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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. Lentigo Maligna
Tuberculosis; sarcoidosis; hodgkin disease
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Fluoroquinolones

2. Recommendations for rear-facing car seat
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
<20lb - <1YO - Reacts to pain - Responds to noise
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Measures strength of contractions

3. Fe deficient anemia tx
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Flexion - internal rotation - extension - external rotation
Starts at contraction. caused by increased vagal tone from fetal head compression.
Ferrous sulfate 325mg tid

4. Sx of hypercalcemia
5+ rads
Onset of labor until cervix dilation
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)
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

5. dyspnea - visceral edema - hypotension
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Oxytocin (IV)
Anaphylaxis

6. Dx criteria for RA
Thiazdes; lithium
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Angioedema
Fluoroquinolones

7. Unstable angina vs MI Dx tests
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
IV penicillin (or ampicillin)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

8. Improve short-term outcomes in acute exacerbations of COPD - asthma
5+ rads
Flexion - internal rotation - extension - external rotation
(ofloxacin OR levofloxacin) +/- metronidazole
Steroids + bronchodilators

9. Oral tx for PID
Short-acting + 40mg prednisone x 10-14days
Diphenhydramine - chlorpheniramine - hydroxyzine
(ofloxacin OR levofloxacin) +/- metronidazole
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

10. Tx acute gout
Colchicine
Measures strength of contractions
Fluoroquinolones
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

11. Sx epiglottitis
Metronidazole or clindamycin
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Stridor - drooling - toxic appearance

12. explorations
Patch - bupropion - varenicline
4 yo - copies triangle - catches ball - dresses self
Prostatitis
9 mo - walks - throws - 1-3 words - 1-step commands

13. Acral lentinous melanoma
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Ampicillin/sulbactam AND doxycycline
Stridor - drooling - toxic appearance

14. Sx otitis externa
Hypomagnesemia
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Colchicine

15. Rod shaped - rhomboid - weakly positive birefringent
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
After delivery until delivery of placenta and membranes <30 mins
Calcium pyrophosphate dehydrate crystals (pseudogout)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

16. Second stage of labor
Patch - bupropion - varenicline
Ferrous sulfate 325mg tid
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
IV penicillin (or ampicillin)

17. Dx bacterial rhinosinusitis
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Nuchal translucency - serum hCG - PAPP-A
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)
Starts at contraction. caused by increased vagal tone from fetal head compression.

18. Smoking cessation agents
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Bupropion - varenicline - nicotine replacement
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

19. Immunizations at visit for 6MO
Starts at contraction. caused by increased vagal tone from fetal head compression.
DTaP - hepB - Hib - rotavirus - inactivated polio
1 mo - eyes follow object to midline - vocalizes
Age-related sensorineural hearing loss (high frequency and speech discrimination)

20. variable deceleration
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Pneumovax - influenza

21. Emphysema - <45YO - nonsmoker
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Conrtaction monitoring along with fetal heart rate assessment
Alpha-1 antitrypsin deficiency
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

22. Bacteria causing chronic sinusitis
Diphenhydramine - chlorpheniramine - hydroxyzine
Alpha-1 antitrypsin deficiency
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

23. Immunizations for adult 65YO+
5+ rads
110-160bpm
Diphenhydramine - chlorpheniramine - hydroxyzine
Tdap - influenza - pneumovax

24. Fetal heart rate range
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Hypomagnesemia
110-160bpm
Short-acting + 40mg prednisone x 10-14days

25. IV tx for PID
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Clindamycin AND gentamicin
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

26. shoulder dystocia
Loratadine - fexofenadine - cetirizine
Anterior shoulder cannot readily pass below the pubic symphysis.
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)
Bupropion - varenicline - nicotine replacement

27. stranger/separation anxiety
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Diphenhydramine - chlorpheniramine - hydroxyzine
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

28. Cockcroft-Gault equation
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Measures strength of contractions
1 mo - eyes follow object to midline - vocalizes
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

29. Tx of traveler's diarrhea
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
4 yo - copies triangle - catches ball - dresses self
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

30. X-ray on knee?
Prostatitis
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Long axis of fetus to long axis of mother (longitudinal or transverse)
Oxygen intervention 15h/d

31. Electrolyte abnormality that increases the incidence of torsades de pointes
Calcium hydroxyapatite crystals
Hypomagnesemia
IV penicillin (or ampicillin)
Anemia

32. Tx RA (best long-term outcome)
MTX
0.2-0.5mg aqueous EPI IM/SubQ
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

33. Only therapy to decrease mortality in stage IV COPD
Oxygen intervention 15h/d
Clindamycin AND gentamicin
1 mo - eyes follow object to midline - vocalizes
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

34. Oral tx for PID
Angioedema
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Thiazdes; lithium
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

35. Tx for anaphylaxis
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
1 mo - eyes follow object to midline - vocalizes
0.2-0.5mg aqueous EPI IM/SubQ
Calcium oxalate crystals

36. Augments contractions
Steroids + bronchodilators
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Urticaria
Oxytocin (IV)

37. Third stage of labor
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
After delivery until delivery of placenta and membranes <30 mins

38. Tx GAS ifxn
Calcium pyrophosphate dehydrate crystals (pseudogout)
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Steroids + bronchodilators

39. Nonfunctioning nodules > 1cm require _____
Stridor - drooling - toxic appearance
Biopsy
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Most aggressive melanoma.

40. DDX for geriatric hearing impairment
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Aortic aneurysm
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

41. Fetal lie
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Long axis of fetus to long axis of mother (longitudinal or transverse)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

42. social smile - parent recognition
Metronidazole or clindamycin
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Angioedema
2 mo - eyes follow object past midline - rolls over - laughs - squeals

43. painless - deep - subQ swelling (periorbital - circumoral - facial)
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Angioedema
Bathing - dressing - eating - transferring - continence - toileting
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

44. X-ray of ankle?
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)
MTX
1 mo - eyes follow object to midline - vocalizes
Normal mental status; no other injuries; seen within 10 days of injury

45. Sx peritonsillar abscess
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)
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

46. Complications of PID
Hypomagnesemia
4mo - sits unsupported - hand transfer - babbles
Metronidazole or clindamycin
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

47. Nodular melanoma
Most aggressive melanoma.
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
MCC melanoma. Radial growth.
Tuberculosis; sarcoidosis; hodgkin disease

48. GBS tx
IV penicillin (or ampicillin)
Prostatitis
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

49. Causes of CKD
5 yo - draws person - ties shoes - skips
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Diabetes - HTN - GN
6 mo - pincer - crawls - cruises - mamma - dada - byebye

50. First stage of labor
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
0.2-0.5mg aqueous EPI IM/SubQ
Onset of labor until cervix dilation
Ampicillin/sulbactam AND doxycycline