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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. Low serum iron - low MCV - low ferritin - +stool guaiac
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Fe deficient anemia
1 mo - eyes follow object to midline - vocalizes
Patch - bupropion - varenicline

2. GBS tx
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
(cefotetan OR cefoxitin) AND doxycycline
IV penicillin (or ampicillin)

3. medications causing hypercalcemia
Metronidazole or clindamycin
Nicotine inhaler - nasal spray - gum
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Thiazdes; lithium

4. Screening for 65-76YO male smoker
Aortic aneurysm
Pneumovax - influenza
Calcium hydroxyapatite crystals
(cefotetan OR cefoxitin) AND doxycycline

5. group play - gender - knows name
Flexion - internal rotation - extension - external rotation
Calcium pyrophosphate dehydrate crystals (pseudogout)
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Patch - bupropion - varenicline

6. Tx for thyroid storm
= LMP + 7 days - 3 months
Ofloxacin OR levofloxacin +/- metronidazole
Esophagitis - gastritis - dysphagia
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

7. Sx otitis media
Clindamycin AND gentamicin
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Oxytocin (IV)
Ampicillin/sulbactam AND doxycycline

8. Dx bacterial rhinosinusitis
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Ampicillin/sulbactam AND doxycycline
16-18 weeks GA
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)

9. X-ray on knee?
4mo - sits unsupported - hand transfer - babbles
Diabetes - HTN - GN
9 mo - walks - throws - 1-3 words - 1-step commands
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

10. Bacteria causing chronic sinusitis
Hypomagnesemia
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
MCC melanoma. Radial growth.
MCC melanoma in Africans/Asians. Under nails - soles - palms.

11. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Thiazides
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Starts at contraction. caused by increased vagal tone from fetal head compression.
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

12. Early deceleration
Ceftriaxone 125mg IM
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
110-160bpm
Starts at contraction. caused by increased vagal tone from fetal head compression.

13. variable deceleration
1 mo - eyes follow object to midline - vocalizes
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Ofloxacin OR levofloxacin +/- metronidazole
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

14. 1st generation antihistamines
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Esophagitis - gastritis - dysphagia
Short-acting + 40mg prednisone x 10-14days
Diphenhydramine - chlorpheniramine - hydroxyzine

15. Tx GAS ifxn
Fe deficient anemia
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Short-acting + 40mg prednisone x 10-14days
Monosodium urate crystals (gout)

16. identifies left - right
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Urticaria
6 yo

17. Lentigo Maligna
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Oxygen intervention 15h/d
MCC melanoma. Radial growth.
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

18. How much radiation is associated with fetal harm?
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
5+ rads

19. First stage of labor
6-9MO
Onset of labor until cervix dilation
Most aggressive melanoma.
Long axis of fetus to long axis of mother (longitudinal or transverse)

20. stranger/separation anxiety
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Thiazides
Monosodium urate crystals (gout)
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

21. IV tx for PID
Loratadine - fexofenadine - cetirizine
(cefotetan OR cefoxitin) AND doxycycline
0.2-0.5mg aqueous EPI IM/SubQ
Ofloxacin OR levofloxacin +/- metronidazole

22. Sx epiglottitis
Long axis of fetus to long axis of mother (longitudinal or transverse)
Stridor - drooling - toxic appearance
Pneumovax - influenza
Calcium oxalate crystals

23. Other causes of hypercalcemia
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Fe deficient anemia
9 mo - walks - throws - 1-3 words - 1-step commands
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

24. Bisphospohonates sfx
Esophagitis - gastritis - dysphagia
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
6-9MO
Tuberculosis; sarcoidosis; hodgkin disease

25. Pflx for traveler's diarrhea
Bathing - dressing - eating - transferring - continence - toileting
Calcium pyrophosphate dehydrate crystals (pseudogout)
Fluoroquinolones
Patch - bupropion - varenicline

26. Tx acute gout
Conrtaction monitoring along with fetal heart rate assessment
Colchicine
Thiazides
Calcium pyrophosphate dehydrate crystals (pseudogout)

27. Causes of CKD
Diphenhydramine - chlorpheniramine - hydroxyzine
Hypomagnesemia
Diabetes - HTN - GN
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors

28. Tx acute sinusitis
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
4mo - sits unsupported - hand transfer - babbles
Calcium hydroxyapatite crystals

29. Tender - boggy prostate. Dx?
Prostatitis
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Ferrous sulfate 325mg tid

30. Signs of rupture of membranes

31. Tx RA (best long-term outcome)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
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
MTX

32. Immunizations for COPD patients
Pneumovax - influenza
Alpha-1 antitrypsin deficiency
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Lung; SCC head & neck; RCC; breast; MM; prostate

33. Tocodynamometer
Fe deficient anemia
Conrtaction monitoring along with fetal heart rate assessment
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

34. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Anemia
Cataracts
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema

35. regards hand
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
4mo - sits unsupported - hand transfer - babbles
Flexion - internal rotation - extension - external rotation
Bathing - dressing - eating - transferring - continence - toileting

36. MONA therapy
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Short-acting + 40mg prednisone x 10-14days
<20lb - <1YO - Reacts to pain - Responds to noise
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

37. Malignancies with hypercalcemia
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Lung; SCC head & neck; RCC; breast; MM; prostate
Ampicillin/sulbactam AND doxycycline

38. Dx criteria for RA
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
(ofloxacin OR levofloxacin) +/- metronidazole
Cataracts

39. explorations
9 mo - walks - throws - 1-3 words - 1-step commands
Prostatitis
Steroids + bronchodilators
Metronidazole or clindamycin

40. IV tx for PID
Ofloxacin OR levofloxacin +/- metronidazole
6 yo
(ofloxacin OR levofloxacin) +/- metronidazole
Patch - bupropion - varenicline

41. ADL
Bathing - dressing - eating - transferring - continence - toileting
(ofloxacin OR levofloxacin) +/- metronidazole
MCC melanoma. Radial growth.
Diphenhydramine - chlorpheniramine - hydroxyzine

42. Mediators released in response to allergen
Nicotine inhaler - nasal spray - gum
Flexion - internal rotation - extension - external rotation
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Clindamycin AND gentamicin

43. CKD Stages
6 yo
Ampicillin/sulbactam AND doxycycline
Fluoroquinolones
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

44. complications of otitis media
Onset of labor until cervix dilation
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
DTaP - hepB - Hib - rotavirus - inactivated polio

45. Recommendations for rear-facing car seat
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Tuberculosis; sarcoidosis; hodgkin disease
<20lb - <1YO - Reacts to pain - Responds to noise

46. MCC blindness worldwide
2 mo - eyes follow object past midline - rolls over - laughs - squeals
9 mo - walks - throws - 1-3 words - 1-step commands
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Cataracts

47. needles - strong negative birefringent (yellow crystals parallel light)
6 yo
Monosodium urate crystals (gout)
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Colchicine

48. Tx for anaphylaxis
Colchicine
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Bathing - dressing - eating - transferring - continence - toileting
0.2-0.5mg aqueous EPI IM/SubQ

49. Complications of GAS infxn
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Measures strength of contractions
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Oxytocin (IV)

50. Screened at 16-20 weeks GA for trisomy
DTaP - hepB - Hib - rotavirus - inactivated polio
<20lb - <1YO - Reacts to pain - Responds to noise
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Tuberculosis; sarcoidosis; hodgkin disease