaHCO3
Ofloxacin OR levofloxacin +/- metronidazole
Starts at contraction. caused by increased vagal tone from fetal head compression.

37. Pflx for traveler's diarrhea
Thiazdes; lithium
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Fluoroquinolones
Calcium hydroxyapatite crystals

38. Complications of PID
Conrtaction monitoring along with fetal heart rate assessment
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Oxytocin (IV)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

39. IV tx for PID
Fe deficient anemia
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
4 yo - copies triangle - catches ball - dresses self
(cefotetan OR cefoxitin) AND doxycycline

40. explorations
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
9 mo - walks - throws - 1-3 words - 1-step commands
Anterior shoulder cannot readily pass below the pubic symphysis.
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)

41. IV tx for PID
Clindamycin AND gentamicin
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

42. Dx PID
Clindamycin AND gentamicin
Long axis of fetus to long axis of mother (longitudinal or transverse)
<20lb - <1YO - Reacts to pain - Responds to noise
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

43. Unstable angina vs MI Dx tests
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Long axis of fetus to long axis of mother (longitudinal or transverse)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

44. Tx RA (best long-term outcome)
Measures strength of contractions
6 yo
MTX
(cefotetan OR cefoxitin) AND doxycycline

45. Tx bacterial vaginosis
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Metronidazole or clindamycin
Bupropion - varenicline - nicotine replacement
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

46. Four cardinal fetal movements
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)
0.2-0.5mg aqueous EPI IM/SubQ
Flexion - internal rotation - extension - external rotation

47. regards hand
4mo - sits unsupported - hand transfer - babbles
Lung; SCC head & neck; RCC; breast; MM; prostate
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema

48. cystoplasmic inclusions - not birefringent
Calcium hydroxyapatite crystals
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
NAC or IV NaHCO3
4mo - sits unsupported - hand transfer - babbles

49. CKD Stages
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
After delivery until delivery of placenta and membranes <30 mins
3 yo - identify body part - copies square - hops - throws - past tense - story telling

50. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
<20lb - <1YO - Reacts to pain - Responds to noise
Anemia
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)