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Family Medicine/ambulatory 1

Subjects : health-sciences, family-medicine

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Answer 50 questions in 15 minutes.
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1. Tocodynamometer
MCC melanoma. Radial growth.
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Conrtaction monitoring along with fetal heart rate assessment
5 yo - draws person - ties shoes - skips

2. Recommendations for rear-facing car seat
1 mo - eyes follow object to midline - vocalizes
Anterior shoulder cannot readily pass below the pubic symphysis.
<20lb - <1YO - Reacts to pain - Responds to noise
= LMP + 7 days - 3 months

3. Electrolyte abnormality that increases the incidence of torsades de pointes
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Hypomagnesemia
DTaP - hepB - Hib - rotavirus - inactivated polio
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

4. complications of otitis media
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Measures strength of contractions
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

5. Screening for 65-76YO male smoker
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Anemia
Biopsy
Aortic aneurysm

6. 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)
4mo - sits unsupported - hand transfer - babbles
Loratadine - fexofenadine - cetirizine
Angioedema

7. Cockcroft-Gault equation
Measures strength of contractions
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
6-9MO

8. social smile - parent recognition
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Urticaria
2 mo - eyes follow object past midline - rolls over - laughs - squeals
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

9. MCC blindness worldwide
Calcium pyrophosphate dehydrate crystals (pseudogout)
Anemia
Monosodium urate crystals (gout)
Cataracts

10. explorations
9 mo - walks - throws - 1-3 words - 1-step commands
<20lb - <1YO - Reacts to pain - Responds to noise
6-9MO
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

11. Tx of traveler's diarrhea
110-160bpm
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Fe deficient anemia

12. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Anemia
16-18 weeks GA
Thiazides

13. X-ray on knee?
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
4mo - sits unsupported - hand transfer - babbles
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

14. Immunizations for COPD patients
= LMP + 7 days - 3 months
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Pneumovax - influenza
DTaP - hepB - Hib - rotavirus - inactivated polio

15. Tx RA (best long-term outcome)
Fe deficient anemia
MTX
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)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

16. Tx acute sinusitis
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Ear pain - itching - inflammation/swollen canal - exudates/discharge
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
DTaP - hepB - Hib - rotavirus - inactivated polio

17. MONA therapy
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
(cefotetan OR cefoxitin) AND doxycycline
5+ rads
Anemia

18. identifies left - right
Loratadine - fexofenadine - cetirizine
Cataracts
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
6 yo

19. presbycusis
Ceftriaxone 125mg IM
Age-related sensorineural hearing loss (high frequency and speech discrimination)
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Ofloxacin OR levofloxacin +/- metronidazole

20. variable deceleration
Flexion - internal rotation - extension - external rotation
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
NAC or IV NaHCO3
Calcium pyrophosphate dehydrate crystals (pseudogout)

21. Other causes of hypercalcemia
Tuberculosis; sarcoidosis; hodgkin disease
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
= LMP + 7 days - 3 months
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

22. Optimal time for trisomy screen
Ampicillin/sulbactam AND doxycycline
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
9 mo - walks - throws - 1-3 words - 1-step commands
16-18 weeks GA

23. Causes of CKD
Steroids + bronchodilators
Diabetes - HTN - GN
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

24. Sx epiglottitis
Thiazides
Stridor - drooling - toxic appearance
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide

25. IV tx for PID
5 yo - draws person - ties shoes - skips
Clindamycin AND gentamicin
Oxygen intervention 15h/d
4mo - sits unsupported - hand transfer - babbles

26. Regards human face - eye contact
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
1 mo - eyes follow object to midline - vocalizes
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Pneumovax - influenza

27. IV tx for PID
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)
Ofloxacin OR levofloxacin +/- metronidazole
Ask - Advise - Assess - Assist - Arrange
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

28. Four cardinal fetal movements
MTX
Flexion - internal rotation - extension - external rotation
Esophagitis - gastritis - dysphagia
Cataracts

29. Granulomatous causes of hypercalcemia
Thiazdes; lithium
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Tuberculosis; sarcoidosis; hodgkin disease
Measures strength of contractions

30. Sx peritonsillar abscess
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Ask - Advise - Assess - Assist - Arrange
Flexion - internal rotation - extension - external rotation
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

31. Bacteria causing chronic sinusitis
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

32. Unstable angina vs MI Dx tests
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
4 yo - copies triangle - catches ball - dresses self
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

33. First stage of labor
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Starts at contraction. caused by increased vagal tone from fetal head compression.
Prostatitis
Onset of labor until cervix dilation

34. Bisphospohonates sfx
Anaphylaxis
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Esophagitis - gastritis - dysphagia
IV penicillin (or ampicillin)

35. Immunizations at visit for 6MO
Alpha-1 antitrypsin deficiency
2 mo - eyes follow object past midline - rolls over - laughs - squeals
DTaP - hepB - Hib - rotavirus - inactivated polio
Steroids + bronchodilators

36. Second stage of labor
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
6-9MO
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Onset of labor until cervix dilation

37. writes name - counts 10 objects
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
5 yo - draws person - ties shoes - skips
16-18 weeks GA
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

38. IV tx for PID
(cefotetan OR cefoxitin) AND doxycycline
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
5+ rads
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

39. IADL
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

40. Pregnancy class D smoking cessation drugs
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
9 mo - walks - throws - 1-3 words - 1-step commands
Nicotine inhaler - nasal spray - gum

41. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Ampicillin/sulbactam AND doxycycline

42. Nodular melanoma
16-18 weeks GA
NAC or IV NaHCO3
= LMP + 7 days - 3 months
Most aggressive melanoma.

43. Emphysema - <45YO - nonsmoker
0.2-0.5mg aqueous EPI IM/SubQ
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Starts at contraction. caused by increased vagal tone from fetal head compression.
Alpha-1 antitrypsin deficiency

44. Large - irregularly shaped - prutitic - erythematous wheals
Esophagitis - gastritis - dysphagia
(cefotetan OR cefoxitin) AND doxycycline
Normal mental status; no other injuries; seen within 10 days of injury
Urticaria

45. medications causing hypercalcemia
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Pneumovax - influenza
Thiazdes; lithium
After delivery until delivery of placenta and membranes <30 mins

46. Late deceleration
Diabetes - HTN - GN
(cefotetan OR cefoxitin) AND doxycycline
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

47. How much radiation is associated with fetal harm?
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
5+ rads
MTX
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

48. 2nd generation antihistamines
Loratadine - fexofenadine - cetirizine
Pneumovax - influenza
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Biopsy

49. Tx GAS ifxn
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Bathing - dressing - eating - transferring - continence - toileting
Lung; SCC head & neck; RCC; breast; MM; prostate
Pneumovax - influenza

50. Tx for thyroid storm
Metronidazole or clindamycin
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Short-acting + 40mg prednisone x 10-14days
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

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Family Medicine/ambulatory 1

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