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Family Medicine/ambulatory 2

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. ROME IBS criteria
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
ACEI - ARB
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
ACEI - diuretic

2. Croup sx
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
Foot/leg deficits - cognitive + personality changes
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose

3. 1st line tx in IBS constipation
Postpartum fever - uterine tenderness - foul-smelling lochia
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
Halothane - succinylcholine
Fiber (e.g. psyllium)

4. Mastitis tx
Cephalexin OR dicloxacillin
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Legionella
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR

5. Tx HTN + CVA
Oral prednisone
Uterine atony
Neonate - infants - bilious vomiting - abdominal pain
ACEI - diuretic

6. vertebrobasilar stroke sx
Uterine atony
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia
Amiodarone/lidocaine
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

7. Headache with sx systemic illness DDx
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
Legionella
Septic arthritis - fractures - congenital hip dysplasia
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic

8. Sx HoCM
Amiodarone/lidocaine
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
'olive' mass in URQ - 'double-track sign -' nonbilious vomiting postparandial - 3-6 weeks old
Renal parenchymal disease

9. IBS pain tx
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
5-HT blockers: tegasorad - alosetron
Temporal arteritis - mass lesion
H. flu - S. pneumo - S. aureus - Strep A/B/C

10. Pyloric stenosis sx

11. Cholesterol absorption blocker (ezetimibe)
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
Eikenella species
Obesity; increased NE release

12. Papilledema DDx
Uterine atony
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Mass lesion - pseudotumor cerebri - meningitis
Moderate/severe alzheimer dementia

13. DDx postoperative fever
SCFE (slipped capital femoral epiphysis)
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Septic arthritis - fractures - congenital hip dysplasia

14. Tx frequent/severe abd pain

15. Tx HTN + post-MI
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
ACEI - B-blocker - spironolactone
Foot/leg deficits - cognitive + personality changes
Fasting blood glucose - LFTs - renal function - TSH

16. tx malignant hyperthermia
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
Dantrolene IV - antipyretics - O2 - cooling blankets
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR

17. Headaches increasing in severity + intensity DDx
Mass lesion - subdural hematoma - medication overuse
Amiodarone/lidocaine
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400

18. Phendimetrazine
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Obesity; increased NE release
ACEI - ARB - diuretic - Ca-blocker - B-blocker

19. Tx acute pulmonary edema 2ndary to CHF
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Cephalexin OR dicloxacillin
Furosemide - nitroglycerin - IV morphine sulphate
Obesity; NE-uptake inhibition

20. 4 T's of postpartum hemorrhage
Flat disk - button - batteries
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
1st line: TZD
Renal parenchymal disease

21. Bronchiolitis sx
S. aureus
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
Phenelzine - tranylcypramine

22. Tx mild/infrequent abd pain
Dicyclomine - hyoscyamine (antispasmodics)
8%
Dantrolene IV - antipyretics - O2 - cooling blankets
Hemorrhoids > colorectal polyps > diverticulosis > CRC > UC - AVM - colonic strictures

23. Tx HTN + DM
Cephalexin OR dicloxacillin
ACEI - ARB
ACEI - ARB - diuretic - Ca-blocker - B-blocker
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide

24. causes of malignant hyperthernia
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
8%
Halothane - succinylcholine

25. Tx HTN
1st line: TZD
'steeple-sign' (subglottic narrowing)
Furosemide - nitroglycerin - IV morphine sulphate
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose

26. Metabolic syndrome
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Meningitis - brain abscess - metastasis
Obesity; NE-uptake inhibition
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN

27. Dx and Tx of intussception
Barium enema
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Meningitis - brain abscess - metastasis
Cephalexin OR dicloxacillin

28. ACA stroke ssx
Foot/leg deficits - cognitive + personality changes
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer
Amiodarone/lidocaine
ACEI - ARB - B-blocker - diuretic - Spironolactone

29. Antihypertensives in suspected stroke
Colonoscopy
IV labetalol - nicardipine - sodium nitroprusside
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic

30. GI 'alarm' features
Viral infxn of the subglottis
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Alzheimer dementia
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD

31. Drugs causing fever
Lumbar puncture
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Temporal arteritis - mass lesion

32. Epiglottitis pathogens
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
H. flu - S. pneumo - S. aureus - Strep A/B/C
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
S. aureus

33. rtPA should be used within ____ of stroke
3 hours
Obesity; increased NE release
8%
1st line: IV oxytocin - bimanual uterine massage - 2nd line: methylergonovine IM (CI in HTN) - 3rd line: PGF2a (Hemabate) IM (CI in asthma) - 4th line: Misoprostol

34. Tx HTN + CAD
H. flu - S. pneumo - S. aureus - Strep A/B/C
ACEI - B-blocker - diuretic - Ca-blocker
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Verapamil - Li+ - divalproex sodium - methysergide - prednisone

35. Bilateral 'ground glass' infiltrate on CXR
= QT / sqrt(RR interval)
SCFE (slipped capital femoral epiphysis)
Bupriopion - amoxipine - trazodone
PCP pneumonia

36. Stable vtach tx
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia
Bupriopion - amoxipine - trazodone
Amiodarone/lidocaine
Alzheimer dementia

37. Tx HTN + CKD
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
Mass lesion - pseudotumor cerebri - meningitis
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
ACEI - ARB

38. Tx diverticulitis
Quinolone + metronidazole
Amiodarone/lidocaine
Fiber (e.g. psyllium)
Bacterial infxn of supraglottic tissue and surrounding areas

39. Sudden-onset headache DDx
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
Barium enema

40. Standard workup for dyslipidemia
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Fasting blood glucose - LFTs - renal function - TSH
Foot/leg deficits - cognitive + personality changes

41. MCC non-traumatic hip pathology in adolescents
Obesity; NE-uptake inhibition
SCFE (slipped capital femoral epiphysis)
Fasting blood glucose - LFTs - renal function - TSH
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)

42. Peritonsillar abscess Sx
Legionella
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Amitriptyline - propanolol - timolol - divalproex sodium

43. Cluster headache acute tx
Postpartum fever - uterine tenderness - foul-smelling lochia
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;
100% O2 6L/min - dihydroergotamine - triptans

44. Prolonged QT interval (QTc)
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
470ms+ in men - 480ms+ in women
MVP
H. flu - S. pneumo - S. aureus - Strep A/B/C

45. MCC HTN in child
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Renal parenchymal disease
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Septic arthritis - fractures - congenital hip dysplasia

46. Retropharyngeal abscess Sx
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache
Meningitis - brain abscess - metastasis
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance

47. Outpatient tx CHF
TCA's
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy

48. Evaluating limp w/o pain in children
Fiber (e.g. psyllium)
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)

49. Cardiac Resynchronization Therapy (CRT) is warranted when ___
Legionella
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Fasting blood glucose - LFTs - renal function - TSH

50. Sx of pneumococcal pneumonia
Barium enema
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR