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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.
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. ACA stroke ssx
Class III/IV CHR - QRS > 120ms - LVED diameter > 55mm - LVEF =< 35% - already on maximal therapy
Oral prednisone
Foot/leg deficits - cognitive + personality changes
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test

2. Phentermine
Obesity; NE-uptake inhibition
Septic arthritis - fractures - congenital hip dysplasia
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD
ACE-I (or ARB) - fluid+sodium restriction - B-blockers - loop diuretics (furosemide - bumetanide - torsemide - ethracrynic acid) - spironolactone - cardiac resynchronization therapy

3. Tx frequent/severe abd pain

4. Metabolic syndrome
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Obesity; increased NE release
5-HT blockers: tegasorad - alosetron
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache

5. MCC HTN in child
Renal parenchymal disease
3 hours
Fiber (e.g. psyllium)
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome

6. Peritonsillar abscess Sx
Fever - sore throat - muffled voice - drooling - trismus - neck pain
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
Oral prednisone
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.

7. vertebrobasilar stroke sx
Temporal arteritis - mass lesion
Obesity; increased NE release
Motor/sensory loss x 4 limbs - crossed signs - disconjugate gaze - nystagmus - dysarthria - dysphagia
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning

8. Tx mild/infrequent abd pain
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
Obesity; increased NE release
10th postpartum day
Dicyclomine - hyoscyamine (antispasmodics)

9. DDx limp in infant/toddler
Septic arthritis - fractures - congenital hip dysplasia
ACEI - ARB - diuretic - Ca-blocker - B-blocker
Cephalexin OR dicloxacillin
ACEI - B-blocker - diuretic - Ca-blocker

10. Tx local - acute rxn to bee sting
Meningitis - brain abscess - metastasis
Oral prednisone
S. aureus
Uterine atony

11. DDx Limp w/o pain in children - orthopedic
'steeple-sign' (subglottic narrowing)
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Congenital dislocation - cerebral palsy - leg-calve-perthes - leg-length discrepancy - proximal focal femoral dysplasia - congenital short femur - congenital tibial bowing
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning

12. New-onset headache in patient with HIV/cancer DDx
Effects: lower LDL; raise HDL - sfx: GI distress - constipation - decreased med absorption - CI: TGA > 400
Meningitis - brain abscess - metastasis
Quinolone + metronidazole
Venlafaxine - duloxetine - mirtazapine

13. Tx HTN + CVA
MVP
Dementia - incontinence - gait disturbance
ACEI - diuretic
Legionella

14. Sx Lewy Body Dementia
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
'steeple-sign' (subglottic narrowing)
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Fever - anemia - weight loss 10+ lbs - hematochezia - melena - refractory/bloody diarrhea - FHx colon cancer/IBD

15. MCC infxn in closed-fist injuries
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
Use: mild/mod alzheimer dementia - sfx: nausea - vomiting - diarrhea - dizzy - headache
5-HT blockers: tegasorad - alosetron
Eikenella species

16. MCC postpartum hemorrhage
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Fiber (e.g. psyllium)
Mass lesion - pseudotumor cerebri - meningitis
Uterine atony

17. DDx dementia
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Fever - drooling - dysphagia - odynophagia - stridor - respiratory distress
Alzheimer - Parkinson - normal pressure hydrocephalus - Lewy Body - chronic EtOH - anticholinergic - benzodiazepines - sleeping pills - narcotics - hypothyroidism - B12 deficiency - neurosyphilis - hyponatremia - hypocalcemia - HIV
Moderate/severe alzheimer dementia

18. Tx HTN + CKD
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
IV labetalol - nicardipine - sodium nitroprusside
ACEI - ARB
Renal parenchymal disease

19. Organism that causes pneumonia post-influenza
Viral infxn of the subglottis
S. aureus
B-blocker - Ca-channel blocker
Obesity; increased NE release

20. Headache post-head trauma DDx
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
Acute - cough w/ rust-colored sputum - fever - chills - lobar infiltrate on CXR
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache

21. contraindications to thrombolytic therapy
Dantrolene IV - antipyretics - O2 - cooling blankets
Recent surgery - trauma - GI bleeding - MI - uncontrolled HTN
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Dementia - incontinence - gait disturbance

22. Dx and Tx of intussception
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement
Subarachnoid hemorrhage - pituitary apoplexy - hemorrhage into mass lesion/vascular malformation - mass lesion
Use: mild/mod alzheimer dementia - sfx: arrhythmia - dementia - bradycardia - urinary obstruction
Barium enema

23. MCC non-traumatic hip pathology in adolescents
PCP pneumonia
H. flu - S. pneumo - S. aureus - Strep A/B/C
SCFE (slipped capital femoral epiphysis)
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance

24. Malrotation sx
Neonate - infants - bilious vomiting - abdominal pain
Insulin resistance - abdominal obesity - dyslipidemia - elevated BP - high fasting glucose
Obesity; increased NE release
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine

25. Baby blues resolves by ______
Eikenella species
10th postpartum day
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
3 hours

26. DDx postoperative fever
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Fasting blood glucose - LFTs - renal function - TSH
Wind (pneumonia) - Water (UTI) - Wound (SSI) - Walk (DVT) - Wonder drugs (drug fever)
Uterine atony

27. Primary SVT tx
MVP
B-blocker - Ca-channel blocker
470ms+ in men - 480ms+ in women
Weight loss - progressive dysphagia - recurring vomiting - GI bleeding - FHx cancer

28. Tx HTN + post-MI
Furosemide - nitroglycerin - IV morphine sulphate
Obesity; increased NE release
ACEI - B-blocker - spironolactone
Obesity; NE-uptake inhibition

29. SSRI's
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Fluoxetine - Paroxetine - Sertraline - Fluvoxamine - Citalopram - Escitalopram
Butterfly pattern of perihilar infiltrates on CXR - cardiomegaly - chamber enlargement

30. ROME IBS criteria
Cephalexin OR dicloxacillin
Recurrent abd pain 3+ days/month for 3+ months with 2 of: improvement w/ defecation; change in stool freq; change in stool appearance
Verapamil - Li+ - divalproex sodium - methysergide - prednisone
Moderate/severe alzheimer dementia

31. TCA
Fever - sore throat - muffled voice - drooling - trismus - neck pain
ACEI - ARB - B-blocker - diuretic - Spironolactone
Marfan syndrome stigmata - HCM murmur - 3/6 systolic - ANY diastolic
Amitriptyline - nortriptyline - desipramine - clomipramine - doxepin - imipramine

32. Rivastigmine
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B
Amitriptyline - propanolol - timolol - divalproex sodium
Alzheimer dementia
Triptans - dihydroergotamine - erogtamine - NSAIDsl; aspirin + acetaminophen + caffeine;

33. DDx pediatric intestinal obsutrction
Have been asked to CUT down? people have been ANNOYED? felt GUILTY? EYE opener
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
RSV - PIV - adenoviris - rhinovirus - enterovirus - influenza - m. pneumo
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)

34. Focal neurologic sx (other than aura) DDx
Mass lesion - vascular malformation - stroke - collagen vascular disease
Barium enema
'thumb sign' (protrusion of into anterior wall of hypopharynx)
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)

35. Bronchiolitis sx
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
SCFE (slipped capital femoral epiphysis)
B-blocker - Ca-channel blocker
Coryza - congestion - pharyngitis - nasal discharge - fever - cough - dyspnea

36. malignant hyperthermia
104F+ - tachycardia - metabolic acidosis - skeletal muscle rigidity
3rd month postpartum
Obesity; increased NE release
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)

37. Sx HoCM
100% O2 6L/min - dihydroergotamine - triptans
Amoxicillin-clavulanate (augmentin) p.o 7-14 days
Systolic murmur. louder with valsalva - standing. softer with squatting - leg raising - handgrip.
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)

38. causes of malignant hyperthernia
Dicyclomine - hyoscyamine (antispasmodics)
Obesity (short/long term); 5-HT reuptake inhibition; sfx: 5-HT syndrome
1.B-lactam (cefuroxime/ cefotaxime/ceftriaxone / ampicillin-sulbatam) AND erythromycin/azithrymycin 2. IV fluoroquinolone
Halothane - succinylcholine

39. epiglottitis
Hallucinations - vivid dreams - fluctuating cognition - sleep disorder - frequent falls - visuospatial deficit - REM sleep disorder (vivid dreams)
Bacterial infxn of supraglottic tissue and surrounding areas
H. flu - S. pneumo - S. aureus - Strep A/B/C
Intracranial hemorrhage - subdural hematoma - epidural hematoma - posttraumatic headache

40. Prolonged QT interval (QTc)
470ms+ in men - 480ms+ in women
B-blocker - Ca-channel blocker - Warfarin. Antiarrhythmics (amiodarone - sotalol - flecainide - propafenone)
Viral infxn of the subglottis
'steeple-sign' (subglottic narrowing)

41. Commonly ingested foreign bodies
Flat disk - button - batteries
Cephalexin OR dicloxacillin
Venlafaxine - duloxetine - mirtazapine
Measure umbilicus to medial malleolus; Barlow test; Galeazzi test

42. Headache after 50 YO DDx
Temporal arteritis - mass lesion
Colonoscopy
100% O2 6L/min - dihydroergotamine - triptans
ACEI - ARB

43. Cluster headache acute tx
Intussception - hypertrophic pyloric stenosis - malrotation with volvulus - foreign-body ingestion - poisoning
Effects: lower LDL - TGA; raise HDL - sfx: abdominal pain - diarrhea - CI: liver disease
100% O2 6L/min - dihydroergotamine - triptans
Mech: Activates intestinal chloride channels - use: IBS in women w/ constipation - sfx: nausea

44. Nicotinic acids
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Effects: lower LDL - TGA; raise HDL - sfx: flushing - hyperglycemia - hyperuricemia - upper GI distress - hepatotoxic - CI: liver disease - gout - DM - PUD
Effects: lower LDL - TGA; raise HDL - sfx: dyspepsia - gallstones - myopathy - CI: renal - hepatic disease
Barium enema

45. Empiric CAP tx in healthy person
Obesity; increased NE release
1. macrolide OR doxycycline 2. if resistant: fluoroquinolone OR B-lactam + macrolide
Phenelzine - tranylcypramine
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic

46. Pyloric stenosis sx

47. If not breast-feeding - when does menstruation restart?
Laryngotracheitis; laryngotracheobronchitis; laryngotracheobronchopneumonitis; spasmodic
3rd month postpartum
Amiodarone/lidocaine
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool

48. Diethylpropion
Amitriptyline - propanolol - timolol - divalproex sodium
8%
Renal parenchymal disease
Obesity; increased NE release

49. Lochia
Yellow-white discharge with blood cells - decidual cells - and fibrinous products post-delivery.
Intermittent - severe abdominal pain - vomiting that becomes bilious - currant jelly stool
Tone (uretine atony) - Trauma (cervical - vaginal - perineal) - Tissue (retained placenta - membranes) - Thrombin (coagulopathies)
Cephalosporins - fluoroquinolones - sulfonamides - penicillins - heparin - amphotericin B

50. Statins
Effects: lower LDL - TGA; raise HDL - sfx: myopathy - myalgia - increased LFTs - CI: liver disease - P-450 inhibitors (cyclosporine - macrolides - antifungals)
Meningitis - encephalitis - Lyme disease - systemic infxn - collagen vascular disease
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
= QT / sqrt(RR interval)