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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.
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. Immunizations at visit for 6MO
DTaP - hepB - Hib - rotavirus - inactivated polio
Ask - Advise - Assess - Assist - Arrange
Bupropion - varenicline - nicotine replacement
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

2. Tx gonorrhea
NAC or IV NaHCO3
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Ceftriaxone 125mg IM
Metronidazole or clindamycin

3. Emphysema - <45YO - nonsmoker
Long axis of fetus to long axis of mother (longitudinal or transverse)
Alpha-1 antitrypsin deficiency
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Biopsy

4. Dx bacterial vaginosis
Bathing - dressing - eating - transferring - continence - toileting
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Patch - bupropion - varenicline

5. Electrolyte abnormality that increases the incidence of torsades de pointes
Calcium hydroxyapatite crystals
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Thiazides
Hypomagnesemia

6. Recommended folic acid daily dose
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
MTX
Colchicine
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

7. Tx acute sinusitis
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Alpha-1 antitrypsin deficiency
NAC or IV NaHCO3

8. Recommendations for rear-facing car seat
<20lb - <1YO - Reacts to pain - Responds to noise
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)
Normal mental status; no other injuries; seen within 10 days of injury

9. X-ray of ankle?
Loratadine - fexofenadine - cetirizine
Monosodium urate crystals (gout)
Normal mental status; no other injuries; seen within 10 days of injury
Fluoroquinolones

10. Complications of GAS infxn
Nicotine inhaler - nasal spray - gum
(cefotetan OR cefoxitin) AND doxycycline
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

11. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Urinary calcium. Hyper PTH (high) >> FHH (normal)
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Biopsy

12. Fe deficient anemia tx
Bupropion - varenicline - nicotine replacement
Ferrous sulfate 325mg tid
0.2-0.5mg aqueous EPI IM/SubQ
(ofloxacin OR levofloxacin) +/- metronidazole

13. Third stage of labor
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
5+ rads
After delivery until delivery of placenta and membranes <30 mins
IV penicillin (or ampicillin)

14. Acral lentinous melanoma
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
MCC melanoma in Africans/Asians. Under nails - soles - palms.
3 yo - identify body part - copies square - hops - throws - past tense - story telling

15. Tx acute exacerbation COPD
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Calcium hydroxyapatite crystals
Short-acting + 40mg prednisone x 10-14days

16. dyspnea - visceral edema - hypotension
Anaphylaxis
4 yo - copies triangle - catches ball - dresses self
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
3 yo - identify body part - copies square - hops - throws - past tense - story telling

17. bacteria causing pharyngitis
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Ferrous sulfate 325mg tid

18. bipyramidal - strongly positive birefringent
Short-acting + 40mg prednisone x 10-14days
Thiazides
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Calcium oxalate crystals

19. Optimal time for trisomy screen
16-18 weeks GA
Lung; SCC head & neck; RCC; breast; MM; prostate
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Thiazdes; lithium

20. MONA therapy
0.2-0.5mg aqueous EPI IM/SubQ
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Ear pain - itching - inflammation/swollen canal - exudates/discharge

21. Estimated delivery date (Naegele's rule)
= LMP + 7 days - 3 months
Lung; SCC head & neck; RCC; breast; MM; prostate
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

22. DOC for HTN in elderly
Most aggressive melanoma.
Thiazides
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)
Patch - bupropion - varenicline

23. DDX for geriatric hearing impairment
Nuchal translucency - serum hCG - PAPP-A
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

24. social smile - parent recognition
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
2 mo - eyes follow object past midline - rolls over - laughs - squeals
IV penicillin (or ampicillin)
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

25. Dx bacterial rhinosinusitis
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
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)
Anaphylaxis

26. Pregnancy class C smoking cessation drugs
Patch - bupropion - varenicline
Diphenhydramine - chlorpheniramine - hydroxyzine
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

27. IV tx for PID
Esophagitis - gastritis - dysphagia
(cefotetan OR cefoxitin) AND doxycycline
1 mo - eyes follow object to midline - vocalizes
Ofloxacin OR levofloxacin +/- metronidazole

28. Nonfunctioning nodules > 1cm require _____
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Aortic aneurysm
Biopsy

29. Dx criteria for RA
4 yo - copies triangle - catches ball - dresses self
Metronidazole or clindamycin
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)

30. causes of acute bronchitis
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Monosodium urate crystals (gout)
9 mo - walks - throws - 1-3 words - 1-step commands
Anemia

31. Tx acute gout
Colchicine
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Urinary calcium. Hyper PTH (high) >> FHH (normal)

32. Four cardinal fetal movements
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Flexion - internal rotation - extension - external rotation
Conrtaction monitoring along with fetal heart rate assessment
MTX

33. Tocodynamometer
Fe deficient anemia
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Conrtaction monitoring along with fetal heart rate assessment
5+ rads

34. Tx otitis media
Anterior shoulder cannot readily pass below the pubic symphysis.
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

35. Unstable angina vs MI Dx tests
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Starts at contraction. caused by increased vagal tone from fetal head compression.
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Calcium oxalate crystals

36. Oral 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)
0.2-0.5mg aqueous EPI IM/SubQ
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Oxytocin (IV)

37. Mediators released in response to allergen
Stridor - drooling - toxic appearance
2 mo - eyes follow object past midline - rolls over - laughs - squeals
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

38. Bacteria causing chronic sinusitis
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
= LMP + 7 days - 3 months
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

39. needles - strong negative birefringent (yellow crystals parallel light)
1 mo - eyes follow object to midline - vocalizes
Measures strength of contractions
Angioedema
Monosodium urate crystals (gout)

40. Late deceleration
DTaP - hepB - Hib - rotavirus - inactivated polio
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
3 yo - identify body part - copies square - hops - throws - past tense - story telling
NAC or IV NaHCO3

41. tx shoulder dystocia

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42. MCC blindness worldwide
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Cataracts
110-160bpm
Diabetes - HTN - GN

43. Sx otitis externa
Normal mental status; no other injuries; seen within 10 days of injury
Ear pain - itching - inflammation/swollen canal - exudates/discharge
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Oxytocin (IV)

44. Cockcroft-Gault equation
Onset of labor until cervix dilation
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Hypomagnesemia

45. 1st generation antihistamines
Tdap - influenza - pneumovax
Anterior shoulder cannot readily pass below the pubic symphysis.
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Diphenhydramine - chlorpheniramine - hydroxyzine

46. Screened at 16-20 weeks GA for trisomy
Ferrous sulfate 325mg tid
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)
4mo - sits unsupported - hand transfer - babbles

47. Screening for 65-76YO male smoker
Aortic aneurysm
Anaphylaxis
3 yo - identify body part - copies square - hops - throws - past tense - story telling
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

48. IV tx for PID
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Cataracts
Ampicillin/sulbactam AND doxycycline
MCC melanoma. Radial growth.

49. First stage of labor
Biopsy
Fluoroquinolones
Ofloxacin OR levofloxacin +/- metronidazole
Onset of labor until cervix dilation

50. CKD Stages
Flexion - internal rotation - extension - external rotation
Long axis of fetus to long axis of mother (longitudinal or transverse)
4mo - sits unsupported - hand transfer - babbles
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis