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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. DDX for geriatric hearing impairment
Bathing - dressing - eating - transferring - continence - toileting
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

2. Dx PID
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Onset of labor until cervix dilation
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)

3. Complications of PID
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
1 mo - eyes follow object to midline - vocalizes

4. bipyramidal - strongly positive birefringent
Oxygen intervention 15h/d
Calcium oxalate crystals
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Ask - Advise - Assess - Assist - Arrange

5. IV tx for PID
(cefotetan OR cefoxitin) AND doxycycline
Colchicine
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

6. Tx chlamydia
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Thiazdes; lithium
Hypomagnesemia
Ear pain - itching - inflammation/swollen canal - exudates/discharge

7. How much radiation is associated with fetal harm?
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Metronidazole or clindamycin
Diabetes - HTN - GN
5+ rads

8. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
IV penicillin (or ampicillin)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Cataracts

9. Sx epiglottitis
Stridor - drooling - toxic appearance
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

10. Tx gonorrhea
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Ceftriaxone 125mg IM
Oxygen intervention 15h/d
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

11. Oral tx for PID
(ofloxacin OR levofloxacin) +/- metronidazole
(cefotetan OR cefoxitin) AND doxycycline
Thiazides
5 yo - draws person - ties shoes - skips

12. Screened at 16-20 weeks GA for trisomy
Angioedema
Nuchal translucency - serum hCG - PAPP-A
4 yo - copies triangle - catches ball - dresses self
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

13. Tx for thyroid storm
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
110-160bpm
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
NAC or IV NaHCO3

14. Immunizations for adult 65YO+
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Tdap - influenza - pneumovax
Anterior shoulder cannot readily pass below the pubic symphysis.
1 mo - eyes follow object to midline - vocalizes

15. Nodular melanoma
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Most aggressive melanoma.
Angioedema

16. Pregnancy class D smoking cessation drugs
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Anterior shoulder cannot readily pass below the pubic symphysis.
Nicotine inhaler - nasal spray - gum
6 yo

17. DOC for HTN in elderly
NAC or IV NaHCO3
Thiazides
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

18. IV tx for PID
Ferrous sulfate 325mg tid
Patch - bupropion - varenicline
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Ofloxacin OR levofloxacin +/- metronidazole

19. cystoplasmic inclusions - not birefringent
Ceftriaxone 125mg IM
Bathing - dressing - eating - transferring - continence - toileting
Most aggressive melanoma.
Calcium hydroxyapatite crystals

20. Tx otitis media
Ask - Advise - Assess - Assist - Arrange
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
MCC melanoma. Radial growth.

21. Lentigo Maligna
Thiazides
6 mo - pincer - crawls - cruises - mamma - dada - byebye
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Monosodium urate crystals (gout)

22. Large - irregularly shaped - prutitic - erythematous wheals
0.2-0.5mg aqueous EPI IM/SubQ
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
DTaP - hepB - Hib - rotavirus - inactivated polio
Urticaria

23. Tx acute sinusitis
Urinary calcium. Hyper PTH (high) >> FHH (normal)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Angioedema
Bathing - dressing - eating - transferring - continence - toileting

24. Electrolyte abnormality that increases the incidence of torsades de pointes
Anemia
Hypomagnesemia
Diphenhydramine - chlorpheniramine - hydroxyzine
Fluoroquinolones

25. Causes of CKD
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Prostatitis
Hypomagnesemia
Diabetes - HTN - GN

26. First stage of labor
Starts at contraction. caused by increased vagal tone from fetal head compression.
Onset of labor until cervix dilation
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

27. Rod shaped - rhomboid - weakly positive birefringent
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
<20lb - <1YO - Reacts to pain - Responds to noise
Calcium pyrophosphate dehydrate crystals (pseudogout)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

28. The five A's of smoking cessation
Short-acting + 40mg prednisone x 10-14days
Diphenhydramine - chlorpheniramine - hydroxyzine
Thiazides
Ask - Advise - Assess - Assist - Arrange

29. complications of otitis media
16-18 weeks GA
Fe deficient anemia
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

30. Sx of hypercalcemia
5+ rads
Nicotine inhaler - nasal spray - gum
Clindamycin AND gentamicin
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

31. Only therapy to decrease mortality in stage IV COPD
Oxygen intervention 15h/d
Age-related sensorineural hearing loss (high frequency and speech discrimination)
4mo - sits unsupported - hand transfer - babbles
Nuchal translucency - serum hCG - PAPP-A

32. Oral tx for PID
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Flexion - internal rotation - extension - external rotation
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Esophagitis - gastritis - dysphagia

33. Corrected serum calcium =

34. IUPC (intrauterine pressure catheter)
Urticaria
Steroids + bronchodilators
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Measures strength of contractions

35. X-ray of ankle?
Normal mental status; no other injuries; seen within 10 days of injury
Calcium pyrophosphate dehydrate crystals (pseudogout)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Biopsy

36. Tx acute gout
Esophagitis - gastritis - dysphagia
Urinary calcium. Hyper PTH (high) >> FHH (normal)
0.2-0.5mg aqueous EPI IM/SubQ
Colchicine

37. variable deceleration
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
IV penicillin (or ampicillin)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Fluoroquinolones

38. Pflx for traveler's diarrhea
Fluoroquinolones
Lung; SCC head & neck; RCC; breast; MM; prostate
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
<20lb - <1YO - Reacts to pain - Responds to noise

39. Malignancies with hypercalcemia
Calcium pyrophosphate dehydrate crystals (pseudogout)
Lung; SCC head & neck; RCC; breast; MM; prostate
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

40. 1st generation antihistamines
Diphenhydramine - chlorpheniramine - hydroxyzine
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Onset of labor until cervix dilation

41. IV tx for PID
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Ampicillin/sulbactam AND doxycycline
Calcium pyrophosphate dehydrate crystals (pseudogout)
Ask - Advise - Assess - Assist - Arrange

42. Tx hyperkalemia in CKD
Steroids + bronchodilators
Esophagitis - gastritis - dysphagia
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

43. social smile - parent recognition
Monosodium urate crystals (gout)
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

44. medications causing hypercalcemia
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Flexion - internal rotation - extension - external rotation
Thiazdes; lithium
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

45. Tx RA (best long-term outcome)
MTX
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Angioedema
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

46. X-ray on knee?
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Ceftriaxone 125mg IM
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Ofloxacin OR levofloxacin +/- metronidazole

47. Immunizations for COPD patients
Pneumovax - influenza
Thiazides
Stridor - drooling - toxic appearance
MCC melanoma. Radial growth.

48. Superficial spreading melanoma
Starts at contraction. caused by increased vagal tone from fetal head compression.
MCC melanoma. Radial growth.
Clindamycin AND gentamicin
Stridor - drooling - toxic appearance

49. 2nd generation antihistamines
Prostatitis
Loratadine - fexofenadine - cetirizine
Ferrous sulfate 325mg tid
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

50. IV tx for PID
Long axis of fetus to long axis of mother (longitudinal or transverse)
Nicotine inhaler - nasal spray - gum
Clindamycin AND gentamicin
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)