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Family Medicine/ambulatory 1

Subjects : health-sciences, family-medicine

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. complications of otitis media
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Short-acting + 40mg prednisone x 10-14days

2. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
0.2-0.5mg aqueous EPI IM/SubQ
Pneumovax - influenza
Anterior shoulder cannot readily pass below the pubic symphysis.

3. Sx peritonsillar abscess
MCC melanoma in Africans/Asians. Under nails - soles - palms.
MCC melanoma. Radial growth.
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Long axis of fetus to long axis of mother (longitudinal or transverse)

4. X-ray on knee?
Diabetes - HTN - GN
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Ampicillin/sulbactam AND doxycycline

5. Smoking cessation agents
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Bupropion - varenicline - nicotine replacement
Tdap - influenza - pneumovax

6. The five A's of smoking cessation
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Ask - Advise - Assess - Assist - Arrange

7. Only therapy to decrease mortality in stage IV COPD
Oxygen intervention 15h/d
Short-acting + 40mg prednisone x 10-14days
Conrtaction monitoring along with fetal heart rate assessment
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

8. Tx bacterial vaginosis
Metronidazole or clindamycin
NAC or IV NaHCO3
MTX
= LMP + 7 days - 3 months

9. Complications of GAS infxn
1 mo - eyes follow object to midline - vocalizes
Stridor - drooling - toxic appearance
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema

10. Bisphospohonates sfx
6 yo
MCC melanoma. Radial growth.
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Esophagitis - gastritis - dysphagia

11. Third stage of labor
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
After delivery until delivery of placenta and membranes <30 mins
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
16-18 weeks GA

12. Pregnancy class D smoking cessation drugs
Nicotine inhaler - nasal spray - gum
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
0.2-0.5mg aqueous EPI IM/SubQ
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

13. MCC blindness worldwide
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Ofloxacin OR levofloxacin +/- metronidazole
Cataracts
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

14. group play - gender - knows name
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
1 mo - eyes follow object to midline - vocalizes
Tuberculosis; sarcoidosis; hodgkin disease
3 yo - identify body part - copies square - hops - throws - past tense - story telling

15. 1st generation antihistamines
Metronidazole or clindamycin
Diphenhydramine - chlorpheniramine - hydroxyzine
(ofloxacin OR levofloxacin) +/- metronidazole
Ear pain - itching - inflammation/swollen canal - exudates/discharge

16. Immunizations at visit for 6MO
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Stridor - drooling - toxic appearance
DTaP - hepB - Hib - rotavirus - inactivated polio
Thiazides

17. IUPC (intrauterine pressure catheter)
Hypomagnesemia
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Anterior shoulder cannot readily pass below the pubic symphysis.
Measures strength of contractions

18. bacteria causing pharyngitis
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

19. painless - deep - subQ swelling (periorbital - circumoral - facial)
Angioedema
After delivery until delivery of placenta and membranes <30 mins
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

20. Premedication with ___ or ___ reduces risk of contrast-induced nephropathy
Ask - Advise - Assess - Assist - Arrange
Ear pain - itching - inflammation/swollen canal - exudates/discharge
5 yo - draws person - ties shoes - skips
NAC or IV NaHCO3

21. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
MCC melanoma. Radial growth.
= LMP + 7 days - 3 months

22. Sx otitis media
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Hypomagnesemia
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

23. Mediators released in response to allergen
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

24. Electrolyte abnormality that increases the incidence of torsades de pointes
After delivery until delivery of placenta and membranes <30 mins
Biopsy
Calcium pyrophosphate dehydrate crystals (pseudogout)
Hypomagnesemia

25. Corrected serum calcium =

26. Estimated delivery date (Naegele's rule)
= LMP + 7 days - 3 months
MTX
Ofloxacin OR levofloxacin +/- metronidazole
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

27. Dx bacterial rhinosinusitis
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Calcium pyrophosphate dehydrate crystals (pseudogout)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
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. needles - strong negative birefringent (yellow crystals parallel light)
Anterior shoulder cannot readily pass below the pubic symphysis.
Clindamycin AND gentamicin
Monosodium urate crystals (gout)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

29. Tx RA (best long-term outcome)
MTX
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Urticaria
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

30. Tx chlamydia
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
After delivery until delivery of placenta and membranes <30 mins
Alpha-1 antitrypsin deficiency

31. stranger/separation anxiety
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
(cefotetan OR cefoxitin) AND doxycycline
Ceftriaxone 125mg IM
After delivery until delivery of placenta and membranes <30 mins

32. Nodular melanoma
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
4mo - sits unsupported - hand transfer - babbles
Most aggressive melanoma.

33. Tx GAS ifxn
Ask - Advise - Assess - Assist - Arrange
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Fe deficient anemia
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

34. Causes of CKD
Diabetes - HTN - GN
Tuberculosis; sarcoidosis; hodgkin disease
Ferrous sulfate 325mg tid
MTX

35. identifies left - right
6 yo
2 mo - eyes follow object past midline - rolls over - laughs - squeals
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Calcium pyrophosphate dehydrate crystals (pseudogout)

36. Rod shaped - rhomboid - weakly positive birefringent
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Patch - bupropion - varenicline
Bupropion - varenicline - nicotine replacement
Calcium pyrophosphate dehydrate crystals (pseudogout)

37. explorations
Fluoroquinolones
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
9 mo - walks - throws - 1-3 words - 1-step commands

38. presbycusis
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Oxytocin (IV)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
6-9MO

39. Granulomatous causes of hypercalcemia
Tuberculosis; sarcoidosis; hodgkin disease
Bupropion - varenicline - nicotine replacement
Oxygen intervention 15h/d
Calcium oxalate crystals

40. Pregnancy class C smoking cessation drugs
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Patch - bupropion - varenicline
Fluoroquinolones
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

41. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Anemia
Most aggressive melanoma.
4mo - sits unsupported - hand transfer - babbles

42. bipyramidal - strongly positive birefringent
4mo - sits unsupported - hand transfer - babbles
Calcium oxalate crystals
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

43. Unstable angina vs MI Dx tests
3 yo - identify body part - copies square - hops - throws - past tense - story telling
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Anemia

44. Low serum iron - low MCV - low ferritin - +stool guaiac
Stridor - drooling - toxic appearance
Monosodium urate crystals (gout)
Ampicillin/sulbactam AND doxycycline
Fe deficient anemia

45. Cockcroft-Gault equation
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
MTX
Pneumovax - influenza

46. Early deceleration
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Clindamycin AND gentamicin
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Starts at contraction. caused by increased vagal tone from fetal head compression.

47. recognizes strangers
Stridor - drooling - toxic appearance
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Lung; SCC head & neck; RCC; breast; MM; prostate

48. parallel play
Nuchal translucency - serum hCG - PAPP-A
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
9 mo - walks - throws - 1-3 words - 1-step commands
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

49. ADL
Most aggressive melanoma.
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Hypomagnesemia
Bathing - dressing - eating - transferring - continence - toileting

50. social interaction
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Short-acting + 40mg prednisone x 10-14days
4 yo - copies triangle - catches ball - dresses self
5+ rads