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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.
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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. Pflx for traveler's diarrhea
Fluoroquinolones
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Ampicillin/sulbactam AND doxycycline
Ask - Advise - Assess - Assist - Arrange

2. GBS tx
Angioedema
Colchicine
IV penicillin (or ampicillin)
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

3. Sx of hypercalcemia
6-9MO
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

4. causes of acute bronchitis
Most aggressive melanoma.
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Ofloxacin OR levofloxacin +/- metronidazole

5. Screened at 11-13 weeks GA for trisomy
Nuchal translucency - serum hCG - PAPP-A
Cataracts
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Onset of labor until cervix dilation

6. Early deceleration
Clindamycin AND gentamicin
Starts at contraction. caused by increased vagal tone from fetal head compression.
Tdap - influenza - pneumovax
16-18 weeks GA

7. Late deceleration
Urinary calcium. Hyper PTH (high) >> FHH (normal)
5 yo - draws person - ties shoes - skips
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

8. stranger/separation anxiety
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Esophagitis - gastritis - dysphagia
110-160bpm
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

9. X-ray on knee?
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
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
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

10. bipyramidal - strongly positive birefringent
Ceftriaxone 125mg IM
Thiazdes; lithium
Calcium oxalate crystals
Most aggressive melanoma.

11. variable deceleration
DTaP - hepB - Hib - rotavirus - inactivated polio
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Cataracts
Pneumovax - influenza

12. Tx otitis media
Patch - bupropion - varenicline
(ofloxacin OR levofloxacin) +/- metronidazole
Calcium hydroxyapatite crystals
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

13. IV tx for PID
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Urticaria
Ofloxacin OR levofloxacin +/- metronidazole
(ofloxacin OR levofloxacin) +/- metronidazole

14. Complications of PID
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Colchicine
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

15. Sx epiglottitis
Nuchal translucency - serum hCG - PAPP-A
Metronidazole or clindamycin
Stridor - drooling - toxic appearance
Thiazdes; lithium

16. bacteria causing pharyngitis
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Ask - Advise - Assess - Assist - Arrange

17. DOC for HTN in elderly
Metronidazole or clindamycin
Oxygen intervention 15h/d
Thiazides
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

18. Screened at 16-20 weeks GA for trisomy
(ofloxacin OR levofloxacin) +/- metronidazole
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
110-160bpm

19. shoulder dystocia
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Tdap - influenza - pneumovax
Alpha-1 antitrypsin deficiency
Anterior shoulder cannot readily pass below the pubic symphysis.

20. social smile - parent recognition
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Biopsy
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
MTX

21. Mediators released in response to allergen
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Lung; SCC head & neck; RCC; breast; MM; prostate
MCC melanoma. Radial growth.
<20lb - <1YO - Reacts to pain - Responds to noise

22. complications of otitis media
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Stridor - drooling - toxic appearance
Starts at contraction. caused by increased vagal tone from fetal head compression.
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

23. How much radiation is associated with fetal harm?
Onset of labor until cervix dilation
5+ rads
Ceftriaxone 125mg IM
Angioedema

24. Tx chlamydia
Conrtaction monitoring along with fetal heart rate assessment
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
= LMP + 7 days - 3 months

25. Tx RA (best long-term outcome)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Bupropion - varenicline - nicotine replacement
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
MTX

26. Sx peritonsillar abscess
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
1 mo - eyes follow object to midline - vocalizes
Pneumovax - influenza
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

27. Four cardinal fetal movements
Normal mental status; no other injuries; seen within 10 days of injury
Flexion - internal rotation - extension - external rotation
NAC or IV NaHCO3
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)

28. Tx GAS ifxn
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
DTaP - hepB - Hib - rotavirus - inactivated polio
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

29. Optimal time for trisomy screen
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
16-18 weeks GA
110-160bpm
After delivery until delivery of placenta and membranes <30 mins

30. tx shoulder dystocia

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31. Rod shaped - rhomboid - weakly positive birefringent
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Colchicine
Calcium pyrophosphate dehydrate crystals (pseudogout)
Measures strength of contractions

32. Immunizations for adult 65YO+
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
16-18 weeks GA
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Tdap - influenza - pneumovax

33. IV tx for PID
(cefotetan OR cefoxitin) AND doxycycline
Nuchal translucency - serum hCG - PAPP-A
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Tuberculosis; sarcoidosis; hodgkin disease

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

35. MCC blindness worldwide
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Cataracts
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

36. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
Fe deficient anemia
NAC or IV NaHCO3
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
2 mo - eyes follow object past midline - rolls over - laughs - squeals

37. Dx criteria for RA
MCC melanoma. Radial growth.
Onset of labor until cervix dilation
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

38. needles - strong negative birefringent (yellow crystals parallel light)
Nuchal translucency - serum hCG - PAPP-A
Ceftriaxone 125mg IM
= LMP + 7 days - 3 months
Monosodium urate crystals (gout)

39. ADL
Bathing - dressing - eating - transferring - continence - toileting
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
1 mo - eyes follow object to midline - vocalizes
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

40. Pregnancy class D smoking cessation drugs
Nicotine inhaler - nasal spray - gum
Anemia
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

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)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Onset of labor until cervix dilation

42. Augments contractions
Oxytocin (IV)
Measures strength of contractions
Pneumovax - influenza
Urinary calcium. Hyper PTH (high) >> FHH (normal)

43. 2nd generation antihistamines
Normal mental status; no other injuries; seen within 10 days of injury
NAC or IV NaHCO3
Loratadine - fexofenadine - cetirizine
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

44. Only therapy to decrease mortality in stage IV COPD
5+ rads
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Oxygen intervention 15h/d
= LMP + 7 days - 3 months

45. Estimated delivery date (Naegele's rule)
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
= LMP + 7 days - 3 months
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

46. dyspnea - visceral edema - hypotension
Anaphylaxis
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Pneumovax - influenza
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

47. parallel play
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Loratadine - fexofenadine - cetirizine
Calcium pyrophosphate dehydrate crystals (pseudogout)
Fe deficient anemia

48. Tocodynamometer
Conrtaction monitoring along with fetal heart rate assessment
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
5+ rads
Diphenhydramine - chlorpheniramine - hydroxyzine

49. Immunizations for COPD patients
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Pneumovax - influenza
Loratadine - fexofenadine - cetirizine
After delivery until delivery of placenta and membranes <30 mins

50. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Urinary calcium. Hyper PTH (high) >> FHH (normal)
4 yo - copies triangle - catches ball - dresses self
Ampicillin/sulbactam AND doxycycline