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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. Complications of GAS infxn
Ofloxacin OR levofloxacin +/- metronidazole
<20lb - <1YO - Reacts to pain - Responds to noise
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

2. Immunizations at visit for 6MO
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Tdap - influenza - pneumovax
DTaP - hepB - Hib - rotavirus - inactivated polio
Aortic aneurysm

3. shoulder dystocia
Nuchal translucency - serum hCG - PAPP-A
Anterior shoulder cannot readily pass below the pubic symphysis.
Biopsy
= LMP + 7 days - 3 months

4. CKD Stages
(ofloxacin OR levofloxacin) +/- metronidazole
Nuchal translucency - serum hCG - PAPP-A
5 yo - draws person - ties shoes - skips
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

5. Four cardinal fetal movements
Ofloxacin OR levofloxacin +/- metronidazole
1 mo - eyes follow object to midline - vocalizes
Flexion - internal rotation - extension - external rotation
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

6. Screened at 11-13 weeks GA for trisomy
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Age-related sensorineural hearing loss (high frequency and speech discrimination)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Nuchal translucency - serum hCG - PAPP-A

7. Sx of hypercalcemia
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Nicotine inhaler - nasal spray - gum
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Ampicillin/sulbactam AND doxycycline

8. 1st generation antihistamines
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Diphenhydramine - chlorpheniramine - hydroxyzine
Lung; SCC head & neck; RCC; breast; MM; prostate
Esophagitis - gastritis - dysphagia

9. tx shoulder dystocia

10. Third stage of labor
After delivery until delivery of placenta and membranes <30 mins
Cataracts
Thiazides
Pneumovax - influenza

11. Early deceleration
Starts at contraction. caused by increased vagal tone from fetal head compression.
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
= LMP + 7 days - 3 months
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

12. Other causes of hypercalcemia
DTaP - hepB - Hib - rotavirus - inactivated polio
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

13. Fetal heart rate range
Biopsy
110-160bpm
4 yo - copies triangle - catches ball - dresses self
5+ rads

14. group play - gender - knows name
3 yo - identify body part - copies square - hops - throws - past tense - story telling
IV penicillin (or ampicillin)
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

15. Tx otitis media
Anaphylaxis
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
1 mo - eyes follow object to midline - vocalizes

16. Sx otitis externa
Bupropion - varenicline - nicotine replacement
Ear pain - itching - inflammation/swollen canal - exudates/discharge
MCC melanoma. Radial growth.
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

17. Tx RA (best long-term outcome)
MTX
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Anemia
Normal mental status; no other injuries; seen within 10 days of injury

18. Tx acute exacerbation COPD
Conrtaction monitoring along with fetal heart rate assessment
Short-acting + 40mg prednisone x 10-14days
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Thiazides

19. Sx peritonsillar abscess
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

20. Acral lentinous melanoma
Ceftriaxone 125mg IM
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Metronidazole or clindamycin
IV penicillin (or ampicillin)

21. Tx acute gout
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
4 yo - copies triangle - catches ball - dresses self
(cefotetan OR cefoxitin) AND doxycycline
Colchicine

22. writes name - counts 10 objects
Cataracts
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
5 yo - draws person - ties shoes - skips

23. Recommendations for rear-facing car seat
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
<20lb - <1YO - Reacts to pain - Responds to noise
Calcium hydroxyapatite crystals
Hypomagnesemia

24. Mediators released in response to allergen
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Fe deficient anemia
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

25. Corrected serum calcium =

26. Optimal time for trisomy screen
16-18 weeks GA
Esophagitis - gastritis - dysphagia
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Age-related sensorineural hearing loss (high frequency and speech discrimination)

27. cystoplasmic inclusions - not birefringent
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Urticaria
Calcium hydroxyapatite crystals

28. Pregnancy class C smoking cessation drugs
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Ask - Advise - Assess - Assist - Arrange
Patch - bupropion - varenicline

29. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
NAC or IV NaHCO3
0.2-0.5mg aqueous EPI IM/SubQ
Hypomagnesemia

30. IV tx for PID
<20lb - <1YO - Reacts to pain - Responds to noise
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Ampicillin/sulbactam AND doxycycline
Monosodium urate crystals (gout)

31. bacteria causing pharyngitis
Ear pain - itching - inflammation/swollen canal - exudates/discharge
NAC or IV NaHCO3
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Bathing - dressing - eating - transferring - continence - toileting

32. The five A's of smoking cessation
Calcium oxalate crystals
Ask - Advise - Assess - Assist - Arrange
Steroids + bronchodilators
Bathing - dressing - eating - transferring - continence - toileting

33. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
6 mo - pincer - crawls - cruises - mamma - dada - byebye
After delivery until delivery of placenta and membranes <30 mins
Ofloxacin OR levofloxacin +/- metronidazole
Urinary calcium. Hyper PTH (high) >> FHH (normal)

34. Tx bacterial vaginosis
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Metronidazole or clindamycin
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

35. Tx for anaphylaxis
0.2-0.5mg aqueous EPI IM/SubQ
Long axis of fetus to long axis of mother (longitudinal or transverse)
6-9MO
Calcium hydroxyapatite crystals

36. Late deceleration
Esophagitis - gastritis - dysphagia
Nicotine inhaler - nasal spray - gum
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

37. Regards human face - eye contact
1 mo - eyes follow object to midline - vocalizes
DTaP - hepB - Hib - rotavirus - inactivated polio
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

38. social interaction
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Cataracts
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)

39. DDX for geriatric hearing impairment
Starts at contraction. caused by increased vagal tone from fetal head compression.
(ofloxacin OR levofloxacin) +/- metronidazole
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

40. IUPC (intrauterine pressure catheter)
Anterior shoulder cannot readily pass below the pubic symphysis.
Diphenhydramine - chlorpheniramine - hydroxyzine
Measures strength of contractions
Pneumovax - influenza

41. IV tx for PID
(cefotetan OR cefoxitin) AND doxycycline
Most aggressive melanoma.
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Flexion - internal rotation - extension - external rotation

42. needles - strong negative birefringent (yellow crystals parallel light)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Monosodium urate crystals (gout)
DTaP - hepB - Hib - rotavirus - inactivated polio
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

43. Low serum iron - low MCV - low ferritin - +stool guaiac
Ferrous sulfate 325mg tid
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Fe deficient anemia

44. Only therapy to decrease mortality in stage IV COPD
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Alpha-1 antitrypsin deficiency
Tuberculosis; sarcoidosis; hodgkin disease
Oxygen intervention 15h/d

45. medications causing hypercalcemia
Steroids + bronchodilators
Thiazdes; lithium
= LMP + 7 days - 3 months
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

46. Tocodynamometer
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
110-160bpm
Conrtaction monitoring along with fetal heart rate assessment
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

47. Pregnancy class D smoking cessation drugs
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
5 yo - draws person - ties shoes - skips
Nicotine inhaler - nasal spray - gum
Ofloxacin OR levofloxacin +/- metronidazole

48. Augments contractions
Oxytocin (IV)
Flexion - internal rotation - extension - external rotation
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Long axis of fetus to long axis of mother (longitudinal or transverse)

49. Second stage of labor
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

50. Emphysema - <45YO - nonsmoker
Calcium pyrophosphate dehydrate crystals (pseudogout)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
DTaP - hepB - Hib - rotavirus - inactivated polio
Alpha-1 antitrypsin deficiency