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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. Cockcroft-Gault equation
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Conrtaction monitoring along with fetal heart rate assessment
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

2. Unstable angina vs MI Dx tests
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
<20lb - <1YO - Reacts to pain - Responds to noise
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)

3. Tx for anaphylaxis
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
0.2-0.5mg aqueous EPI IM/SubQ
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Thiazides

4. parallel play
Ceftriaxone 125mg IM
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

5. IV tx for PID
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
(cefotetan OR cefoxitin) AND doxycycline
5 yo - draws person - ties shoes - skips
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

6. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Biopsy
NAC or IV NaHCO3
Anemia

7. Immunizations at visit for 6MO
= LMP + 7 days - 3 months
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
16-18 weeks GA
DTaP - hepB - Hib - rotavirus - inactivated polio

8. MCC blindness worldwide
Cataracts
Conrtaction monitoring along with fetal heart rate assessment
Nicotine inhaler - nasal spray - gum
Calcium oxalate crystals

9. Tx acute sinusitis
DTaP - hepB - Hib - rotavirus - inactivated polio
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

10. stranger/separation anxiety
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Nuchal translucency - serum hCG - PAPP-A
DTaP - hepB - Hib - rotavirus - inactivated polio

11. dyspnea - visceral edema - hypotension
Tdap - influenza - pneumovax
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Anaphylaxis

12. Dx PID
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Fe deficient anemia
Ofloxacin OR levofloxacin +/- metronidazole
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

13. X-ray of ankle?
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Normal mental status; no other injuries; seen within 10 days of injury
Urticaria
3 yo - identify body part - copies square - hops - throws - past tense - story telling

14. The five A's of smoking cessation
9 mo - walks - throws - 1-3 words - 1-step commands
Starts at contraction. caused by increased vagal tone from fetal head compression.
Tuberculosis; sarcoidosis; hodgkin disease
Ask - Advise - Assess - Assist - Arrange

15. DOC for HTN in elderly
Diphenhydramine - chlorpheniramine - hydroxyzine
Tuberculosis; sarcoidosis; hodgkin disease
9 mo - walks - throws - 1-3 words - 1-step commands
Thiazides

16. Pregnancy class D smoking cessation drugs
9 mo - walks - throws - 1-3 words - 1-step commands
Nicotine inhaler - nasal spray - gum
Urticaria
Ampicillin/sulbactam AND doxycycline

17. tx shoulder dystocia

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18. needles - strong negative birefringent (yellow crystals parallel light)
Monosodium urate crystals (gout)
Measures strength of contractions
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
MCC melanoma in Africans/Asians. Under nails - soles - palms.

19. Nonfunctioning nodules > 1cm require _____
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Biopsy
Diphenhydramine - chlorpheniramine - hydroxyzine
Calcium hydroxyapatite crystals

20. Dx bacterial vaginosis
Angioedema
Age-related sensorineural hearing loss (high frequency and speech discrimination)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

21. Rod shaped - rhomboid - weakly positive birefringent
Calcium pyrophosphate dehydrate crystals (pseudogout)
6-9MO
9 mo - walks - throws - 1-3 words - 1-step commands
Patch - bupropion - varenicline

22. Only therapy to decrease mortality in stage IV COPD
110-160bpm
Oxygen intervention 15h/d
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Prostatitis

23. DDX for geriatric hearing impairment
Conrtaction monitoring along with fetal heart rate assessment
Normal mental status; no other injuries; seen within 10 days of injury
Alpha-1 antitrypsin deficiency
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

24. Fetal lie
Esophagitis - gastritis - dysphagia
Calcium oxalate crystals
Long axis of fetus to long axis of mother (longitudinal or transverse)
Onset of labor until cervix dilation

25. Sx of hypercalcemia
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Calcium hydroxyapatite crystals

26. Pflx for traveler's diarrhea
Fluoroquinolones
5+ rads
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

27. Mediators released in response to allergen
Loratadine - fexofenadine - cetirizine
Diabetes - HTN - GN
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

28. variable deceleration
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Fluoroquinolones
Diphenhydramine - chlorpheniramine - hydroxyzine

29. Bacteria causing chronic sinusitis
NAC or IV NaHCO3
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

30. Optimal time for trisomy screen
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
16-18 weeks GA
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Ferrous sulfate 325mg tid

31. Sx otitis media
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Flexion - internal rotation - extension - external rotation
After delivery until delivery of placenta and membranes <30 mins
MTX

32. cystoplasmic inclusions - not birefringent
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Nuchal translucency - serum hCG - PAPP-A
5 yo - draws person - ties shoes - skips
Calcium hydroxyapatite crystals

33. Pregnancy class C smoking cessation drugs
Urinary calcium. Hyper PTH (high) >> FHH (normal)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Diphenhydramine - chlorpheniramine - hydroxyzine
Patch - bupropion - varenicline

34. Tx gonorrhea
Monosodium urate crystals (gout)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Ceftriaxone 125mg IM
Cataracts

35. Fe deficient anemia tx
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Alpha-1 antitrypsin deficiency
Ferrous sulfate 325mg tid

36. IADL
Anterior shoulder cannot readily pass below the pubic symphysis.
Ceftriaxone 125mg IM
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Measures strength of contractions

37. Oral tx for PID
Prostatitis
Thiazdes; lithium
(ofloxacin OR levofloxacin) +/- metronidazole
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

38. How much radiation is associated with fetal harm?
Nuchal translucency - serum hCG - PAPP-A
5+ rads
Flexion - internal rotation - extension - external rotation
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

39. Complications of PID
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Oxygen intervention 15h/d
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
1 mo - eyes follow object to midline - vocalizes

40. regards hand
4mo - sits unsupported - hand transfer - babbles
Thiazdes; lithium
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Anterior shoulder cannot readily pass below the pubic symphysis.

41. Tocodynamometer
Anterior shoulder cannot readily pass below the pubic symphysis.
MTX
Conrtaction monitoring along with fetal heart rate assessment
Steroids + bronchodilators

42. Third stage of labor
After delivery until delivery of placenta and membranes <30 mins
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Diphenhydramine - chlorpheniramine - hydroxyzine
Oxytocin (IV)

43. Nodular melanoma
Most aggressive melanoma.
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Esophagitis - gastritis - dysphagia
Cataracts

44. Tx bacterial vaginosis
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Starts at contraction. caused by increased vagal tone from fetal head compression.
Metronidazole or clindamycin

45. IV tx for PID
Tdap - influenza - pneumovax
Fe deficient anemia
Clindamycin AND gentamicin
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

46. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Ear pain - itching - inflammation/swollen canal - exudates/discharge
= LMP + 7 days - 3 months
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

47. Complications of GAS infxn
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

48. Tx for thyroid storm
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

49. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
Ampicillin/sulbactam AND doxycycline
NAC or IV NaHCO3
Aortic aneurysm
Anterior shoulder cannot readily pass below the pubic symphysis.

50. Tx acute gout
Colchicine
Ofloxacin OR levofloxacin +/- metronidazole
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR