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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. cystoplasmic inclusions - not birefringent
Ceftriaxone 125mg IM
Calcium hydroxyapatite crystals
Metronidazole or clindamycin
(ofloxacin OR levofloxacin) +/- metronidazole

2. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Ampicillin/sulbactam AND doxycycline
Anaphylaxis
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

3. Fe deficient anemia tx
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Ferrous sulfate 325mg tid
<20lb - <1YO - Reacts to pain - Responds to noise
Oxygen intervention 15h/d

4. painless - deep - subQ swelling (periorbital - circumoral - facial)
Angioedema
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)
Flexion - internal rotation - extension - external rotation
Starts at contraction. caused by increased vagal tone from fetal head compression.

5. How much radiation is associated with fetal harm?
5+ rads
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Stridor - drooling - toxic appearance
Metronidazole or clindamycin

6. Third stage of labor
Loratadine - fexofenadine - cetirizine
After delivery until delivery of placenta and membranes <30 mins
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Normal mental status; no other injuries; seen within 10 days of injury

7. Pregnancy class D smoking cessation drugs
Thiazides
Nicotine inhaler - nasal spray - gum
Diphenhydramine - chlorpheniramine - hydroxyzine
DTaP - hepB - Hib - rotavirus - inactivated polio

8. Screened at 11-13 weeks GA for trisomy
Pneumovax - influenza
0.2-0.5mg aqueous EPI IM/SubQ
Nuchal translucency - serum hCG - PAPP-A
Ceftriaxone 125mg IM

9. Complications of PID
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Bathing - dressing - eating - transferring - continence - toileting
Alpha-1 antitrypsin deficiency

10. Other causes of hypercalcemia
NAC or IV NaHCO3
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
0.2-0.5mg aqueous EPI IM/SubQ
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency

11. regards hand
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
4mo - sits unsupported - hand transfer - babbles
Tuberculosis; sarcoidosis; hodgkin disease
5+ rads

12. ADL
6 yo
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Ampicillin/sulbactam AND doxycycline
Bathing - dressing - eating - transferring - continence - toileting

13. Electrolyte abnormality that increases the incidence of torsades de pointes
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Hypomagnesemia
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
16-18 weeks GA

14. Tx for anaphylaxis
0.2-0.5mg aqueous EPI IM/SubQ
Oxygen intervention 15h/d
Diabetes - HTN - GN
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

15. Sx otitis media
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Oxygen intervention 15h/d
Patch - bupropion - varenicline

16. Unstable angina vs MI Dx tests
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Most aggressive melanoma.
Tuberculosis; sarcoidosis; hodgkin disease
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

17. Acral lentinous melanoma
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Anemia
Long axis of fetus to long axis of mother (longitudinal or transverse)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

18. needles - strong negative birefringent (yellow crystals parallel light)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
6-9MO
Monosodium urate crystals (gout)
MCC melanoma. Radial growth.

19. Superficial spreading melanoma
MCC melanoma. Radial growth.
IV penicillin (or ampicillin)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

20. Age by which child says 'mama' and 'dada'
6-9MO
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
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)
6 mo - pincer - crawls - cruises - mamma - dada - byebye

21. X-ray on knee?
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
4mo - sits unsupported - hand transfer - babbles

22. Tx for thyroid storm
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
After delivery until delivery of placenta and membranes <30 mins
MCC melanoma in Africans/Asians. Under nails - soles - palms.

23. Fetal lie
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
0.2-0.5mg aqueous EPI IM/SubQ
Long axis of fetus to long axis of mother (longitudinal or transverse)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

24. social interaction
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
4 yo - copies triangle - catches ball - dresses self
DTaP - hepB - Hib - rotavirus - inactivated polio
After delivery until delivery of placenta and membranes <30 mins

25. Tx gonorrhea
Ceftriaxone 125mg IM
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Monosodium urate crystals (gout)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption

26. Tx chlamydia
1 mo - eyes follow object to midline - vocalizes
110-160bpm
Anaphylaxis
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

27. Large - irregularly shaped - prutitic - erythematous wheals
6-9MO
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Fluoroquinolones
Urticaria

28. Dx bacterial rhinosinusitis
Nuchal translucency - serum hCG - PAPP-A
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)
NAC or IV NaHCO3
After delivery until delivery of placenta and membranes <30 mins

29. IADL
Starts at contraction. caused by increased vagal tone from fetal head compression.
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Angioedema

30. Tx bacterial vaginosis
Metronidazole or clindamycin
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Ofloxacin OR levofloxacin +/- metronidazole
Alpha-1 antitrypsin deficiency

31. complications of otitis media
4mo - sits unsupported - hand transfer - babbles
Clindamycin AND gentamicin
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Diphenhydramine - chlorpheniramine - hydroxyzine

32. Pregnancy class C smoking cessation drugs
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Measures strength of contractions
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Patch - bupropion - varenicline

33. IUPC (intrauterine pressure catheter)
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
(ofloxacin OR levofloxacin) +/- metronidazole
Measures strength of contractions

34. bipyramidal - strongly positive birefringent
Calcium oxalate crystals
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Fluoroquinolones

35. Nonfunctioning nodules > 1cm require _____
Biopsy
Nicotine inhaler - nasal spray - gum
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Oxytocin (IV)

36. Second stage of labor
5 yo - draws person - ties shoes - skips
Loratadine - fexofenadine - cetirizine
9 mo - walks - throws - 1-3 words - 1-step commands
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

37. Tx acute gout
Colchicine
<20lb - <1YO - Reacts to pain - Responds to noise
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

38. Immunizations for COPD patients
4 yo - copies triangle - catches ball - dresses self
Oxygen intervention 15h/d
Pneumovax - influenza
Tuberculosis; sarcoidosis; hodgkin disease

39. presbycusis
Alpha-1 antitrypsin deficiency
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Age-related sensorineural hearing loss (high frequency and speech discrimination)
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

40. Improve short-term outcomes in acute exacerbations of COPD - asthma
Ask - Advise - Assess - Assist - Arrange
Fluoroquinolones
Steroids + bronchodilators
Loratadine - fexofenadine - cetirizine

41. Low serum iron - low MCV - low ferritin - +stool guaiac
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Fe deficient anemia
Biopsy
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

42. Tx otitis media
Conrtaction monitoring along with fetal heart rate assessment
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
IV penicillin (or ampicillin)
Masoiditis - bacterial meningitis - brain abscess - subdural empyema

43. Dx PID
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
0.2-0.5mg aqueous EPI IM/SubQ

44. GBS tx
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Conrtaction monitoring along with fetal heart rate assessment
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
IV penicillin (or ampicillin)

45. The five A's of smoking cessation
Ask - Advise - Assess - Assist - Arrange
Hypomagnesemia
Alpha-1 antitrypsin deficiency
Esophagitis - gastritis - dysphagia

46. Early deceleration
Fluoroquinolones
Starts at contraction. caused by increased vagal tone from fetal head compression.
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
5 yo - draws person - ties shoes - skips

47. parallel play
Onset of labor until cervix dilation
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Flexion - internal rotation - extension - external rotation
After delivery until delivery of placenta and membranes <30 mins

48. Oral tx for PID
Onset of labor until cervix dilation
(ofloxacin OR levofloxacin) +/- metronidazole
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

49. Sx of hypercalcemia
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
4 yo - copies triangle - catches ball - dresses self
Alpha-1 antitrypsin deficiency
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)

50. Immunizations for adult 65YO+
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Onset of labor until cervix dilation
Tdap - influenza - pneumovax