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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. Tx for anaphylaxis
Biopsy
0.2-0.5mg aqueous EPI IM/SubQ
3 yo - identify body part - copies square - hops - throws - past tense - story telling
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

2. social smile - parent recognition
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Tuberculosis; sarcoidosis; hodgkin disease
6-9MO

3. Cockcroft-Gault equation
Flexion - internal rotation - extension - external rotation
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Pneumovax - influenza
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

4. Sx otitis media
Anterior shoulder cannot readily pass below the pubic symphysis.
Anaphylaxis
Steroids + bronchodilators
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

5. Sx otitis externa
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Short-acting + 40mg prednisone x 10-14days
Hypomagnesemia
Bathing - dressing - eating - transferring - continence - toileting

6. Tx GAS ifxn
Stridor - drooling - toxic appearance
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

7. cystoplasmic inclusions - not birefringent
Calcium hydroxyapatite crystals
After delivery until delivery of placenta and membranes <30 mins
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

8. Tx otitis media
2 mo - eyes follow object past midline - rolls over - laughs - squeals
IV penicillin (or ampicillin)
Patch - bupropion - varenicline
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

9. Tx of traveler's diarrhea
Normal mental status; no other injuries; seen within 10 days of injury
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
NAC or IV NaHCO3
Angioedema

10. bacteria causing pharyngitis
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)
Patch - bupropion - varenicline
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Biopsy

11. MONA therapy
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
110-160bpm
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Metronidazole or clindamycin

12. explorations
Urinary calcium. Hyper PTH (high) >> FHH (normal)
DTaP - hepB - Hib - rotavirus - inactivated polio
9 mo - walks - throws - 1-3 words - 1-step commands
<20lb - <1YO - Reacts to pain - Responds to noise

13. DOC for HTN in elderly
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Thiazides
Fe deficient anemia
Conrtaction monitoring along with fetal heart rate assessment

14. Dx bacterial vaginosis
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
(cefotetan OR cefoxitin) AND doxycycline
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
<20lb - <1YO - Reacts to pain - Responds to noise

15. Late deceleration
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Loratadine - fexofenadine - cetirizine
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

16. 1st generation antihistamines
Diphenhydramine - chlorpheniramine - hydroxyzine
Calcium pyrophosphate dehydrate crystals (pseudogout)
Prostatitis
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

17. IV tx for PID
Bupropion - varenicline - nicotine replacement
Ampicillin/sulbactam AND doxycycline
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

18. Screening for 65-76YO male smoker
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Ceftriaxone 125mg IM
Aortic aneurysm
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

19. Signs of rupture of membranes

20. X-ray on knee?
Nuchal translucency - serum hCG - PAPP-A
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Steroids + bronchodilators
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema

21. complications of otitis media
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Steroids + bronchodilators
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Oxygen intervention 15h/d

22. Immunizations for COPD patients
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Pneumovax - influenza
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

23. IV tx for PID
Oxytocin (IV)
Clindamycin AND gentamicin
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

24. Screened at 11-13 weeks GA for trisomy
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Metronidazole or clindamycin
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Nuchal translucency - serum hCG - PAPP-A

25. How much radiation is associated with fetal harm?
Diabetes - HTN - GN
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
5+ rads
Bupropion - varenicline - nicotine replacement

26. IV tx for PID
Tdap - influenza - pneumovax
(cefotetan OR cefoxitin) AND doxycycline
Steroids + bronchodilators
Biopsy

27. Improve short-term outcomes in acute exacerbations of COPD - asthma
Calcium oxalate crystals
16-18 weeks GA
Steroids + bronchodilators
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema

28. Pflx for traveler's diarrhea
Fluoroquinolones
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Calcium oxalate crystals

29. Fetal lie
Clindamycin AND gentamicin
MCC melanoma. Radial growth.
Long axis of fetus to long axis of mother (longitudinal or transverse)
Metronidazole or clindamycin

30. Electrolyte abnormality that increases the incidence of torsades de pointes
Hypomagnesemia
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Conrtaction monitoring along with fetal heart rate assessment
2 mo - eyes follow object past midline - rolls over - laughs - squeals

31. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Anemia
Nicotine inhaler - nasal spray - gum
Urticaria

32. Complications of PID
Calcium hydroxyapatite crystals
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Ampicillin/sulbactam AND doxycycline
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

33. writes name - counts 10 objects
5+ rads
4 yo - copies triangle - catches ball - dresses self
Fe deficient anemia
5 yo - draws person - ties shoes - skips

34. Only therapy to decrease mortality in stage IV COPD
Prostatitis
Oxygen intervention 15h/d
Anaphylaxis
Flexion - internal rotation - extension - external rotation

35. Oral tx for PID
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
= LMP + 7 days - 3 months
(ofloxacin OR levofloxacin) +/- metronidazole
Anterior shoulder cannot readily pass below the pubic symphysis.

36. Four cardinal fetal movements
Ampicillin/sulbactam AND doxycycline
Flexion - internal rotation - extension - external rotation
1 mo - eyes follow object to midline - vocalizes
2 mo - eyes follow object past midline - rolls over - laughs - squeals

37. group play - gender - knows name
Prostatitis
Tuberculosis; sarcoidosis; hodgkin disease
Anemia
3 yo - identify body part - copies square - hops - throws - past tense - story telling

38. Augments contractions
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Oxytocin (IV)
Diabetes - HTN - GN
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

39. Tx chlamydia
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Diphenhydramine - chlorpheniramine - hydroxyzine

40. Granulomatous causes of hypercalcemia
Tuberculosis; sarcoidosis; hodgkin disease
Hypomagnesemia
Monosodium urate crystals (gout)
Steroids + bronchodilators

41. Dx bacterial rhinosinusitis
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)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Hypomagnesemia
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

42. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
NAC or IV NaHCO3
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

43. Dx criteria for RA
Steroids + bronchodilators
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
4 yo - copies triangle - catches ball - dresses self
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

44. DDX for geriatric hearing impairment
(cefotetan OR cefoxitin) AND doxycycline
Urinary calcium. Hyper PTH (high) >> FHH (normal)
MTX
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

45. Nodular melanoma
Long axis of fetus to long axis of mother (longitudinal or transverse)
Most aggressive melanoma.
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Normal mental status; no other injuries; seen within 10 days of injury

46. Low serum iron - low MCV - low ferritin - +stool guaiac
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Fe deficient anemia
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
<20lb - <1YO - Reacts to pain - Responds to noise

47. presbycusis
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Loratadine - fexofenadine - cetirizine

48. IV tx for PID
Ofloxacin OR levofloxacin +/- metronidazole
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
MCC melanoma. Radial growth.
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

49. Second stage of labor
Measures strength of contractions
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
6-9MO

50. Bacteria causing chronic sinusitis
Thiazides
Metronidazole or clindamycin
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
IV penicillin (or ampicillin)