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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. Oral tx for PID
4mo - sits unsupported - hand transfer - babbles
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Diabetes - HTN - GN
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole

2. medications causing hypercalcemia
Thiazdes; lithium
Aortic aneurysm
Starts at contraction. caused by increased vagal tone from fetal head compression.
Onset of labor until cervix dilation

3. Sx otitis media
Age-related sensorineural hearing loss (high frequency and speech discrimination)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

4. Fe deficient anemia tx
Thiazdes; lithium
Diphenhydramine - chlorpheniramine - hydroxyzine
Steroids + bronchodilators
Ferrous sulfate 325mg tid

5. Sx peritonsillar abscess
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

6. MCC blindness worldwide
Cataracts
Alpha-1 antitrypsin deficiency
Loratadine - fexofenadine - cetirizine
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

7. X-ray on knee?
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Oxygen intervention 15h/d
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Cataracts

8. Oral tx for PID
Conrtaction monitoring along with fetal heart rate assessment
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
(ofloxacin OR levofloxacin) +/- metronidazole
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

9. Immunizations for COPD patients
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Pneumovax - influenza
Calcium oxalate crystals
Anterior shoulder cannot readily pass below the pubic symphysis.

10. Sx epiglottitis
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Stridor - drooling - toxic appearance
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Short-acting + 40mg prednisone x 10-14days

11. Sx otitis externa
DTaP - hepB - Hib - rotavirus - inactivated polio
Colchicine
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Stridor - drooling - toxic appearance

12. 1st generation antihistamines
16-18 weeks GA
= LMP + 7 days - 3 months
Diphenhydramine - chlorpheniramine - hydroxyzine
4mo - sits unsupported - hand transfer - babbles

13. Malignancies with hypercalcemia
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Lung; SCC head & neck; RCC; breast; MM; prostate
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

14. Smoking cessation agents
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Ofloxacin OR levofloxacin +/- metronidazole
Bupropion - varenicline - nicotine replacement
4mo - sits unsupported - hand transfer - babbles

15. CKD Stages
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
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

16. Pflx for traveler's diarrhea
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Bupropion - varenicline - nicotine replacement
Fluoroquinolones
5+ rads

17. group play - gender - knows name
Anaphylaxis
Onset of labor until cervix dilation
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
3 yo - identify body part - copies square - hops - throws - past tense - story telling

18. Tx for thyroid storm
Calcium pyrophosphate dehydrate crystals (pseudogout)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

19. Tx RA (best long-term outcome)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
(ofloxacin OR levofloxacin) +/- metronidazole
Ofloxacin OR levofloxacin +/- metronidazole
MTX

20. painless - deep - subQ swelling (periorbital - circumoral - facial)
Angioedema
Flexion - internal rotation - extension - external rotation
5 yo - draws person - ties shoes - skips
Nicotine inhaler - nasal spray - gum

21. Regards human face - eye contact
MTX
1 mo - eyes follow object to midline - vocalizes
Calcium hydroxyapatite crystals
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

22. Nodular melanoma
Thiazdes; lithium
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Most aggressive melanoma.
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

23. IV tx for PID
Ampicillin/sulbactam AND doxycycline
Clindamycin AND gentamicin
Oxygen intervention 15h/d
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

24. needles - strong negative birefringent (yellow crystals parallel light)
6-9MO
Conrtaction monitoring along with fetal heart rate assessment
MTX
Monosodium urate crystals (gout)

25. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Anemia
5+ rads

26. identifies left - right
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Alpha-1 antitrypsin deficiency
6 yo
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

27. Fetal lie
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Long axis of fetus to long axis of mother (longitudinal or transverse)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Calcium oxalate crystals

28. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
110-160bpm
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Bupropion - varenicline - nicotine replacement
Flexion - internal rotation - extension - external rotation

29. Age by which child says 'mama' and 'dada'
6-9MO
Prostatitis
Fluoroquinolones
Thiazdes; lithium

30. dyspnea - visceral edema - hypotension
Lung; SCC head & neck; RCC; breast; MM; prostate
Stridor - drooling - toxic appearance
Anaphylaxis
1 mo - eyes follow object to midline - vocalizes

31. First stage of labor
Onset of labor until cervix dilation
Anterior shoulder cannot readily pass below the pubic symphysis.
Ferrous sulfate 325mg tid
5 yo - draws person - ties shoes - skips

32. tx shoulder dystocia

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33. Large - irregularly shaped - prutitic - erythematous wheals
Patch - bupropion - varenicline
Urticaria
Onset of labor until cervix dilation
Starts at contraction. caused by increased vagal tone from fetal head compression.

34. bipyramidal - strongly positive birefringent
Calcium oxalate crystals
Oxygen intervention 15h/d
5+ rads
Angioedema

35. stranger/separation anxiety
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Esophagitis - gastritis - dysphagia

36. Four cardinal fetal movements
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
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)
Flexion - internal rotation - extension - external rotation

37. Signs of rupture of membranes

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38. variable deceleration
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
<20lb - <1YO - Reacts to pain - Responds to noise

39. Sx of hypercalcemia
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Most aggressive melanoma.
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

40. Bisphospohonates sfx
Fluoroquinolones
Esophagitis - gastritis - dysphagia
(cefotetan OR cefoxitin) AND doxycycline
Anterior shoulder cannot readily pass below the pubic symphysis.

41. Dx PID
Tdap - influenza - pneumovax
Oxygen intervention 15h/d
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

42. Granulomatous causes of hypercalcemia
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Urticaria
6-9MO
Tuberculosis; sarcoidosis; hodgkin disease

43. Dx criteria for RA
Hypomagnesemia
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Lung; SCC head & neck; RCC; breast; MM; prostate

44. Pregnancy class C smoking cessation drugs
<20lb - <1YO - Reacts to pain - Responds to noise
Patch - bupropion - varenicline
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)
Diphenhydramine - chlorpheniramine - hydroxyzine

45. Other causes of hypercalcemia
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Fe deficient anemia
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

46. cystoplasmic inclusions - not birefringent
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Long axis of fetus to long axis of mother (longitudinal or transverse)
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Calcium hydroxyapatite crystals

47. 2nd generation antihistamines
Steroids + bronchodilators
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Loratadine - fexofenadine - cetirizine

48. Cockcroft-Gault equation
Flexion - internal rotation - extension - external rotation
0.2-0.5mg aqueous EPI IM/SubQ
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

49. IUPC (intrauterine pressure catheter)
Loratadine - fexofenadine - cetirizine
Measures strength of contractions
Urinary calcium. Hyper PTH (high) >> FHH (normal)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

50. Acral lentinous melanoma
MCC melanoma in Africans/Asians. Under nails - soles - palms.
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Bathing - dressing - eating - transferring - continence - toileting