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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. Sx of hypercalcemia
Stones; bondes; psychic groans (poor concentration - supor coma - weakness - fatigue); abdominal moans (pancreatitis - anorexia - pain - constipation - nausea - vomiting)
Nuchal translucency - serum hCG - PAPP-A
Flexion - internal rotation - extension - external rotation
0.2-0.5mg aqueous EPI IM/SubQ

2. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Anaphylaxis
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Tdap - influenza - pneumovax

3. IV tx for PID
Ampicillin/sulbactam AND doxycycline
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
9 mo - walks - throws - 1-3 words - 1-step commands
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

4. X-ray of ankle?
Normal mental status; no other injuries; seen within 10 days of injury
(ofloxacin OR levofloxacin) +/- metronidazole
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Conrtaction monitoring along with fetal heart rate assessment

5. Augments contractions
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
MCC melanoma. Radial growth.
Tdap - influenza - pneumovax
Oxytocin (IV)

6. DOC for HTN in elderly
Thiazides
Calcium oxalate crystals
Diabetes - HTN - GN
Fluoroquinolones

7. parallel play
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Ampicillin/sulbactam AND doxycycline
Alpha-1 antitrypsin deficiency

8. Other causes of hypercalcemia
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Cataracts
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
MTX

9. social interaction
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)
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
4 yo - copies triangle - catches ball - dresses self
Onset of labor until cervix dilation

10. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Lung; SCC head & neck; RCC; breast; MM; prostate
Anemia
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
IV penicillin (or ampicillin)

11. bacteria causing pharyngitis
Thiazides
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount

12. dyspnea - visceral edema - hypotension
3 yo - identify body part - copies square - hops - throws - past tense - story telling
DTaP - hepB - Hib - rotavirus - inactivated polio
Lung; SCC head & neck; RCC; breast; MM; prostate
Anaphylaxis

13. Early deceleration
Starts at contraction. caused by increased vagal tone from fetal head compression.
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Oxytocin (IV)
= LMP + 7 days - 3 months

14. Rod shaped - rhomboid - weakly positive birefringent
Ofloxacin OR levofloxacin +/- metronidazole
Calcium pyrophosphate dehydrate crystals (pseudogout)
3 yo - identify body part - copies square - hops - throws - past tense - story telling
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy

15. Nodular melanoma
Most aggressive melanoma.
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Oxygen intervention 15h/d
Thiazdes; lithium

16. Nonfunctioning nodules > 1cm require _____
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Biopsy
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

17. Emphysema - <45YO - nonsmoker
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Esophagitis - gastritis - dysphagia
Alpha-1 antitrypsin deficiency
Clindamycin AND gentamicin

18. Bacteria causing chronic sinusitis
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
After delivery until delivery of placenta and membranes <30 mins
Aortic aneurysm
Stridor - drooling - toxic appearance

19. Sx otitis media
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
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)

20. Immunizations for adult 65YO+
Fe deficient anemia
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Tdap - influenza - pneumovax

21. social smile - parent recognition
Bupropion - varenicline - nicotine replacement
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Alpha-1 antitrypsin deficiency
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

22. Granulomatous causes of hypercalcemia
Tuberculosis; sarcoidosis; hodgkin disease
5+ rads
Nuchal translucency - serum hCG - PAPP-A
Clindamycin AND gentamicin

23. tx shoulder dystocia

24. Lentigo Maligna
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Stridor - drooling - toxic appearance
Patch - bupropion - varenicline
Conrtaction monitoring along with fetal heart rate assessment

25. Corrected serum calcium =

26. stranger/separation anxiety
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Clindamycin AND gentamicin
Flexion - internal rotation - extension - external rotation
Patch - bupropion - varenicline

27. Tx of traveler's diarrhea
Ceftriaxone 125mg IM
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Pneumovax - influenza
Angioedema

28. Cockcroft-Gault equation
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Tuberculosis; sarcoidosis; hodgkin disease
Short-acting + 40mg prednisone x 10-14days

29. Fe deficient anemia tx
Cataracts
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Ferrous sulfate 325mg tid
Angioedema

30. Regards human face - eye contact
1 mo - eyes follow object to midline - vocalizes
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Loratadine - fexofenadine - cetirizine
Monosodium urate crystals (gout)

31. Immunizations at visit for 6MO
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Colchicine
DTaP - hepB - Hib - rotavirus - inactivated polio
Anterior shoulder cannot readily pass below the pubic symphysis.

32. DDX for geriatric hearing impairment
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Fe deficient anemia

33. explorations
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
9 mo - walks - throws - 1-3 words - 1-step commands
Angioedema
Diabetes - HTN - GN

34. Signs of rupture of membranes

35. presbycusis
Anterior shoulder cannot readily pass below the pubic symphysis.
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
6 mo - pincer - crawls - cruises - mamma - dada - byebye

36. Third stage of labor
After delivery until delivery of placenta and membranes <30 mins
Bathing - dressing - eating - transferring - continence - toileting
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

37. Tx gonorrhea
Diabetes - HTN - GN
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Ceftriaxone 125mg IM

38. 2nd generation antihistamines
Loratadine - fexofenadine - cetirizine
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Hypomagnesemia
MTX

39. Superficial spreading melanoma
0.2-0.5mg aqueous EPI IM/SubQ
Fluoroquinolones
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
MCC melanoma. Radial growth.

40. Tx chlamydia
16-18 weeks GA
6-9MO
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Calcium oxalate crystals

41. Large - irregularly shaped - prutitic - erythematous wheals
Calcium hydroxyapatite crystals
Diabetes - HTN - GN
Thiazdes; lithium
Urticaria

42. Second stage of labor
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Urticaria
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Cataracts

43. MONA therapy
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

44. Oral tx for PID
(cefotetan OR cefoxitin) AND doxycycline
Starts at contraction. caused by increased vagal tone from fetal head compression.
(ofloxacin OR levofloxacin) +/- metronidazole
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)

45. Sx peritonsillar abscess
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
Starts at peak of contraction. caused by uteroplacental insufficiency: maternal hypotension; diabetes; prolonged pregnancy; placental abruption
Onset of labor until cervix dilation

46. Fetal heart rate range
110-160bpm
Clindamycin AND gentamicin
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

47. Bisphospohonates sfx
Ofloxacin OR levofloxacin +/- metronidazole
4 yo - copies triangle - catches ball - dresses self
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Esophagitis - gastritis - dysphagia

48. Tx RA (best long-term outcome)
MTX
Esophagitis - gastritis - dysphagia
MCC melanoma. Radial growth.
Short-acting + 40mg prednisone x 10-14days

49. Malignancies with hypercalcemia
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
Anemia
Lung; SCC head & neck; RCC; breast; MM; prostate
4mo - sits unsupported - hand transfer - babbles

50. Tender - boggy prostate. Dx?
6 yo
Prostatitis
NAC or IV NaHCO3
Calcium hydroxyapatite crystals