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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. Tx GAS ifxn
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Ask - Advise - Assess - Assist - Arrange
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

2. Bacteria causing chronic sinusitis
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Stridor - drooling - toxic appearance
Normal mental status; no other injuries; seen within 10 days of injury
Steroids + bronchodilators

3. 1st generation antihistamines
Oxygen intervention 15h/d
Short-acting + 40mg prednisone x 10-14days
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Diphenhydramine - chlorpheniramine - hydroxyzine

4. IV tx for PID
Calcium hydroxyapatite crystals
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Ofloxacin OR levofloxacin +/- metronidazole
Thiazides

5. medications causing hypercalcemia
Thiazdes; lithium
Measures strength of contractions
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Thiazides

6. IUPC (intrauterine pressure catheter)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Clindamycin AND gentamicin
Measures strength of contractions

7. Regards human face - eye contact
1 mo - eyes follow object to midline - vocalizes
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Aortic aneurysm
IV penicillin (or ampicillin)

8. painless - deep - subQ swelling (periorbital - circumoral - facial)
5+ rads
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Angioedema

9. Electrolyte abnormality that increases the incidence of torsades de pointes
Onset of labor until cervix dilation
5 yo - draws person - ties shoes - skips
Hypomagnesemia
Loratadine - fexofenadine - cetirizine

10. social interaction
4 yo - copies triangle - catches ball - dresses self
Biopsy
(cefotetan OR cefoxitin) AND doxycycline
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

11. DOC for HTN in elderly
Thiazides
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Aortic aneurysm
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

12. explorations
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
MTX
9 mo - walks - throws - 1-3 words - 1-step commands

13. Fe deficient anemia tx
Ferrous sulfate 325mg tid
Prostatitis
DTaP - hepB - Hib - rotavirus - inactivated polio
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

14. Granulomatous causes of hypercalcemia
Thiazdes; lithium
6 yo
Angioedema
Tuberculosis; sarcoidosis; hodgkin disease

15. Second stage of labor
5 yo - draws person - ties shoes - skips
0.2-0.5mg aqueous EPI IM/SubQ
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

16. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
16-18 weeks GA
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Anemia
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

17. Complications of GAS infxn
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
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

18. tx shoulder dystocia

19. Early deceleration
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Starts at contraction. caused by increased vagal tone from fetal head compression.
= LMP + 7 days - 3 months
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

20. dyspnea - visceral edema - hypotension
110-160bpm
0.2-0.5mg aqueous EPI IM/SubQ
Anaphylaxis
Calcium pyrophosphate dehydrate crystals (pseudogout)

21. First stage of labor
Onset of labor until cervix dilation
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)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
MCC melanoma. Radial growth.

22. Nodular melanoma
4 yo - copies triangle - catches ball - dresses self
Flexion - internal rotation - extension - external rotation
Most aggressive melanoma.
Urticaria

23. Bisphospohonates sfx
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
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)
Esophagitis - gastritis - dysphagia
Diphenhydramine - chlorpheniramine - hydroxyzine

24. writes name - counts 10 objects
5 yo - draws person - ties shoes - skips
Alpha-1 antitrypsin deficiency
Diphenhydramine - chlorpheniramine - hydroxyzine
6-9MO

25. Tx acute gout
Cataracts
Ask - Advise - Assess - Assist - Arrange
Colchicine
Fe deficient anemia

26. Tx RA (best long-term outcome)
Prostatitis
MTX
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
1 mo - eyes follow object to midline - vocalizes

27. Fetal lie
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Long axis of fetus to long axis of mother (longitudinal or transverse)
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Anterior shoulder cannot readily pass below the pubic symphysis.

28. Superficial spreading melanoma
MCC melanoma. Radial growth.
5 yo - draws person - ties shoes - skips
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

29. Third stage of labor
Flexion - internal rotation - extension - external rotation
Colchicine
After delivery until delivery of placenta and membranes <30 mins
Lung; SCC head & neck; RCC; breast; MM; prostate

30. Immunizations for COPD patients
Pneumovax - influenza
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Oxytocin (IV)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

31. Low serum iron - low MCV - low ferritin - +stool guaiac
Bupropion - varenicline - nicotine replacement
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Fe deficient anemia
NAC or IV NaHCO3

32. Only therapy to decrease mortality in stage IV COPD
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Ask - Advise - Assess - Assist - Arrange
Calcium pyrophosphate dehydrate crystals (pseudogout)
Oxygen intervention 15h/d

33. Immunizations for adult 65YO+
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Tdap - influenza - pneumovax

34. Dx PID
Clindamycin AND gentamicin
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Ferrous sulfate 325mg tid
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

35. Mediators released in response to allergen
Anemia
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
IV penicillin (or ampicillin)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

36. X-ray of ankle?
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Normal mental status; no other injuries; seen within 10 days of injury
5+ rads
Ampicillin/sulbactam AND doxycycline

37. How much radiation is associated with fetal harm?
NAC or IV NaHCO3
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Ask - Advise - Assess - Assist - Arrange
5+ rads

38. Tx chlamydia
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Loratadine - fexofenadine - cetirizine
5 yo - draws person - ties shoes - skips
Biopsy

39. 2nd generation antihistamines
Loratadine - fexofenadine - cetirizine
Onset of labor until cervix dilation
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
= LMP + 7 days - 3 months

40. Screening for 65-76YO male smoker
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Aortic aneurysm
16-18 weeks GA

41. Late deceleration
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

42. MONA therapy
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
110-160bpm
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

43. Tx hyperkalemia in CKD
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Nuchal translucency - serum hCG - PAPP-A

44. complications of otitis media
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
MTX
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Calcium pyrophosphate dehydrate crystals (pseudogout)

45. IV tx for PID
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Ampicillin/sulbactam AND doxycycline
MTX
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

46. Dx bacterial vaginosis
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Loratadine - fexofenadine - cetirizine
Esophagitis - gastritis - dysphagia

47. Augments contractions
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
110-160bpm
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Oxytocin (IV)

48. GBS tx
Biopsy
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
IV penicillin (or ampicillin)
Clindamycin AND gentamicin

49. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
4mo - sits unsupported - hand transfer - babbles
IV penicillin (or ampicillin)
Urinary calcium. Hyper PTH (high) >> FHH (normal)

50. Tx acute sinusitis
Hypomagnesemia
(ofloxacin OR levofloxacin) +/- metronidazole
110-160bpm
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)