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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. Corrected serum calcium =

2. Granulomatous causes of hypercalcemia
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Tuberculosis; sarcoidosis; hodgkin disease
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Ampicillin/sulbactam AND doxycycline

3. How to differentiate primary hyperPTH from FHH (familial hypocalciuric hypercalcemia)
Diabetes - HTN - GN
0.2-0.5mg aqueous EPI IM/SubQ
Urinary calcium. Hyper PTH (high) >> FHH (normal)
Most aggressive melanoma.

4. Immunizations for adult 65YO+
6-9MO
IV penicillin (or ampicillin)
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Tdap - influenza - pneumovax

5. Fetal heart rate range
110-160bpm
Most aggressive melanoma.
= LMP + 7 days - 3 months
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.

6. Dx bacterial vaginosis
Calcium pyrophosphate dehydrate crystals (pseudogout)
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
Urinary calcium. Hyper PTH (high) >> FHH (normal)

7. IUPC (intrauterine pressure catheter)
Measures strength of contractions
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

8. Estimated delivery date (Naegele's rule)
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
= LMP + 7 days - 3 months
CBC - electrolytes - BUN - creatinine - PT - PTT - INR - glucose - ECG - CXR - Ck-MB - Troponin T and I - O2 sat

9. Tx gonorrhea
4mo - sits unsupported - hand transfer - babbles
Onset of labor until cervix dilation
Ceftriaxone 125mg IM
Monosodium urate crystals (gout)

10. Fetal lie
Ampicillin/sulbactam AND doxycycline
Long axis of fetus to long axis of mother (longitudinal or transverse)
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
After delivery until delivery of placenta and membranes <30 mins

11. Immunizations at visit for 6MO
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Hypervitaminosis A; hypervitaminosis D; rhabdomyolysis; adrenal insufficiency
DTaP - hepB - Hib - rotavirus - inactivated polio
(cefotetan OR cefoxitin) AND doxycycline

12. IV tx for PID
Urticaria
Ampicillin/sulbactam AND doxycycline
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Starts at contraction. caused by increased vagal tone from fetal head compression.

13. IV tx for PID
(cefotetan OR cefoxitin) AND doxycycline
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Calcium hydroxyapatite crystals
Patch - bupropion - varenicline

14. Optimal time for trisomy screen
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
0.2-0.5mg aqueous EPI IM/SubQ
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
16-18 weeks GA

15. Emphysema - <45YO - nonsmoker
MTX
Alpha-1 antitrypsin deficiency
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane

16. regards hand
Patch - bupropion - varenicline
4mo - sits unsupported - hand transfer - babbles
Fluoroquinolones
Morphine - Oxygen - Nitroglycerin - Aspirin (clopidogrel if allergic) + B-blocker - GPIIb/IIIa inhibitors

17. Recommendations for rear-facing car seat
5 yo - draws person - ties shoes - skips
0.2-0.5mg aqueous EPI IM/SubQ
Metronidazole or clindamycin
<20lb - <1YO - Reacts to pain - Responds to noise

18. Screened at 11-13 weeks GA for trisomy
Thin homogenous discharge; pH > 4.5; +KOH whiff test; clue cells on wet mount
55+; patella tenderness; fibular head tenderness; inability to flex knee 90o; inability to bear weight for 4 steps
Metronidazole or clindamycin
Nuchal translucency - serum hCG - PAPP-A

19. Sx epiglottitis
(cefotetan OR cefoxitin) AND doxycycline
Stridor - drooling - toxic appearance
Tdap - influenza - pneumovax
Ofloxacin OR levofloxacin +/- metronidazole

20. recognizes strangers
Ceftriaxone 125mg IM
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
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)

21. social smile - parent recognition
Tdap - influenza - pneumovax
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Normal mental status; no other injuries; seen within 10 days of injury
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

22. Early deceleration
Masoiditis - bacterial meningitis - brain abscess - subdural empyema
Cataracts
Starts at contraction. caused by increased vagal tone from fetal head compression.
Ear pain - itching - inflammation/swollen canal - exudates/discharge

23. Malignancies with hypercalcemia
Most aggressive melanoma.
PH > 6.5 (Nitrazine) - 'ferning' on air-dried microscope slide
Lung; SCC head & neck; RCC; breast; MM; prostate
Anemia

24. Tx for thyroid storm
High dose PTU - B-blocker - hydrocortisone (prevent adrenal crisis)
Colchicine
DTaP - hepB - Hib - rotavirus - inactivated polio
MTX

25. Sx otitis media
Ask - Advise - Assess - Assist - Arrange
Conrtaction monitoring along with fetal heart rate assessment
Ear pain - fever - diminished hearing - vertigo - tinnitus; decreased membrane mobility - fluid behind tympanic membrane
Patch - bupropion - varenicline

26. Progressive fatigue - weakness - dyspnea - conjunctival pallor in an elderly patient
Prostatitis
4 yo - copies triangle - catches ball - dresses self
MTX
Anemia

27. Nodular melanoma
Most aggressive melanoma.
Oxytocin (IV)
Monosodium urate crystals (gout)
Ciprofloxacin 500mg bid x 1-2days - azithromycin 1000mg or 10mg/kg daily x 3d (children) - Rifaximin (noninvasive E. coli)

28. Mediators released in response to allergen
2 yo - copies circle - tricycle - 3 cubes - sentences - 3 colors
Monosodium urate crystals (gout)
Histamine - tryptase - chymase - kinase - leukotrienes - PGD2
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)

29. X-ray of ankle?
Stridor - drooling - toxic appearance
Cataracts
Normal mental status; no other injuries; seen within 10 days of injury
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae

30. Four cardinal fetal movements
<20lb - <1YO - Reacts to pain - Responds to noise
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Tdap - influenza - pneumovax
Flexion - internal rotation - extension - external rotation

31. Tx otitis media
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Hypomagnesemia
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
Age-related sensorineural hearing loss (high frequency and speech discrimination)

32. Fe deficient anemia tx
Age-related sensorineural hearing loss (high frequency and speech discrimination)
Nicotine inhaler - nasal spray - gum
Ferrous sulfate 325mg tid
[0.8 x (normal albumin - patient's albumin)] + serum Ca level

33. Tx RA (best long-term outcome)
MTX
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
Anterior shoulder cannot readily pass below the pubic symphysis.

34. Age by which child says 'mama' and 'dada'
Thiazdes; lithium
6-9MO
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once
MCC melanoma. Radial growth.

35. Tx acute sinusitis
MTX
400ug (low risk) - 4mg (high-risk: e.g. anticonvulsant therapy - previous defect)
1st line: amoxicillin - TMP-SMX 10-14d 2nd line: amoxicillin-clavulanic acid; 2nd-3rd gen cephalosporin; fluoroquinolone; 2nd gen macrolides (azithromycin - clarithromycin)
Ofloxacin OR levofloxacin +/- metronidazole

36. Second 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)
Complete cervical dilation (10cm) until delivery <2 hrs (nulliparous) <1hr (parous)

37. Sx otitis externa
2 mo - eyes follow object past midline - rolls over - laughs - squeals
Cr Clearance = [(140-age) x weight/72 x SCr] x 0.85 (if female)
<20lb - <1YO - Reacts to pain - Responds to noise
Ear pain - itching - inflammation/swollen canal - exudates/discharge

38. Pregnancy class C smoking cessation drugs
Hypomagnesemia
MCC melanoma. Radial growth.
Ferrous sulfate 325mg tid
Patch - bupropion - varenicline

39. causes of acute bronchitis
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)
Stridor - drooling - toxic appearance
Influenza PIV - adenovirus - rhinovirus - mycoplasma - c. pneumoniae
Cataracts

40. painless - deep - subQ swelling (periorbital - circumoral - facial)
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Onset of labor until cervix dilation
Angioedema
6 yo

41. IV tx for PID
Starts at contraction. caused by increased vagal tone from fetal head compression.
Rheumatic fever - PSGN - TSS - peritonsillar abscess - meningitis - bacteremia
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Ofloxacin OR levofloxacin +/- metronidazole

42. Oral tx for PID
[ceftriaxone OR (cefoxitin + probenecid)] AND doxycycline +/- metronidazole
12 mo - walks up/down stairs - runs - kicks - 2-3w phrases - uses name
Urticaria
Lower abdominal tenderness - adnexal tenderness - CMT - febrile - discharge - elevated ESR - CRP - gonorrhea/chlamydia infxn

43. Superficial spreading melanoma
DTaP - hepB - Hib - rotavirus - inactivated polio
Urticaria
Ofloxacin OR levofloxacin +/- metronidazole
MCC melanoma. Radial growth.

44. MCC blindness worldwide
Cataracts
[0.8 x (normal albumin - patient's albumin)] + serum Ca level
1st line: penicillin V (oral) - penicillin G (IM) - if allergy: cephalosporin - macrolide
Morning stiffness - 3+ joints - hands - symmetric - nodules - +anti-Ig (RF) - erosions/decalcifications on XR

45. Improve short-term outcomes in acute exacerbations of COPD - asthma
Steroids + bronchodilators
Angioedema
Anemia
Ofloxacin OR levofloxacin +/- metronidazole

46. Tx chlamydia
Calcium pyrophosphate dehydrate crystals (pseudogout)
Oxygen intervention 15h/d
Metronidazole or clindamycin
Doxycycline 100mg bid x 7days OR azithromycin 1000mg once

47. variable deceleration
Triple/quad screen (AFP - b-hCG - estriol +/- inhibin A)
6 mo - pincer - crawls - cruises - mamma - dada - byebye
Abrupt decrease in fetal heart rate - inconsistent timing. caused by umbilical cord compression during contractions.
Most aggressive melanoma.

48. Tx for anaphylaxis
0.2-0.5mg aqueous EPI IM/SubQ
LCC melanoma. MCC in Hawaii. Mostly elderly. Face - ears - arms - upper trunk.
Initial: Amoxicillin - alternative: amoxicillin-clavulanic acid - TMP-SMX - 2nd-3rd gen cephalosporins
2 mo - eyes follow object past midline - rolls over - laughs - squeals

49. bipyramidal - strongly positive birefringent
Nuchal translucency - serum hCG - PAPP-A
Tdap - influenza - pneumovax
Alpha-1 antitrypsin deficiency
Calcium oxalate crystals

50. Tx acute gout
Colchicine
6-9MO
4mo - sits unsupported - hand transfer - babbles
Presbycusis - noise-induced - cerumen impaction - otosclerosis - central auditory processing disorder (CAPD)