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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. IADL
MCC melanoma. Radial growth.
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)

2. Dx bacterial vaginosis
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Conrtaction monitoring along with fetal heart rate assessment
9 mo - walks - throws - 1-3 words - 1-step commands

3. Complications of GAS infxn
110-160bpm
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Bupropion - varenicline - nicotine replacement
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

4. Dx criteria for RA
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
6 yo
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR
3 yo - identify body part - copies square - hops - throws - past tense - story telling

5. Large - irregularly shaped - prutitic - erythematous wheals
Urticaria
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Loratadine - fexofenadine - cetirizine
Starts at contraction. caused by increased vagal tone from fetal head compression.

6. Tx for thyroid storm
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Ear pain - itching - inflammation/swollen canal - exudates/discharge
Calcium oxalate crystals

7. stranger/separation anxiety
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Fe deficient anemia
1 mo - eyes follow object to midline - vocalizes
Ear pain - itching - inflammation/swollen canal - exudates/discharge

8. First stage of labor
Biopsy
Onset of labor until cervix dilation
Loratadine - fexofenadine - cetirizine
Anterior shoulder cannot readily pass below the pubic symphysis.

9. explorations
Most aggressive melanoma.
9 mo - walks - throws - 1-3 words - 1-step commands
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)

10. parallel play
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
(cefotetan OR cefoxitin) AND doxycycline
Thiazides
Ask - Advise - Assess - Assist - Arrange

11. IV tx for PID
Steroids + bronchodilators
16-18 weeks GA
5 yo - draws person - ties shoes - skips
(cefotetan OR cefoxitin) AND doxycycline

12. Lentigo Maligna
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name

13. Screened at 16-20 weeks GA for trisomy
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Anemia
3 yo - identify body part - copies square - hops - throws - past tense - story telling

14. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Measures strength of contractions
Anterior shoulder cannot readily pass below the pubic symphysis.
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

15. Nonfunctioning nodules > 1cm require _____
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
McRobert's manuever (hyperflexion of hips); suprapubic pressure; episiotomy
Biopsy
Thiazdes; lithium

16. Nodular melanoma
Anterior shoulder cannot readily pass below the pubic symphysis.
Most aggressive melanoma.
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Aortic aneurysm

17. Causes of CKD
Diabetes - HTN - GN
Anaphylaxis
Pneumovax - influenza
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

18. Oral tx for PID
Transport - shopping - cooking - telephone - money management - medications - housecleaning - laundry
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
(ofloxacin OR levofloxacin) +/- metronidazole
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)

19. Recommendations for rear-facing car seat
<20lb - <1YO - Reacts to pain - Responds to noise
Calcium oxalate crystals
Nicotine inhaler - nasal spray - gum
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2

20. The five A's of smoking cessation
Calcium hydroxyapatite crystals
Ampicillin/sulbactam AND doxycycline
Ask - Advise - Assess - Assist - Arrange
= LMP + 7 days - 3 months

21. needles - strong negative birefringent (yellow crystals parallel light)
= LMP + 7 days - 3 months
Conrtaction monitoring along with fetal heart rate assessment
Monosodium urate crystals (gout)
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia

22. Fe deficient anemia tx
Cataracts
Bathing - dressing - eating - transferring - continence - toileting
Biopsy
Ferrous sulfate 325mg tid

23. Superficial spreading melanoma
MCC melanoma. Radial growth.
Alpha-1 antitrypsin deficiency
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)
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins

24. Granulomatous causes of hypercalcemia
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Tuberculosis; sarcoidosis; hodgkin disease
Urticaria
Oxytocin (IV)

25. Screening for 65-76YO male smoker
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Aortic aneurysm
5+ rads
Calcium oxalate crystals

26. tx shoulder dystocia

27. group play - gender - knows name
<20lb - <1YO - Reacts to pain - Responds to noise
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Pneumovax - influenza
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)

28. Emphysema - <45YO - nonsmoker
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Nuchal translucency - serum hCG - PAPP-A
Fluoroquinolones
Alpha-1 antitrypsin deficiency

29. Mediators released in response to allergen
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
3 yo - identify body part - copies square - hops - throws - past tense - story telling
Long axis of fetus to long axis of mother (longitudinal or transverse)
Nicotine inhaler - nasal spray - gum

30. bipyramidal - strongly positive birefringent
Steroids + bronchodilators
6-9MO
Calcium oxalate crystals
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)

31. regards hand
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
4mo - sits unsupported - hand transfer - babbles
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Diphenhydramine - chlorpheniramine - hydroxyzine

32. Sx peritonsillar abscess
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)
Measures strength of contractions
Flexion - internal rotation - extension - external rotation

33. Tx hyperkalemia in CKD
Sodium polystyrene sulfonate (kayexalate) - insulin + glucose - retention enema
DTaP - hepB - Hib - rotavirus - inactivated polio
NAC or IV NaHCO3
Stridor - drooling - toxic appearance

34. MONA therapy
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
5 yo - draws person - ties shoes - skips
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.

35. DDX for geriatric hearing impairment
Anaphylaxis
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)
9 mo - walks - throws - 1-3 words - 1-step commands
Diabetes - HTN - GN

36. 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)
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Calcium hydroxyapatite crystals
4mo - sits unsupported - hand transfer - babbles

37. Fetal heart rate range
110-160bpm
Patch - bupropion - varenicline
Thiazdes; lithium
Short-acting + 40mg prednisone x 10-14days

38. Bacteria causing chronic sinusitis
Anaerobic: bacteroides - peptostreptococcus - fusobacterium
Loratadine - fexofenadine - cetirizine
Flexion - internal rotation - extension - external rotation
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy

39. Tx otitis media
Steroids + bronchodilators
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Ofloxacin OR levofloxacin +/- metronidazole

40. painless - deep - subQ swelling (periorbital - circumoral - facial)
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
Angioedema
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

41. Tocodynamometer
Conrtaction monitoring along with fetal heart rate assessment
4mo - sits unsupported - hand transfer - babbles
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
Alpha-1 antitrypsin deficiency

42. Unstable angina vs MI Dx tests
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat
Lung; SCC head & neck; RCC; breast; MM; prostate
Nicotine inhaler - nasal spray - gum
Long axis of fetus to long axis of mother (longitudinal or transverse)

43. Age by which child says 'mama' and 'dada'
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
110-160bpm
Measures strength of contractions
6-9MO

44. cystoplasmic inclusions - not birefringent
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors
Calcium hydroxyapatite crystals
MCC melanoma. Radial growth.
Ear pain - itching - inflammation/swollen canal - exudates/discharge

45. Tender - boggy prostate. Dx?
Prostatitis
Mycoplasma - c. pneumoniae - arcanobacterium haemolyticus - GAS (strep pyogenes)
Recurrence - tuboovarian abscess - chronic abdominal pain - infertility - ectopic pregnancy
16-18 weeks GA

46. Tx GAS ifxn
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Angioedema
Urticaria
1 = 90+ GFR - 2 = 60-89 - 3 = 30-59 - 4 = 15-29 - 5 = <15 or dialysis

47. Second stage of labor
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Bathing - dressing - eating - transferring - continence - toileting
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Peritonsillar swelling - tonsil pushed to midline with contralateral uvula deviation; sore throat - trismus (pain w/ chewing)

48. Signs of rupture of membranes

49. Only therapy to decrease mortality in stage IV COPD
110-160bpm
16-18 weeks GA
Oxygen intervention 15h/d
(ofloxacin OR levofloxacin) +/- metronidazole

50. identifies left - right
6 yo
DTaP - hepB - Hib - rotavirus - inactivated polio
Anemia
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)