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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. variable deceleration
MCC melanoma. Radial growth.
Calcium oxalate crystals
Anterior shoulder cannot readily pass below the pubic symphysis.
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

2. Second stage of labor
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Ampicillin/sulbactam AND doxycycline
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

3. Oral tx for PID
Tuberculosis; sarcoidosis; hodgkin disease
Urticaria
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

4. needles - strong negative birefringent (yellow crystals parallel light)
Tuberculosis; sarcoidosis; hodgkin disease
Monosodium urate crystals (gout)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

5. The five A's of smoking cessation
Ask - Advise - Assess - Assist - Arrange
Bathing - dressing - eating - transferring - continence - toileting
6 mo - pincer - crawls - cruises - mamma - dada - byebye
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

6. Dx criteria for RA
Biopsy
Prostatitis
Ofloxacin OR levofloxacin +/- metronidazole
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

7. parallel play
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
1 mo - eyes follow object to midline - vocalizes
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

8. Bacteria causing chronic sinusitis
110-160bpm
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

9. CKD Stages
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
4 yo - copies triangle - catches ball - dresses self
MCC melanoma in Africans/Asians. Under nails - soles - palms.

10. identifies left - right
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
6 yo
Ofloxacin OR levofloxacin +/- metronidazole
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

11. Tx acute gout
Colchicine
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Angioedema
Alpha-1 antitrypsin deficiency

12. Causes of CKD
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Biopsy
Diabetes - HTN - GN

13. X-ray of ankle?
Normal mental status; no other injuries; seen within 10 days of injury
MCC melanoma in Africans/Asians. Under nails - soles - palms.
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

14. Dx bacterial rhinosinusitis
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)
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
<20lb - <1YO - Reacts to pain - Responds to noise
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

15. explorations
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Stridor - drooling - toxic appearance
9 mo - walks - throws - 1-3 words - 1-step commands

16. DOC for HTN in elderly
MTX
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Long axis of fetus to long axis of mother (longitudinal or transverse)
Thiazides

17. Sx otitis media
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Patch - bupropion - varenicline
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Calcium hydroxyapatite crystals

18. cystoplasmic inclusions - not birefringent
Ceftriaxone 125mg IM
Biopsy
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Calcium hydroxyapatite crystals

19. causes of acute bronchitis
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
4 yo - copies triangle - catches ball - dresses self
Bupropion - varenicline - nicotine replacement
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

20. Sx of hypercalcemia
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

21. Early deceleration
Starts at contraction. caused by increased vagal tone from fetal head compression.
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

22. Fetal lie
IV penicillin (or ampicillin)
Cataracts
Long axis of fetus to long axis of mother (longitudinal or transverse)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

23. Immunizations for COPD patients
Pneumovax - influenza
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Urticaria
Ferrous sulfate 325mg tid

24. bacteria causing pharyngitis
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Clindamycin AND gentamicin
Metronidazole or clindamycin
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

25. Mediators released in response to allergen
Starts at contraction. caused by increased vagal tone from fetal head compression.
Ceftriaxone 125mg IM
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Anterior shoulder cannot readily pass below the pubic symphysis.

26. Nodular melanoma
Most aggressive melanoma.
Aortic aneurysm
Calcium hydroxyapatite crystals
Fluoroquinolones

27. Estimated delivery date (Naegele's rule)
Most aggressive melanoma.
After delivery until delivery of placenta and membranes <30 mins
6-9MO
= LMP + 7 days - 3 months

28. Optimal time for trisomy screen
Long axis of fetus to long axis of mother (longitudinal or transverse)
Monosodium urate crystals (gout)
Patch - bupropion - varenicline
16-18 weeks GA

29. Tx chlamydia
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Ampicillin/sulbactam AND doxycycline
Hypomagnesemia
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

30. IV tx for PID
Anaphylaxis
Flexion - internal rotation - extension - external rotation
(cefotetan OR cefoxitin) AND doxycycline
Metronidazole or clindamycin

31. Oral tx for PID
= LMP + 7 days - 3 months
Diabetes - HTN - GN
(ofloxacin OR levofloxacin) +/- metronidazole
16-18 weeks GA

32. Immunizations at visit for 6MO
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
DTaP - hepB - Hib - rotavirus - inactivated polio
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

33. IV tx for PID
Lung; SCC head & neck; RCC; breast; MM; prostate
Clindamycin AND gentamicin
<20lb - <1YO - Reacts to pain - Responds to noise
Metronidazole or clindamycin

34. Smoking cessation agents
Anaphylaxis
Bupropion - varenicline - nicotine replacement
Colchicine
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

35. Sx peritonsillar abscess
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Colchicine
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

36. shoulder dystocia
Anterior shoulder cannot readily pass below the pubic symphysis.
Colchicine
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

37. Pregnancy class D smoking cessation drugs
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Nuchal translucency - serum hCG - PAPP-A
Nicotine inhaler - nasal spray - gum
Monosodium urate crystals (gout)

38. Granulomatous causes of hypercalcemia
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Tuberculosis; sarcoidosis; hodgkin disease
Colchicine
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

39. Tx RA (best long-term outcome)
110-160bpm
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
MTX
Thiazides

40. Complications of GAS infxn
Steroids + bronchodilators
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Conrtaction monitoring along with fetal heart rate assessment

41. Recommended folic acid daily dose
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Tdap - influenza - pneumovax
DTaP - hepB - Hib - rotavirus - inactivated polio

42. Emphysema - <45YO - nonsmoker
Fe deficient anemia
Alpha-1 antitrypsin deficiency
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Patch - bupropion - varenicline

43. social smile - parent recognition
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
NAC or IV NaHCO3
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Short-acting + 40mg prednisone x 10-14days

44. Pflx for traveler's diarrhea
Fluoroquinolones
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
9 mo - walks - throws - 1-3 words - 1-step commands

45. Age by which child says 'mama' and 'dada'
Onset of labor until cervix dilation
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
6-9MO
Loratadine - fexofenadine - cetirizine

46. 2nd generation antihistamines
Diphenhydramine - chlorpheniramine - hydroxyzine
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Loratadine - fexofenadine - cetirizine

47. Tx otitis media
= LMP + 7 days - 3 months
Biopsy
(ofloxacin OR levofloxacin) +/- metronidazole
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

48. Tender - boggy prostate. Dx?
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Prostatitis
Calcium pyrophosphate dehydrate crystals (pseudogout)

49. Corrected serum calcium =

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50. complications of otitis media
Lung; SCC head & neck; RCC; breast; MM; prostate
Colchicine
Long axis of fetus to long axis of mother (longitudinal or transverse)
Masoiditis - bacterial meningitis - brain abscess - subdural empyema