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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 hyperkalemia in CKD
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Fe deficient anemia

2. 2nd generation antihistamines
Short-acting + 40mg prednisone x 10-14days
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Loratadine - fexofenadine - cetirizine
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

3. Lentigo Maligna
Calcium pyrophosphate dehydrate crystals (pseudogout)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

4. explorations
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
9 mo - walks - throws - 1-3 words - 1-step commands
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

5. presbycusis
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Age-related sensorineural hearing loss (high frequency and speech discrimination)
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

6. Screened at 16-20 weeks GA for trisomy
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
16-18 weeks GA
Starts at contraction. caused by increased vagal tone from fetal head compression.

7. Fetal lie
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Colchicine
Long axis of fetus to long axis of mother (longitudinal or transverse)

8. Tx for thyroid storm
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Onset of labor until cervix dilation
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

9. Tender - boggy prostate. Dx?
Tuberculosis; sarcoidosis; hodgkin disease
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Esophagitis - gastritis - dysphagia
Prostatitis

10. CKD Stages
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
IV penicillin (or ampicillin)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Colchicine

11. Tx of traveler's diarrhea
Ofloxacin OR levofloxacin +/- metronidazole
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

12. Fetal heart rate range
Lung; SCC head & neck; RCC; breast; MM; prostate
Long axis of fetus to long axis of mother (longitudinal or transverse)
110-160bpm
Bupropion - varenicline - nicotine replacement

13. Dx bacterial rhinosinusitis
Nuchal translucency - serum hCG - PAPP-A
Hypomagnesemia
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)
IV penicillin (or ampicillin)

14. Immunizations for adult 65YO+
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
4 yo - copies triangle - catches ball - dresses self
Tdap - influenza - pneumovax
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)

15. GBS tx
IV penicillin (or ampicillin)
Normal mental status; no other injuries; seen within 10 days of injury
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Biopsy

16. DOC for HTN in elderly
Thiazides
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Calcium hydroxyapatite crystals
Anterior shoulder cannot readily pass below the pubic symphysis.

17. Sx peritonsillar abscess
Starts at contraction. caused by increased vagal tone from fetal head compression.
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Diphenhydramine - chlorpheniramine - hydroxyzine

18. Granulomatous causes of hypercalcemia
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Tuberculosis; sarcoidosis; hodgkin disease
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

19. MCC blindness worldwide
5 yo - draws person - ties shoes - skips
MCC melanoma. Radial growth.
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Cataracts

20. Malignancies with hypercalcemia
Ceftriaxone 125mg IM
Calcium pyrophosphate dehydrate crystals (pseudogout)
Alpha-1 antitrypsin deficiency
Lung; SCC head & neck; RCC; breast; MM; prostate

21. Nonfunctioning nodules > 1cm require _____
Tdap - influenza - pneumovax
Short-acting + 40mg prednisone x 10-14days
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Biopsy

22. Estimated delivery date (Naegele's rule)
Angioedema
= LMP + 7 days - 3 months
Anemia
Ofloxacin OR levofloxacin +/- metronidazole

23. Tocodynamometer
Conrtaction monitoring along with fetal heart rate assessment
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Tdap - influenza - pneumovax

24. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Anemia
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
DTaP - hepB - Hib - rotavirus - inactivated polio
Steroids + bronchodilators

25. Early deceleration
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
DTaP - hepB - Hib - rotavirus - inactivated polio
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Starts at contraction. caused by increased vagal tone from fetal head compression.

26. Cockcroft-Gault equation
Alpha-1 antitrypsin deficiency
Onset of labor until cervix dilation
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

27. Sx otitis externa
Lung; SCC head & neck; RCC; breast; MM; prostate
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Metronidazole or clindamycin
Urticaria

28. X-ray on knee?
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Anaphylaxis
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

29. IV tx for PID
NAC or IV NaHCO3
Thiazides
Ofloxacin OR levofloxacin +/- metronidazole
Tdap - influenza - pneumovax

30. recognizes strangers
(cefotetan OR cefoxitin) AND doxycycline
6 mo - pincer - crawls - cruises - mamma - dada - byebye
16-18 weeks GA
Hypomagnesemia

31. painless - deep - subQ swelling (periorbital - circumoral - facial)
Ask - Advise - Assess - Assist - Arrange
MCC melanoma. Radial growth.
4 yo - copies triangle - catches ball - dresses self
Angioedema

32. Complications of PID
Hypomagnesemia
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Stridor - drooling - toxic appearance

33. needles - strong negative birefringent (yellow crystals parallel light)
Monosodium urate crystals (gout)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Calcium oxalate crystals
Calcium hydroxyapatite crystals

34. bipyramidal - strongly positive birefringent
Diphenhydramine - chlorpheniramine - hydroxyzine
Fluoroquinolones
Diabetes - HTN - GN
Calcium oxalate crystals

35. social smile - parent recognition
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
MTX
2 mo - eyes follow object past midline - rolls over - laughs - squeals
IV penicillin (or ampicillin)

36. shoulder dystocia
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)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Anterior shoulder cannot readily pass below the pubic symphysis.
Thiazdes; lithium

37. writes name - counts 10 objects
Metronidazole or clindamycin
Pneumovax - influenza
DTaP - hepB - Hib - rotavirus - inactivated polio
5 yo - draws person - ties shoes - skips

38. Causes of CKD
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Alpha-1 antitrypsin deficiency
Diabetes - HTN - GN
Ferrous sulfate 325mg tid

39. medications causing hypercalcemia
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Metronidazole or clindamycin
Thiazdes; lithium

40. Superficial spreading melanoma
Lung; SCC head & neck; RCC; breast; MM; prostate
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
MCC melanoma. Radial growth.

41. Pflx for traveler's diarrhea
Fluoroquinolones
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
= LMP + 7 days - 3 months

42. Third stage of labor
After delivery until delivery of placenta and membranes <30 mins
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Hypomagnesemia
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

43. Improve short-term outcomes in acute exacerbations of COPD - asthma
Steroids + bronchodilators
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Cataracts
Tdap - influenza - pneumovax

44. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Short-acting + 40mg prednisone x 10-14days
Urinary calcium. Hyper PTH (high) >> FHH (normal)
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Hypomagnesemia

45. Tx bacterial vaginosis
Metronidazole or clindamycin
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
110-160bpm
1 mo - eyes follow object to midline - vocalizes

46. IADL
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Bathing - dressing - eating - transferring - continence - toileting
Alpha-1 antitrypsin deficiency

47. Screened at 11-13 weeks GA for trisomy
Conrtaction monitoring along with fetal heart rate assessment
Biopsy
MTX
Nuchal translucency - serum hCG - PAPP-A

48. causes of acute bronchitis
Diabetes - HTN - GN
Calcium hydroxyapatite crystals
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

49. identifies left - right
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
1 mo - eyes follow object to midline - vocalizes
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
6 yo

50. Immunizations at visit for 6MO
2 mo - eyes follow object past midline - rolls over - laughs - squeals
5+ rads
Esophagitis - gastritis - dysphagia
DTaP - hepB - Hib - rotavirus - inactivated polio