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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. Age by which child says 'mama' and 'dada'
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Alpha-1 antitrypsin deficiency
6-9MO
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

2. tx shoulder dystocia

3. Causes of CKD
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Flexion - internal rotation - extension - external rotation
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Diabetes - HTN - GN

4. Nodular melanoma
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Tuberculosis; sarcoidosis; hodgkin disease
Most aggressive melanoma.
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

5. Other causes of hypercalcemia
Calcium pyrophosphate dehydrate crystals (pseudogout)
Angioedema
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

6. Unstable angina vs MI Dx tests
Bathing - dressing - eating - transferring - continence - toileting
Loratadine - fexofenadine - cetirizine
Ferrous sulfate 325mg tid
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

7. CKD Stages
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Diabetes - HTN - GN
Thiazdes; lithium
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

8. Smoking cessation agents
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Bupropion - varenicline - nicotine replacement
Anterior shoulder cannot readily pass below the pubic symphysis.

9. Only therapy to decrease mortality in stage IV COPD
4mo - sits unsupported - hand transfer - babbles
Oxygen intervention 15h/d
Onset of labor until cervix dilation
Esophagitis - gastritis - dysphagia

10. Low serum iron - low MCV - low ferritin - +stool guaiac
Long axis of fetus to long axis of mother (longitudinal or transverse)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Short-acting + 40mg prednisone x 10-14days
Fe deficient anemia

11. X-ray of ankle?
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
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
Normal mental status; no other injuries; seen within 10 days of injury

12. Third stage of labor
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Ask - Advise - Assess - Assist - Arrange
After delivery until delivery of placenta and membranes <30 mins
1 mo - eyes follow object to midline - vocalizes

13. bacteria causing pharyngitis
Steroids + bronchodilators
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

14. variable deceleration
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
2 mo - eyes follow object past midline - rolls over - laughs - squeals
MTX

15. Malignancies with hypercalcemia
Onset of labor until cervix dilation
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Metronidazole or clindamycin
Lung; SCC head & neck; RCC; breast; MM; prostate

16. MCC blindness worldwide
Oxygen intervention 15h/d
Ferrous sulfate 325mg tid
Cataracts
Calcium oxalate crystals

17. cystoplasmic inclusions - not birefringent
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Calcium hydroxyapatite crystals
Esophagitis - gastritis - dysphagia

18. Late deceleration
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Tuberculosis; sarcoidosis; hodgkin disease
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
0.2-0.5mg aqueous EPI IM/SubQ

19. regards hand
(ofloxacin OR levofloxacin) +/- metronidazole
Short-acting + 40mg prednisone x 10-14days
Anaphylaxis
4mo - sits unsupported - hand transfer - babbles

20. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Flexion - internal rotation - extension - external rotation
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Aortic aneurysm

21. stranger/separation anxiety
Ceftriaxone 125mg IM
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

22. Cockcroft-Gault equation
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
9 mo - walks - throws - 1-3 words - 1-step commands
Thiazides

23. X-ray on knee?
Short-acting + 40mg prednisone x 10-14days
Tdap - influenza - pneumovax
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

24. medications causing hypercalcemia
Bathing - dressing - eating - transferring - continence - toileting
Bupropion - varenicline - nicotine replacement
Thiazdes; lithium
Long axis of fetus to long axis of mother (longitudinal or transverse)

25. Screening for 65-76YO male smoker
Calcium oxalate crystals
Prostatitis
Ceftriaxone 125mg IM
Aortic aneurysm

26. Fetal lie
Bathing - dressing - eating - transferring - continence - toileting
Flexion - internal rotation - extension - external rotation
Nicotine inhaler - nasal spray - gum
Long axis of fetus to long axis of mother (longitudinal or transverse)

27. Tx acute exacerbation COPD
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Stridor - drooling - toxic appearance
Short-acting + 40mg prednisone x 10-14days

28. Improve short-term outcomes in acute exacerbations of COPD - asthma
Cataracts
Nicotine inhaler - nasal spray - gum
Steroids + bronchodilators
5+ rads

29. causes of acute bronchitis
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Onset of labor until cervix dilation
4mo - sits unsupported - hand transfer - babbles

30. Second stage of labor
Urticaria
Bupropion - varenicline - nicotine replacement
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Pneumovax - influenza

31. Tx chlamydia
6 yo
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Lung; SCC head & neck; RCC; breast; MM; prostate
0.2-0.5mg aqueous EPI IM/SubQ

32. Oral tx for PID
(ofloxacin OR levofloxacin) +/- metronidazole
(cefotetan OR cefoxitin) AND doxycycline
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Diphenhydramine - chlorpheniramine - hydroxyzine

33. Dx PID
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

34. Tx hyperkalemia in CKD
Clindamycin AND gentamicin
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Diphenhydramine - chlorpheniramine - hydroxyzine

35. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Fluoroquinolones
Starts at contraction. caused by increased vagal tone from fetal head compression.
Anemia
Short-acting + 40mg prednisone x 10-14days

36. needles - strong negative birefringent (yellow crystals parallel light)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Monosodium urate crystals (gout)
Stridor - drooling - toxic appearance
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

37. Recommendations for rear-facing car seat
Ampicillin/sulbactam AND doxycycline
DTaP - hepB - Hib - rotavirus - inactivated polio
<20lb - <1YO - Reacts to pain - Responds to noise
4mo - sits unsupported - hand transfer - babbles

38. Bisphospohonates sfx
Esophagitis - gastritis - dysphagia
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
MTX

39. Tx gonorrhea
9 mo - walks - throws - 1-3 words - 1-step commands
Ceftriaxone 125mg IM
Anterior shoulder cannot readily pass below the pubic symphysis.
Calcium hydroxyapatite crystals

40. Tocodynamometer
Conrtaction monitoring along with fetal heart rate assessment
Anemia
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)
Biopsy

41. Dx criteria for RA
5 yo - draws person - ties shoes - skips
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Thiazdes; lithium
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

42. IV tx for PID
Ofloxacin OR levofloxacin +/- metronidazole
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Ceftriaxone 125mg IM

43. First stage of labor
Steroids + bronchodilators
Thiazdes; lithium
Onset of labor until cervix dilation
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

44. DDX for geriatric hearing impairment
Fe deficient anemia
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

45. The five A's of smoking cessation
Ask - Advise - Assess - Assist - Arrange
Fe deficient anemia
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Conrtaction monitoring along with fetal heart rate assessment

46. Lentigo Maligna
Steroids + bronchodilators
Prostatitis
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

47. IV tx for PID
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
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)
Tdap - influenza - pneumovax
Clindamycin AND gentamicin

48. Sx otitis externa
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Calcium oxalate crystals

49. recognizes strangers
Cataracts
MTX
Alpha-1 antitrypsin deficiency
6 mo - pincer - crawls - cruises - mamma - dada - byebye

50. Sx peritonsillar abscess
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Patch - bupropion - varenicline