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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. Oral tx for PID
Stridor - drooling - toxic appearance
MTX
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
(ofloxacin OR levofloxacin) +/- metronidazole

2. shoulder dystocia
Measures strength of contractions
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Anterior shoulder cannot readily pass below the pubic symphysis.
Calcium hydroxyapatite crystals

3. Pflx for traveler's diarrhea
Urticaria
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Fluoroquinolones
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry

4. Fetal heart rate range
110-160bpm
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Patch - bupropion - varenicline
After delivery until delivery of placenta and membranes <30 mins

5. Smoking cessation agents
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
5+ rads
16-18 weeks GA
Bupropion - varenicline - nicotine replacement

6. Immunizations at visit for 6MO
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Thiazdes; lithium
DTaP - hepB - Hib - rotavirus - inactivated polio
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

7. Estimated delivery date (Naegele's rule)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
= LMP + 7 days - 3 months
Oxytocin (IV)

8. Immunizations for COPD patients
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Measures strength of contractions
Pneumovax - influenza
Bupropion - varenicline - nicotine replacement

9. MCC blindness worldwide
Cataracts
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Short-acting + 40mg prednisone x 10-14days
After delivery until delivery of placenta and membranes <30 mins

10. First stage of labor
(ofloxacin OR levofloxacin) +/- metronidazole
Most aggressive melanoma.
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)
Onset of labor until cervix dilation

11. bipyramidal - strongly positive birefringent
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Starts at contraction. caused by increased vagal tone from fetal head compression.
Calcium oxalate crystals
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

12. Dx PID
Fe deficient anemia
Hypomagnesemia
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Ask - Advise - Assess - Assist - Arrange

13. MONA therapy
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Thiazdes; lithium
Calcium oxalate crystals
Diphenhydramine - chlorpheniramine - hydroxyzine

14. group play - gender - knows name
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
After delivery until delivery of placenta and membranes <30 mins
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

15. Mediators released in response to allergen
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

16. Tx for anaphylaxis
Anemia
<20lb - <1YO - Reacts to pain - Responds to noise
0.2-0.5mg aqueous EPI IM/SubQ
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps

17. DDX for geriatric hearing impairment
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Ferrous sulfate 325mg tid

18. explorations
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
Fe deficient anemia
9 mo - walks - throws - 1-3 words - 1-step commands

19. Rod shaped - rhomboid - weakly positive birefringent
Stridor - drooling - toxic appearance
Calcium pyrophosphate dehydrate crystals (pseudogout)
Normal mental status; no other injuries; seen within 10 days of injury
Age-related sensorineural hearing loss (high frequency and speech discrimination)

20. IUPC (intrauterine pressure catheter)
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Measures strength of contractions
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

21. Electrolyte abnormality that increases the incidence of torsades de pointes
Pneumovax - influenza
Stridor - drooling - toxic appearance
Hypomagnesemia
Metronidazole or clindamycin

22. Pregnancy class D smoking cessation drugs
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Colchicine
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Nicotine inhaler - nasal spray - gum

23. Tx otitis media
Measures strength of contractions
NAC or IV NaHCO3
5+ rads
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

24. Oral tx for PID
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
MTX
Urinary calcium. Hyper PTH (high) >> FHH (normal)

25. Pregnancy class C smoking cessation drugs
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Nuchal translucency - serum hCG - PAPP-A
Patch - bupropion - varenicline
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide

26. Age by which child says 'mama' and 'dada'
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
6-9MO
Calcium oxalate crystals
Loratadine - fexofenadine - cetirizine

27. needles - strong negative birefringent (yellow crystals parallel light)
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
IV penicillin (or ampicillin)
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)
Monosodium urate crystals (gout)

28. Tx gonorrhea
Calcium hydroxyapatite crystals
Thiazides
Ceftriaxone 125mg IM
6 yo

29. IV tx for PID
Monosodium urate crystals (gout)
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Clindamycin AND gentamicin
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

30. Tx for thyroid storm
<20lb - <1YO - Reacts to pain - Responds to noise
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

31. Augments contractions
Oxytocin (IV)
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
Fluoroquinolones

32. Only therapy to decrease mortality in stage IV COPD
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Metronidazole or clindamycin
Oxygen intervention 15h/d
Oxytocin (IV)

33. social smile - parent recognition
Age-related sensorineural hearing loss (high frequency and speech discrimination)
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
6-9MO
2 mo - eyes follow object past midline - rolls over - laughs - squeals

34. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Tdap - influenza - pneumovax
Ear pain - itching - inflammation/swollen canal - exudates/discharge
2 mo - eyes follow object past midline - rolls over - laughs - squeals

35. parallel play
5+ rads
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Anterior shoulder cannot readily pass below the pubic symphysis.

36. Corrected serum calcium =

37. Nonfunctioning nodules > 1cm require _____
Biopsy
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Loratadine - fexofenadine - cetirizine
NAC or IV NaHCO3

38. Tender - boggy prostate. Dx?
Clindamycin AND gentamicin
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Prostatitis
Flexion - internal rotation - extension - external rotation

39. Complications of GAS infxn
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
110-160bpm
6 yo

40. Sx otitis media
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Nicotine inhaler - nasal spray - gum

41. Improve short-term outcomes in acute exacerbations of COPD - asthma
Loratadine - fexofenadine - cetirizine
Most aggressive melanoma.
Steroids + bronchodilators
<20lb - <1YO - Reacts to pain - Responds to noise

42. Optimal time for trisomy screen
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
16-18 weeks GA

43. Early deceleration
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Ear pain - itching - inflammation/swollen canal - exudates/discharge
MCC melanoma in Africans/Asians. Under nails - soles - palms.
Starts at contraction. caused by increased vagal tone from fetal head compression.

44. IV tx for PID
1 mo - eyes follow object to midline - vocalizes
Ampicillin/sulbactam AND doxycycline
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

45. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Aortic aneurysm
MCC melanoma. Radial growth.
Anemia
4 yo - copies triangle - catches ball - dresses self

46. Fe deficient anemia tx
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Bathing - dressing - eating - transferring - continence - toileting
Ferrous sulfate 325mg tid

47. medications causing hypercalcemia
Calcium pyrophosphate dehydrate crystals (pseudogout)
Nicotine inhaler - nasal spray - gum
1 mo - eyes follow object to midline - vocalizes
Thiazdes; lithium

48. Immunizations for adult 65YO+
Diphenhydramine - chlorpheniramine - hydroxyzine
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Tdap - influenza - pneumovax
Anaerobic: bacteroides - peptostreptococcus - fusobacterium

49. Tx acute gout
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
DTaP - hepB - Hib - rotavirus - inactivated polio
MCC melanoma. Radial growth.
Colchicine

50. Tx hyperkalemia in CKD
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors