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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. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
4mo - sits unsupported - hand transfer - babbles
Nicotine inhaler - nasal spray - gum
Urinary calcium. Hyper PTH (high) >> FHH (normal)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

2. Oral tx for PID
1 mo - eyes follow object to midline - vocalizes
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Steroids + bronchodilators
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

3. Electrolyte abnormality that increases the incidence of torsades de pointes
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Hypomagnesemia

4. Bacteria causing chronic sinusitis
Anaphylaxis
Starts at contraction. caused by increased vagal tone from fetal head compression.
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Thiazdes; lithium

5. Sx peritonsillar abscess
0.2-0.5mg aqueous EPI IM/SubQ
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Calcium pyrophosphate dehydrate crystals (pseudogout)
Ask - Advise - Assess - Assist - Arrange

6. Unstable angina vs MI Dx tests
Fe deficient anemia
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Loratadine - fexofenadine - cetirizine

7. Tx acute exacerbation COPD
= LMP + 7 days - 3 months
Lung; SCC head & neck; RCC; breast; MM; prostate
Short-acting + 40mg prednisone x 10-14days
Flexion - internal rotation - extension - external rotation

8. MCC blindness worldwide
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Loratadine - fexofenadine - cetirizine
Cataracts

9. Rod shaped - rhomboid - weakly positive birefringent
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Nicotine inhaler - nasal spray - gum
MTX
Calcium pyrophosphate dehydrate crystals (pseudogout)

10. Only therapy to decrease mortality in stage IV COPD
Anterior shoulder cannot readily pass below the pubic symphysis.
6 yo
Oxygen intervention 15h/d
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

11. medications causing hypercalcemia
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Thiazdes; lithium
Steroids + bronchodilators
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

12. shoulder dystocia
Clindamycin AND gentamicin
Anterior shoulder cannot readily pass below the pubic symphysis.
Ofloxacin OR levofloxacin +/- metronidazole
Short-acting + 40mg prednisone x 10-14days

13. Cockcroft-Gault equation
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Tuberculosis; sarcoidosis; hodgkin disease
Monosodium urate crystals (gout)
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

14. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
Measures strength of contractions
NAC or IV NaHCO3
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Nuchal translucency - serum hCG - PAPP-A

15. needles - strong negative birefringent (yellow crystals parallel light)
DTaP - hepB - Hib - rotavirus - inactivated polio
Loratadine - fexofenadine - cetirizine
(ofloxacin OR levofloxacin) +/- metronidazole
Monosodium urate crystals (gout)

16. Second stage of labor
Onset of labor until cervix dilation
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Alpha-1 antitrypsin deficiency

17. Regards human face - eye contact
Clindamycin AND gentamicin
1 mo - eyes follow object to midline - vocalizes
Tuberculosis; sarcoidosis; hodgkin disease
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

18. Dx PID
Lung; SCC head & neck; RCC; breast; MM; prostate
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Bathing - dressing - eating - transferring - continence - toileting
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

19. parallel play
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

20. Tx RA (best long-term outcome)
Onset of labor until cervix dilation
Metronidazole or clindamycin
MTX
Calcium oxalate crystals

21. IV tx for PID
Ampicillin/sulbactam AND doxycycline
Onset of labor until cervix dilation
Ceftriaxone 125mg IM
(cefotetan OR cefoxitin) AND doxycycline

22. Tx for anaphylaxis
0.2-0.5mg aqueous EPI IM/SubQ
Diphenhydramine - chlorpheniramine - hydroxyzine
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Tuberculosis; sarcoidosis; hodgkin disease

23. Pregnancy class C smoking cessation drugs
Esophagitis - gastritis - dysphagia
Aortic aneurysm
Thiazdes; lithium
Patch - bupropion - varenicline

24. Sx otitis externa
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
= LMP + 7 days - 3 months
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

25. social interaction
Flexion - internal rotation - extension - external rotation
1 mo - eyes follow object to midline - vocalizes
4 yo - copies triangle - catches ball - dresses self
MCC melanoma in Africans/Asians. Under nails - soles - palms.

26. identifies left - right
6 yo
Clindamycin AND gentamicin
Conrtaction monitoring along with fetal heart rate assessment
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

27. Augments contractions
Oxytocin (IV)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Anemia
Short-acting + 40mg prednisone x 10-14days

28. cystoplasmic inclusions - not birefringent
6-9MO
MCC melanoma in Africans/Asians. Under nails - soles - palms.
MTX
Calcium hydroxyapatite crystals

29. Tender - boggy prostate. Dx?
Calcium hydroxyapatite crystals
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Prostatitis
Esophagitis - gastritis - dysphagia

30. Tx hyperkalemia in CKD
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Ferrous sulfate 325mg tid
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema

31. IUPC (intrauterine pressure catheter)
Flexion - internal rotation - extension - external rotation
Measures strength of contractions
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)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

32. Tx bacterial vaginosis
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Metronidazole or clindamycin
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

33. Sx epiglottitis
Stridor - drooling - toxic appearance
Calcium pyrophosphate dehydrate crystals (pseudogout)
Urticaria
9 mo - walks - throws - 1-3 words - 1-step commands

34. X-ray on knee?
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Thiazdes; lithium
Starts at contraction. caused by increased vagal tone from fetal head compression.
4mo - sits unsupported - hand transfer - babbles

35. explorations
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
5 yo - draws person - ties shoes - skips
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
9 mo - walks - throws - 1-3 words - 1-step commands

36. regards hand
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
MTX
4mo - sits unsupported - hand transfer - babbles

37. Third stage of labor
After delivery until delivery of placenta and membranes <30 mins
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Hypomagnesemia
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

38. Sx of hypercalcemia
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
0.2-0.5mg aqueous EPI IM/SubQ
Anemia
Anterior shoulder cannot readily pass below the pubic symphysis.

39. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Nuchal translucency - serum hCG - PAPP-A
Onset of labor until cervix dilation
Monosodium urate crystals (gout)

40. Other causes of hypercalcemia
NAC or IV NaHCO3
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

41. Tocodynamometer
Fluoroquinolones
Conrtaction monitoring along with fetal heart rate assessment
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

42. presbycusis
Starts at contraction. caused by increased vagal tone from fetal head compression.
Lung; SCC head & neck; RCC; breast; MM; prostate
MCC melanoma. Radial growth.
Age-related sensorineural hearing loss (high frequency and speech discrimination)

43. Four cardinal fetal movements
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
After delivery until delivery of placenta and membranes <30 mins
Bupropion - varenicline - nicotine replacement
Flexion - internal rotation - extension - external rotation

44. bacteria causing pharyngitis
Bupropion - varenicline - nicotine replacement
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
0.2-0.5mg aqueous EPI IM/SubQ

45. recognizes strangers
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Alpha-1 antitrypsin deficiency
Cataracts
2 mo - eyes follow object past midline - rolls over - laughs - squeals

46. Tx chlamydia
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Ask - Advise - Assess - Assist - Arrange
Angioedema
Ferrous sulfate 325mg tid

47. Complications of PID
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Nuchal translucency - serum hCG - PAPP-A
(cefotetan OR cefoxitin) AND doxycycline
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

48. Improve short-term outcomes in acute exacerbations of COPD - asthma
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Aortic aneurysm
= LMP + 7 days - 3 months
Steroids + bronchodilators

49. Sx otitis media
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Lung; SCC head & neck; RCC; breast; MM; prostate

50. Bisphospohonates sfx
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Esophagitis - gastritis - dysphagia
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
16-18 weeks GA